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Tahiraj X, Bakalli A, Krasniqi X, Çitaku H, Krasniqi F, Koçinaj D. Acute myocardial infarction and polycythemia rubra vera: The double effect of treatment with hydroxyurea. Radiol Case Rep 2024; 19:3386-3389. [PMID: 38827039 PMCID: PMC11140144 DOI: 10.1016/j.radcr.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/01/2024] [Accepted: 05/03/2024] [Indexed: 06/04/2024] Open
Abstract
We report a case of acute myocardial infarction in a patient with polycythemia rubra vera, who has been treated with hydroxyurea. The patient presented with chest pain extending to both arms accompanied by nausea and sweating. Hemoglobin was 18.1 mg/dL, hematocrit 53.2%, white blood cells 9600/mm³, and platelets 745,000/mm³. The levels of specific cardiac injury markers were increased, troponin I increased to 110 ng/mL and creatine kinase-MB to 361 U/l, respectively. Electrocardiography showed sinus rhythm with ST-segment elevation in leads V2-6, D1, and aVL as well as ST depression in D2, D3 and aVF. Echocardiography demonstrated hypokinesis of the interventricular septum and lateral wall with mildly reduced left ventricle (LV) ejection fraction (EF≈45%). Coronary angiography revealed proximal-LAD subtotal occlusion and 80% mid-LAD stenosis with distal-LAD vasospasm. Percutaneous coronary intervention was performed with a drug-eluting stent in mid- and proximal-LAD. Hypercoagulable state of polycythemia rubra vera may be complicated with acute myocardial infarction, in addition to the vasospastic effect and endothelium lesions of hydroxyurea regardless its favorable effect as a standard therapy.
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Affiliation(s)
| | - Aurora Bakalli
- Medical Faculty, University of Prishtina “Hasan Prishtina”, Republic of kosova
- University Clinical Center of Kosova, Republic of kosova
| | - Xhevdet Krasniqi
- Medical Faculty, University of Prishtina “Hasan Prishtina”, Republic of kosova
- University Clinical Center of Kosova, Republic of kosova
| | - Hajdin Çitaku
- University Clinical Center of Kosova, Republic of kosova
| | - Flora Krasniqi
- University Clinical Center of Kosova, Republic of kosova
| | - Dardan Koçinaj
- University Clinical Center of Kosova, Republic of kosova
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de la Torre C, Wagner JS, Xu J. Concurrent Cardio-Cerebral Infarction - A Case Report and Literature Review. Neurohospitalist 2024; 14:74-78. [PMID: 38235036 PMCID: PMC10790613 DOI: 10.1177/19418744231193181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Concurrent cardio-cerebral infarction (CCI) describes the simultaneous occurrence of an acute myocardial infarction and an acute ischemic stroke. It is a rare phenomenon, and no consensus yet exists on how to best treat it. CCI patients present with variable clinical scenarios and complications which makes the establishment of a treatment guideline difficult. We present here a case of a 67-year-old male with concurrent acute ST-elevation myocardial infarction and acute ischemic stroke due to right middle cerebral artery occlusion who was successfully treated with Tenecteplase and mechanical thrombectomy. A literature review was also conducted in search of potential reasonable management strategies of CCI.
