title: POEMS syndrome associated with ischemic stroke.
abstract: BACKGROUND
  A syndrome variously combining peripheral neuropathy, visceromegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS syndrome) is a rare variant of plasma cell dyscrasia with multisystemic manifestations. Acute ischemic strokes in patients with POEMS syndrome have rarely been reported, and the pathophysiologic mechanism of this disease is unknown. Fibrinogen is reported to be an independent risk factor for cerebrovascular disease and is correlated with the interleukin 6 level in the plasma. The serum level of interleukin 6 is high in the active stage of POEMS syndrome.
  
  
  OBJECTIVE
  To describe the neuroimaging findings and fibrinogen levels in patients with POEMS syndrome.
  
  
  METHODS
  Case series.
  
  
  METHODS
  The neurology department of a tertiary referral center.
  
  
  METHODS
  Three patients with an acute cerebral infarction associated with POEMS syndrome underwent magnetic resonance imaging, diffusion-weighted imaging, magnetic resonance angiography, transcranial Doppler ultrasonography, and serum fibrinogen level and serum C-reactive protein level analysis. The serum fibrinogen level before the stroke was collected retrospectively from the hospital medical records.
  
  
  RESULTS
  There was an elevated fibrinogen level in all of the patients. In 2 patients, unilateral or bilateral end artery border-zone infarcts were observed on the brain magnetic resonance imaging scan. The serum fibrinogen level was high before the stroke in 2 patients.
  
  
  CONCLUSIONS
  The POEMS syndrome can be associated with stroke, particularly end artery border-zone infarctions. We suggest that an elevated fibrinogen level might play a role in the pathogenesis of stroke.
authors.affiliation: Department of Neurology and the Clinical Research Institute, Seoul National University Hospital, Neuroscience Research Institute of Seoul National University Medical Research Center, Korea.
authors.forename: Kyusik
authors.initials: K
authors.lastname: Kang
authors.forename: Kon
authors.initials: K
authors.lastname: Chu
authors.forename: Dong-Eog
authors.initials: DE
authors.lastname: Kim
authors.forename: Sang-Wuk
authors.initials: SW
authors.lastname: Jeong
authors.forename: Jun-Won
authors.initials: JW
authors.lastname: Lee
authors.forename: Jae-Kyu
authors.initials: JK
authors.lastname: Roh
mesh_terms: D000328:Adult; D002545:Brain Ischemia / Q000097:blood / Q000209:etiology* / Q000473:pathology; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016878:POEMS Syndrome / Q000097:blood / Q000150:complications* / Q000473:pathology; D020521:Stroke / Q000097:blood / Q000209:etiology* / Q000473:pathology
chemical_list: D005340:Fibrinogen