Abstract
Case Report
57 Year old Man who was previously healthy presented with sudden onset of slurring of speech with difficulty in walking with swaying to right since 3 days. There was mild holocranial headache along with it without vomiting. Past history of systemic hypertension since 5 years on medications with good control. No history of Smoking, Neck trauma, Cardiac illness or any other vascular risk factors. On General examination he had Conjuctival hyperemia. Neurological Examination showed gaze evoked nystagmus more towards right with dysarthria. There was intention tremor in right upper limb with dysmetria, wide based gait ataxia and swaying to right on walking with inability to perform the tandem walk test. Cardiovascular system examination was normal. There was no hepatosplenomegaly. In view of sudden onset Slurring of speech with right sided cerebellar signs a diagnosis of Cerebrovascular Accident involving the posterior circulation was considered.
MRI scan of the Brain (1.5 Tesla) was done which showed Right cerebellar Acute Infarct without mass effect or hemorrhagic transformation.
References
- Adamson JW, Fialkow PJ, Murphy S, Prchal JF, Steinmann L. Polycythemia vera: stem-cell and probable clonal origin of the disease. N Engl J Med. 1976;295:913-916
- Ash RC, Detrick RA, Zanjani ED. In vitro studies of human pluripotential hematop-oietic progenitors in polycythemia vera: direct evidence of stem cell involvement. J Clin Invest. 1982; 69:1112-1118
- Spivak Jerry L . Polycythemia vera and other myeloproliferative diseases. Harrison’s principles of internal medicine. 18th Edn. (Mc Graw Hill Companies. 2012) 898-904.
- Gruppo Italiano Studio Policitemia. Polycythemia vera: the natural history of 1213 patients followed for 20 years. Ann Intern Med. 1995;123:656-664.
- Spivak JL: The optimal management of polycythemia vera. Br J Haematol 2002, 116(2):243–254.
- Spivak JL: Polycythemia vera: myths, mechanisms, and management. Blood 2002, 100(13):4272–4290
- Millikan CH, Siekert RG, Whisnant JP: Intermittent carotid and vertebralbasilar insufficiency associated with polycyt-hemia. Neurology 1960, 10:188–196.
- Landolfi R, Di Gennaro L, Barbui T, De Stefano V, Finazzi G, Marfisi R, Tognoni G, Marchioli R, European Collaboration on Low-Dose Aspirin in Polycythemia Vera (ECLAP): Leukocytosis as a major thrombotic risk factor in patients with polycythemia vera. Blood 2007, 109(6):2446–2452
- Zoraster and Rison: Acute embolic cerebral ischemia as an initial presentation of polycythemia vera: a case report. Journal of Medical Case Reports 2013 7:131.
- Matijevic N, Wu KK. Hypercoagulable states and strokes. Curr Atheroscler Rep 2006; 8(4): 324-29.
- Budde, U. & van Genderen, P.J. (1997) Acquired von Willebrand disease in patients with high platelet counts. Seminars in Thrombosis and Hemostasis, 23, 425–431.
- Pearce JMS, Chandrasekera CP, Ladusans EJ. Lacunar infarcts in polycythemia with raised packed cell volume . BMJ 1983; 287:935-36.
- Messinezy M, Westwood NB, El-Hemaidi I, Marsden JT, Sherwood RS, Pearson TC. Serum erythropoietin values in erythroc-ytoses and in primary thrombocythaemia. Br J Haematol. 2002;117:47-53.
- Weinfeld A, Swolin B, Westin J. Acute leukaemia after hydroxyurea therapy in polycythaemia vera and allied disorders: prospective study of efficacy and leukae-mogenicity with therapeutic implications. Eur J Haematol1994;52(3):134-9.
- Fruchtman SM, Mack K, Kaplan ME, et al. From efficacy to safety: a Polycythemia Vera Study Group report on hydroxyurea in patients with polycythemia vera. Semin Hematol 1997;34(1):17-23.
Corresponding Author
Praveen Kumar Yadav
Consultant Neurologist and In Charge, Department of Neuromedicine
The Mission Hospital, Durgapur