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Affiliation(s)
| | | | - Jindong Xu
- Cone HealthStroke Center, Greensboro, NC, USA
- Guilford Neurologic Research, Greensboro, NC, USA
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Ng TP, Wong C, Leong ELE, Tan BY, Chan MYY, Yeo LL, Yeo TC, Wong RC, Leow AS, Ho JSY, Sia CH. Simultaneous cardio-cerebral infarction: a meta-analysis. QJM 2022; 115:374-380. [PMID: 34051098 DOI: 10.1093/qjmed/hcab158] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 05/24/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND/INTRODUCTION Cardio-cerebral infarction (CCI), which involves the simultaneous occurrence of acute ischaemic stroke and acute myocardial infarction, has a reported incidence of 0.0009%. Treatment of CCI presents a dilemma to physicians as both conditions are time critical. Despite the need for standardized treatment protocols, published data are sparse. AIM We aimed to summarize the reported cardio-cerebral infarction cases in the literature. DESIGN Meta-analysis. METHODS Four databases, Pubmed, Embase, Scopus and Google Scholar were searched until 25 August 2020. A title and abstract sieve, full-text review and extraction of data were conducted independently by three authors. RESULTS A total of 44 cases of CCI were identified from 37 case reports and series; 15 patients (34.1%) were treated using percutaneous coronary intervention (PCI) with stent, 8 patients (18.2%) were treated with a PCI without stent, 10 patients (22.7%) were treated via a cerebral vessel thrombectomy and 8 patients (18.2%) were treated via a thrombectomy of a coronary vessel. For medications, 20 patients (45.5%) were treated with thrombolytics, 10 patients (22.7%) were treated with anticoagulants, 8 patients (18.2%) were treated with antiplatelets and 11 patients (25.0%) were treated with anticoagulants and antiplatelets. Of 44 patients, 10 patients died, and 9 of those were due to cardiac causes. Among the 44 patients, days to death was observed to be a median of 2.0 days (interquartile range (IQR): 1.5, 4.0). The modified Rankin Score was measured in nine patients, with a median score of 2.0 (IQR: 1.0, 2.5) being reported. DISCUSSION/CONCLUSION The condition of CCI has substantial morbidity and mortality, and further studies are needed to examine the optimal diagnostic and treatment strategies of these patients.
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Affiliation(s)
- T P Ng
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore
| | - C Wong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore
| | - E L E Leong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10 , 119228, Singapore
| | - B Y Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road , NUHS Tower Block Level 10, 119228, Singapore
- Division of Neurology, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore
| | - M Y-Y Chan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore
- Department of Cardiology, National University Heart Centre, Singapore, 5 Lower Kent Ridge Road, 119074, Singapore
| | - L L Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore
- Division of Neurology, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore
| | - T-C Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore
- Department of Cardiology, National University Heart Centre, Singapore, 5 Lower Kent Ridge Road, 119074, Singapore
| | - R C Wong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore
- Department of Cardiology, National University Heart Centre, Singapore, 5 Lower Kent Ridge Road , 119074, Singapore
| | - A S Leow
- Internal Medicine Residency, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore
| | - J S-Y Ho
- Academic Foundation Programme, North Middlesex University Hospital NHS Trust, Sterling Way, London, N18 1QX, UK
| | - C-H Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore
- Department of Cardiology, National University Heart Centre, Singapore , 5 Lower Kent Ridge Road, 119074, Singapore
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Chen R, Shi X, Wang L, Wang X, Wei J, Kang X, Du F, Gao S, Yang F, Jiang W. Essential thrombocythemia with CALR mutation and recurrent stroke: two case reports and literature review. Ther Adv Neurol Disord 2022; 15:17562864221092093. [PMID: 35498365 PMCID: PMC9052815 DOI: 10.1177/17562864221092093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/17/2022] [Indexed: 11/23/2022] Open
Abstract
Cerebrovascular events, especially ischemic stroke, are common complications of
essential thrombocythemia (ET). Compared to JAK2V617 F mutation, CALR mutation
is considered as a lower risk factor of thrombosis in ET. Until now stroke in ET
with CALR mutation has rarely been reported. We retrospectively investigated
patients diagnosed with stroke and ET in Xijing hospital of Air Force Medical
University, from 2015 to 2021. Clinical characteristics (including medical
history, physical and auxiliary examination and prognosis) were recorded and
associated literature was reviewed. Among the 19 patients diagnosed with both
stroke and ET we retrieved, two cases were positive for CALR mutation. In case
1, a 71-year-old man developed the first ischemic event under the treatment of
anagrelide, followed by a hemorrhagic stroke after receiving aspirin and
clopidogrel for 4 months. Ischemic stroke reccurred and the neurological
function deteriorated progressively. In case 2, a 44-year-old man presented with
hypoxic-ischemic encephalopathy due to serious myocardial infarction and
subsequent brain imaging indicated three times of ischemic stroke events. The
patient gradually got improved through cytoreductive and antiplatelet therapy
and rehabilitation. Literature review showed that cerebrovascular event is the
most serious neurological complication of ET and may be the presenting symptom.
