Transient ischaemic attack secondary to paraneoplastic erythrocytosis

Sandoval, Aldo René Hurtarte; Robles, Bryan Josué Flores; Andrus, Robert Francis; Chon, David Alejandro Yaxcal

doi:10.1136/bcr-2013-202572

Cited by 3 publications

(3 citation statements)

References 31 publications

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“…There have been few reports of vascular thrombosis, including cerebral infarction and TIAs precipitated by secondary erythrocytosis of other aetiologies 8–12…”

Section: Discussionmentioning

confidence: 99%

Acute ischaemic stroke in secondary polycythaemia due to complex congenital cyanotic heart disease

2019

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A 65-year-old woman presented to the emergency department with an acute onset of left-sided hemiparesis and slurred speech for 6 hours. Physical examination was notable for clubbing and peripheral cyanosis. Brain MRI showed an acute infarct involving the right gangliocapsular region. Investigations showed an elevated haemoglobin level, a haematocrit level of >65% and thrombocytopaenia. Transthoracic echocardiography revealed tricuspid atresia, ventricular septal defect and atrial septal defect. A diagnosis of cyanotic congenital heart disease was made. Studies have indicated an association between raised haematocrit and vascular occlusive episodes in patients with polycythaemia vera. However, a relationship between raised haematocrit due to polycythaemia secondary to complex congenital heart disease and vascular thrombosis has not been reported. The improvement of neurological deficits in our patient coincided with a decline in haematocrit. The objective of this report was to highlight an association between elevated haematocrit and ischaemic stroke in patients with secondary polycythaemia due to complex congenital heart disease.

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“…There have been few reports of vascular thrombosis, including cerebral infarction and TIAs precipitated by secondary erythrocytosis of other aetiologies 8–12…”

Section: Discussionmentioning

confidence: 99%

Acute ischaemic stroke in secondary polycythaemia due to complex congenital cyanotic heart disease

2019

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“…While polycythemia vera is known to be the cause of serious thrombosis, it is uncertain whether secondary polycythemia might increase the risk of thrombosis. However, as is it has been reported that secondary polycythemia might cause critical infarction or thrombosis [6–8], it is important to pay attention to e-cigarette smokers' polycythemia.…”

Section: Discussionmentioning

confidence: 99%

The First Case of E-Cigarette-Induced Polycythemia

Okuni-Watanabe

Kurata

Yakushijin

2019

Case Reports in Hematology

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A 71-year-old male smoker was referred to our hospital because of increased hemoglobin and hematocrit. At initial consultation, his hemoglobin and hematocrit levels were 21.8 g/dl and 64.8%, respectively. Other laboratory data and his cardiopulmonary functions were almost normal, and JAK2 V617F mutation was negative. He had smoked about 25 cigarettes per day for 50 years until the age of 70, when he switched from conventional smoking to electronic cigarettes (e-cigarettes). We requested that he quit e-cigarette use. Thereafter, his hemoglobin and hematocrit gradually decreased and normalized. Here, we report the first case of e-cigarette-induced polycythemia.

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“…Although it is well-established that cancer can contribute to hypercoagulable states, acute events are not often directly correlated with elevated Epo [ 7 ]. There have been reports on transient ischemic attacks due to paraneoplastic erythrocytosis, and ischemic stroke due to secondary polycythemia of other etiologies [ 2 , 8 – 10 ]. Polycythemia vera, a myeloproliferative disease resulting in an elevated absolute red blood cell mass in the absence of elevated Epo, has been shown to present with acute embolic cerebral ischemia [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Ischemic Stroke Caused by Secondary Polycythemia and Incidentally-Found Renal Cell Carcinoma: A Case Report

Corse

Kurtis

2018

Am J Case Rep

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Patient: Male, 51Final Diagnosis: Renal cell carcinomaSymptoms: Facial droop • headache • slurred speech • weaknessMedication: —Clinical Procedure: —Specialty: HematologyObjective:Unusual clinical courseBackground:Secondary polycythemia is a potential complication of an erythropoietin-secreting renal cell carcinoma. Increased red blood cell mass can elevate blood viscosity, which can impair blood flow, making individuals susceptible to vaso-occlusive events. One of the serious potential complications of a hyper-viscous state is ischemic stroke.Case Report:We present the case of a patient who was brought to the Emergency Department with right-sided extremity weakness and slurred speech consistent with acute ischemic stroke. MRI showed acute infarct involving the left corona radiata and posterior limb of the left internal capsule. On admission, he was found to have increased hemoglobin and hematocrit. An ultrasound of his abdomen found a heterogeneous mass of the right kidney, which was confirmed with CT scan. The patient remained in the hospital for 6 days. His hospital course was complicated by the incidental findings of polycythemia and a renal mass consistent with renal cell carcinoma. His hemoglobin and hematocrit remained elevated throughout his hospital course, and his erythropoietin level was found to be elevated as well.Conclusions:High blood viscosity is associated with increased incidence of cardiovascular complications, including reduced cerebral blood flow. This case report suggests that polycythemia secondary to an erythropoietin-secreting renal cell carcinoma can lead to ischemic stroke. After surgery to remove the carcinoma, the secondary polycythemia may resolve.

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Transient ischaemic attack secondary to paraneoplastic erythrocytosis

Cited by 3 publications

References 31 publications

Acute ischaemic stroke in secondary polycythaemia due to complex congenital cyanotic heart disease

Acute ischaemic stroke in secondary polycythaemia due to complex congenital cyanotic heart disease

The First Case of E-Cigarette-Induced Polycythemia

Ischemic Stroke Caused by Secondary Polycythemia and Incidentally-Found Renal Cell Carcinoma: A Case Report

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