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(Stroke. 1995;26:1463-1466.)
© 1995 American Heart Association, Inc.

Articles

Ischemic Stroke as First Manifestation of Essential Thrombocythemia

Report of Six Cases

Adrià Arboix, MD; Carles Besses, MD; Pilar Acín, MD; Juan B. Massons, MD; Lourdes Florensa, MD; Montserrat Oliveres, MD Jordi Sans-Sabrafen, MD

From the Acute Stroke Unit, Service of Neurology (A.A., J.B.M., M.O.) and Unit of Hematology and Oncology 1973 (C.B., P.A., L.F., J.S.-S.), Hospitals de Barcelona de L'Aliança, Barcelona, Spain.

Background Ischemic stroke as a presenting sign of essential thrombocythemia has been infrequently reported. We describe six patients in whom cerebrovascular disease was the first manifestation of this myeloproliferative disease. A positive endogenous megakaryocyte and/or erythroid colony growth from blood was a diagnostic criterion of essential thrombocythemia in patients with platelets counts lower than 600x10⁹/L.

Case Descriptions These six patients represented 0.54% of all patients with first stroke, 42.8% of all hematologic disorders associated with stroke, and 12.5% of all patients with essential thrombocythemia diagnosed from 1986 to 1992 at our institution. Eleven acute cerebrovascular accidents (6 transient ischemic attacks, 5 definitive cerebral infarcts) were registered. Mean time from ischemic stroke to diagnosis of essential thrombocythemia was 4.5 months (range, 1 to 12 months). The mean platelet count was 597x10⁹/L (range, 414 to 760x10⁹/L). Four patients had platelets counts lower than 600x10⁹/L. All patients had circulating erythroid progenitors, megakaryocytic progenitors, or both.

Conclusions Ischemic stroke as a presenting manifestation of essential thrombocythemia is probably underrecognized. The diagnosis of thrombocythemia should not be excluded on the basis of platelet counts lower than 600x10⁹/L. The availability of in vitro culture of hematopoietic progenitors from peripheral blood makes it possible to diagnose early and atypical cases.

Key Words: cerebral ischemia • myeloproliferative disorders • diagnosis • thrombocythemia, hemorrhagic

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