[The diagnosis and treatment of polycythemia rubra vera manifesting as acute cerebral stroke].
OBJECTIVE
To analyze the particularities of diagnosis and treatment of acute cerebral stroke secondary to polycythemia vera (PV).


METHODS
To track and evaluate the clinical parameters, the manifestations of CT/MRI, the data of laboratory examinations, the therapeutic responses and the prognosis of acute cerebral stroke secondary to PV. Twenty-two cases of PV with initial presentation as acute stroke were analyzed.


RESULTS
(1) 55.0% of the patients with stroke as the initial presentation of to PV had multiple lacuna infarction. (2) 37.5% of the patients had a temporary symptom aggravation after receiving a therapeutic regimen of blood-letting and chemotherapy, whereas, the stroke symptoms improved and became stable when treated with blood-letting combined with hemodilution and chemotherapy simultaneously. (3) Six cases received homoharringtonine treatment and all of them reached complete remission (CR). However, 3 of them showed ST segment and T-wave changes in electrocardiogram and 2 of them had bone marrow depression. Four cases received arsenic trioxide and obtained CR, but the relapse rate reached 50.0%. Nine cases were treated with hydroxycarbamide and all of them obtained CR.


CONCLUSIONS
(1) Stroke secondary to PV should be treated with stroke regimen as well as PV therapy, and hydroxycarbamide might have stable benefit and few side effects. (2) Hematocrit assay should be used as a routine item in stroke patients with frequently relapsed.
Meng
Ran
R
Department of Neurology, Xuanwu Hospital, Capital University of Medical Sciences, Beijing 100053, China.
Zhou
Jin
J
Ji
Xun-ming
XM
Li
Li-min
LM
Jia
Jian-ping
JP
Yang
Bao-feng
BF
D000328:Adult; D000368:Aged; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D006248:Harringtonines / Q000627:therapeutic use; D006400:Hematocrit; D006801:Humans; D006918:Hydroxyurea / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010087:Oxides / Q000627:therapeutic use; D011087:Polycythemia Vera / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D011379:Prognosis; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*
D001152:Arsenicals; D006248:Harringtonines; D010087:Oxides; D000077237:Arsenic Trioxide; D006918:Hydroxyurea