Dados do Trabalho

Título

Ischemic stroke as an initial manifestation of lymphoproliferative disease: a case report os polycythemia vera diagnosis.

RESUMO

Presentation of the Case
A 49-year-old female with uterine myomatosis and controlled arterial hypertension. Admitted with right middle cerebral artery syndrome - NIHSS 13 and 45-minute therapeutic window; intravenous thrombolysis was contraindicated due to vaginal bleeding. Past history of nonspecific symptoms of holocranial headache, dizziness, and mild asthenia.CT angiography was not performed to assess the possibility of mechanical thrombectomy. Initial investigation: Electrocardiogram in sinus rhythm, transthoracic echocardiogram without any abnormalities of chambers, valves and walls, as well as systolic and diastolic functions.
Control brain CT confirmed Ischemic stroke (IS) showed right temporoparietal cortico-subcortical hypodensity with CT angiography showing absence of stenoses or plaques in carotid and vertebral arteries; internal carotid, anterior, middle and posterior cerebral arteries, as well as vertebral and basilar arteries with preserved path, caliber and enhancement. Dynamic assessment with transcranial doppler evidence means intracranial vessel velocities in the lower limits of normality for the patient's age and normal pulsatility indices. In the laboratory investigation observed: 20.3% hemoglobin and 59.1% hematocrit. Hematologist evaluation performed bone marrow biopsy with characteristic immunophenotyping of Polycythemia Vera (PV). She underwent therapeutic phlebotomy with improvement of systemic symptoms, hematimetric indexes: Hemoglobin of 14.6 and Hematocrit of 42% in addition to NIHSS 10 and modified Rankin of 2, outpatient with a Hematologist at discharge in addition to rehabilitation.
Discussion
Hematological diseases are responsible for about 1% of IS. Despite being uncommon, IS can be the initial presentation of lymphoproliferative diseases, with its occurrence as the first symptom in 15% or more of patients with this type of condition.
Final comments
Despite the fact that many patients do not present common causes of IS even in adults or elderly, we should always pay attention to less frequent etiologies (non-atherosclerotic or non-cardiogenic) since the etiological definition of stroke is the starting point of secondary prophylaxis. and recurrence of brain damage. In this case, the etiological hypothesis was based on a basic laboratory test.

Palavras Chave

polycythemia vera, ischemic stroke