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BMJ Case Rep. 2019 Oct 30;12(10). pii: e231261. doi: 10.1136/bcr-2019-231261.

Acute ischaemic stroke in secondary polycythaemia due to complex congenital cyanotic heart disease.

Author information

1
Department of Neurology, Christian Medical College & Hospital Ludhiana, Ludhiana, India.
2
Department of Neurology, Christian Medical College & Hospital Ludhiana, Ludhiana, India ashlee2907@gmail.com.

Abstract

A 65-year-old woman presented to the emergency department with an acute onset of left-sided hemiparesis and slurred speech for 6 hours. Physical examination was notable for clubbing and peripheral cyanosis. Brain MRI showed an acute infarct involving the right gangliocapsular region. Investigations showed an elevated haemoglobin level, a haematocrit level of >65% and thrombocytopaenia. Transthoracic echocardiography revealed tricuspid atresia, ventricular septal defect and atrial septal defect. A diagnosis of cyanotic congenital heart disease was made. Studies have indicated an association between raised haematocrit and vascular occlusive episodes in patients with polycythaemia vera. However, a relationship between raised haematocrit due to polycythaemia secondary to complex congenital heart disease and vascular thrombosis has not been reported. The improvement of neurological deficits in our patient coincided with a decline in haematocrit. The objective of this report was to highlight an association between elevated haematocrit and ischaemic stroke in patients with secondary polycythaemia due to complex congenital heart disease.

KEYWORDS:

stroke; valvar diseases

PMID:
31666251
DOI:
10.1136/bcr-2019-231261

Conflict of interest statement

Competing interests: None declared.

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