Two Cases of Acute Ischemic Stroke Associated with Iron Deficiency Anemia due to Bleeding from Uterine Fibroids in Middle-aged Women

Naito, Hiroyuki; Naka, Hiroyuki; Kanaya, Yuhei; Yamazaki, Yu; Tokinobu, Hiroshi

doi:10.2169/internalmedicine.53.2620

Cited by 19 publications

(16 citation statements)

References 19 publications

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“…Unlike the patient we present here, laboratory tests in that case revealed an elevated platelet count of 564,000/ µL. Similarly, Naito et al provide two accounts of 42-year-old females with a history of menorrhagia presenting with hemiparesis as a result of bleeding uterine fibroids [2]. Both cases had normal platelet counts of 260,000/μL and 429,000/μL.…”

Section: Discussionsupporting

confidence: 44%

“…The last case detailed in the literature describes a 47-year-old woman, also with a history of menorrhagia, who exhibited mild dysarthria, upper extremity weakness, and thrombocytosis with a platelet count of 512,000/μL [1]. There also exists in the literature five reported cases of severe anemia causing a thrombus formation [2,5]. All cases revealed a carotid artery thrombus found on MRI.…”

Section: Discussionmentioning

confidence: 99%

“…1. Low circulating oxygen levels motivate an increase in cerebral blood flow, which may provoke endothelial damage and thus cause thrombus formation and subsequent reactive thrombocytosis [2,5].…”

Section: Discussionmentioning

confidence: 99%

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Iron-deficiency Anemia Causes an Ischemic Stroke in a Young Man

Fluss

Zguri

Rahme

et al. 2019

Cureus

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Iron deficiency anemia is an unusual etiology of ischemic stroke in the adult population. Only a few case reports exist describing this rare cause of cerebrovascular accident due to low circulating levels of oxygen. To the best of our knowledge, we believe we have described here the first patient presenting with an ischemic stroke secondary to severe anemia without an obvious source of blood loss, evidence of thrombus formation, or associated thrombocytosis. A 28-year-old man presented to our institution, complaining of severe fatigue and was admitted under the pretext of dizziness, blurred vision, esotropia, diffuse retinal hemorrhage, and Roth spots found in the left eye. Laboratory investigations reported a hemoglobin level of 1.12 g/dL (13.5-17.5 g/dl) and thrombocytopenia with a platelet count of 16,000/ µL (150,000-450,000). Concomitant magnetic resonance imaging (MRI) of the brain revealed a right 4 mm periaqueductal lesion. After several red blood cell transfusions, the patient hereafter underwent an improvement in his clinical symptoms. Given no past medical history of anemia or thrombocytopenia, an extensive workup was prompted, but only microcytic anemia likely due to iron deficiency was found. Regarding a stroke in the young adult population, a differential beyond atherosclerosis and hypertension must be considered. Coagulopathies, vasculitis, sickle cell anemia, cerebral venous thrombosis, cocaine abuse, and systemic hypoperfusion are less common, but well-documented, causes of ischemia. Although infrequently mentioned, we demonstrate here a real possibility of severe iron deficiency anemia causing ischemic stroke in the brainstem of a young man. While a thorough neurologic evaluation is not often considered in patients presenting with signs and symptoms of severe anemia, vigilance regarding focal neurologic deficits should prompt suspicion for ischemic stroke in patients with significantly low hemoglobin levels.

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Section: Discussionsupporting

confidence: 44%

Section: Discussionmentioning

confidence: 99%

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Iron-deficiency Anemia Causes an Ischemic Stroke in a Young Man

Fluss

Zguri

Rahme

et al. 2019

Cureus

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“…Our patient was not on hormonal contraceptive therapy. Iron deficiency anemia has also been postulated to lead to a hypercoagulable state and stroke in young women with uterine fibroids [2]; however, our patient had no evidence of anemia during her hospitalization. The patient's main cardiovascular risk factor was morbid obesity.…”

Section: Discussionmentioning

confidence: 67%

Stroke due to Paradoxical Embolization Related to Fibroid Uterus Enlargement Compressing the Right Common Iliac Vein

et al. 2018

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Stroke in young women is commonly cryptogenic or associated with an underlying hypercoagulable state (e.g., hormonal contraception). Paradoxical embolization has been postulated as a potential risk factor for stroke in young adults. Many sources of venous thrombosis leading to paradoxical embolization have been described. There have been few reported cases of uterine enlargement leading to iliac vein compression and paradoxical embolization. We present the case of a young adult woman who had a left middle cerebral artery infarction related to patent foramen ovale and right common iliac vein compression from an enlarged fibroid uterus.

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“…As noted earlier, an MRI discovered a posterior ischaemic stroke after the patient presented with seizures, confusion and difficulty moving. Anaemia has been reported to cause reactive thrombosis9 and Naito et al documented a very similar incidence of two patients with chronic anaemia secondary to fibroids who also had cerebrovascular accidents 10…”

Section: Discussionmentioning

confidence: 96%

Acute on chronic anaemia with a haemoglobin of 18 g/L (1.8 g/dL) and haematocrit of 7.2%

Haferkamp¹,

Cherukuri

Valasareddi

et al. 2018

BMJ Case Rep

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Anaemia can present with symptoms of fatigue, shortness of breath, weakness, malaise, tachycardia and skin pallor. If left untreated, this can progress to life-threatening complications such as arrhythmias, cardiac hypertrophy and myocardial infarction. In this report, a 43-year-old woman, who was ambulatory with no exertional dysponea, presented with weakness, fatigue, bilateral lower extremity oedema and intermittent right sided chest pain for several months. This patient was subsequently found to have a haemoglobin of 18 g/L (1.8 g/dL) and haematocrit of 7.2%. She was admitted to the hospital and treated with seven units of blood. CT scan showed a 9.6 cm uterine fibroid in addition to a 5.9×5.4 cm mass near the right kidney, which was later diagnosed as metastatic carcinoid tumour. This case deserves attention due to the importance of looking for multiple causes of blood loss and the effects of low haemoglobin levels.

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Two Cases of Acute Ischemic Stroke Associated with Iron Deficiency Anemia due to Bleeding from Uterine Fibroids in Middle-aged Women

Cited by 19 publications

References 19 publications

Iron-deficiency Anemia Causes an Ischemic Stroke in a Young Man

Iron-deficiency Anemia Causes an Ischemic Stroke in a Young Man

Stroke due to Paradoxical Embolization Related to Fibroid Uterus Enlargement Compressing the Right Common Iliac Vein

Acute on chronic anaemia with a haemoglobin of 18 g/L (1.8 g/dL) and haematocrit of 7.2%

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