Stroke, Vol 21, 1111-1121, Copyright © 1990 by American Heart Association
RG Hart and MC Kanter
More than a dozen primary hematologic disorders have been associated with
ischemic stroke. Inherited deficiencies of antithrombin III, protein C, and
protein S have been linked with stroke in case reports; optimal screening
requires functional as well as antigenic assays. Antiphospholipid
antibodies and lupus anticoagulants are the most frequently identified
acquired states associated with ischemic stroke. Polycythemia vera, sickle
cell anemia, sickle-C disease, and essential thrombocythemia are the major
disorders of formed blood elements causing stroke. Special, step-wise
screening for occult prothrombotic entities in stroke patients is
recommended for young persons with stroke of uncertain cause, for those
with prior venous thrombosis, for those with a family history of unusual
thrombosis, and for those with no other explanation for recurrent stroke.
Acquired, perhaps transient, abnormalities of platelets, coagulation
inhibition, and fibrinolysis may contribute importantly to brain ischemia
in synergy with other mechanisms, but at present these remain ill-defined.
The contribution of prothrombotic diatheses to stroke is probably
underrecognized and warrants further investigation.
ARTICLES
Hematologic disorders and ischemic stroke. A selective review
Department of Medicine (Neurology), University of Texas Health Science Center, San Antonio 78284.
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