Most of reported cases with ET accompanied by stroke were positive for JAK2 V617
F mutation, but with rare CALR mutation. ET with CALR mutation can cause both
hemorrhagic and ischemic stroke. Identification of such rare causes of stroke is
of great importance to provide precise and individualized prevention and
therapy.
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Affiliation(s)
- Rong Chen
- Department of Neurology, Xijing Hospital, Air Force Medical University, Xi’an, China
| | - Xiaodan Shi
- Department of Neurology, Xijing Hospital, Air Force Medical University, Xi’an, China
| | - Luojun Wang
- Department of Neurology, Xijing Hospital, Air Force Medical University, Xi’an, China
| | - Xuan Wang
- Department of Neurology, Xijing Hospital, Air Force Medical University, Xi’an, China
| | - Jingya Wei
- Department of Neurology, Xijing Hospital, Air Force Medical University, Xi’an, China
| | - Xiaogang Kang
- Department of Neurology, Xijing Hospital, Air Force Medical University, Xi’an, China
| | - Fang Du
- Department of Neurology, Xijing Hospital, Air Force Medical University, Xi’an, China
| | - Shan Gao
- Department of Hematology, Xijing Hospital, Air Force Medical University, Xi’an, China
| | - Fang Yang
- Department of Neurology, Xijing Hospital, Air Force Medical University, 127 Changle West Road, Xi’an 710032, Shaanxi Province, China
| | - Wen Jiang
- Department of Neurology, Xijing Hospital, Air Force Medical University, 127 Changle West Road, Xi’an 710032, Shaanxi Province, China
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Chen X, Cao L, Feng H, Huang X. Successive development of ischemic stroke and hemorrhagic stroke in a patient with essential thrombocythemia: a case report. J Int Med Res 2021; 49:300060520987718. [PMID: 33472495 PMCID: PMC7829530 DOI: 10.1177/0300060520987718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Patients with essential thrombocythemia (ET) can experience hemorrhagic or
ischemic vascular events. The prevention of these complications is challenging,
and the overall risk of vascular events caused by ET is often overlooked. A
34-year-old man was admitted for a 10-day history of weakness and numbness in
his right limbs. He had been diagnosed with ET in 2008 but had stopped receiving
treatment half a year before admission. Physical examination showed a
superficial sense of disturbance in the right limbs and decreased muscle
strength in the right upper and lower limbs (4/5). His platelet count
(459 × 109/L) was elevated. Magnetic resonance imaging showed
acute watershed infarction, and he was treated successfully. However, he was
readmitted for headache and left limb weakness 14 months later. A head computed
tomography scan revealed spontaneous subdural hemorrhage. He underwent subdural
hematoma removal and decompressive craniectomy. Surgery and pathological
investigation revealed no venous sinus thrombosis or vascular malformation. His
condition improved, and he exhibited a stable condition 1 year after discharge.
Successive development of ischemic stroke and spontaneous subdural hemorrhage is
rare in a patient with ET. This case suggests that ET is not only a risk factor
for stroke but can also cause highly heterogeneous strokes.
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Affiliation(s)
- Xuhui Chen
- Department of Neurology, 74573Peking University Shenzhen Hospital, Shenzhen, China
| | - Liming Cao
- Department of Neurology, The Third Affiliated Hospital of Shenzhen University, Shenzhen, China.,Department of Neurology, 499778Shenzhen University First Affiliated Hospital, Shenzhen, China
| | - Hongye Feng
- Department of Neurology, 499778Shenzhen University First Affiliated Hospital, Shenzhen, China.,Department of Neurology, Shenzhen Second People's Hospital, Shenzhen, China
| | - Xuming Huang
- Department of Gastroenterology, Shenzhen Shiyan People's Hospital, Shenzhen, China
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