Repeated episodes of ischemic stroke over a short period in a patient with essential thrombocythemia on anticoagulant therapy.
A 69-year-old man who had essential thrombocythemia, for which he was taking no medications, suddenly developed aphasia and right hemiplegia and was admitted to the hospital. He was thought to have had an embolic stroke and was initially treated with warfarin. Although the international normalized ratio was in the therapeutic range, he had 3 additional ischemic stroke episodes with the same symptoms after the index stroke. Magnetic resonance angiographic examinations revealed serial changes in middle cerebral artery stenosis. After administration of an antiplatelet agent and hydroxyurea, he had no additional strokes.
Department of Medicine, Kumamoto Rosai Hospital, Kumamoto, Japan. Electronic address: naganuma@f6.dion.ne.jp.
Masaki
M
Naganuma
Department of Medicine, Kumamoto Rosai Hospital, Kumamoto, Japan.
Kazuya
K
Isoda
Department of Medicine, Kumamoto Rosai Hospital, Kumamoto, Japan.
Shinsuke
S
Nishi
Department of Medicine, Kumamoto Rosai Hospital, Kumamoto, Japan.
Kiyotaka
K
Ito
Department of Neurology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
Teruyuki
T
Hirano
D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use*; D001037:Aphasia / Q000209:etiology; D002545:Brain Ischemia / Q000209:etiology*; D002533:Cerebral Angiography; D000077407:Cilostazol; D038524:Diffusion Magnetic Resonance Imaging; D006429:Hemiplegia / Q000209:etiology; D006801:Humans; D006918:Hydroxyurea / Q000627:therapeutic use; D020244:Infarction, Middle Cerebral Artery / Q000150:complications; D019934:International Normalized Ratio; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D010468:Perceptual Disorders / Q000209:etiology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D020521:Stroke / Q000209:etiology*; D013777:Tetrazoles / Q000627:therapeutic use; D013920:Thrombocythemia, Essential / Q000150:complications* / Q000188:drug therapy*; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D014859:Warfarin; D000077407:Cilostazol; D006918:Hydroxyurea