Acute cerebral infarct as a presentation of polycythemia vera: A case report

Abstract

Polycythemia vera (PV) is a myeloproliferative disorder associated with a JAK2 gene mutation, characterized by excessive production of blood cells, especially red blood cells. This condition is associated with blood hyperviscosity, which predisposes patients to thrombotic events, including cerebral infarction. We report two cases of acute ischemic stroke associated with PV. Case 1: A 55-year-old man presented with sudden-onset left-sided weakness, dysarthria, and fatigue. Routine blood evaluation revealed markedly elevated hemoglobin and hematocrit levels, while brain imaging confirmed a right frontal lobe infarct. Peripheral blood examination showed normocytic hypochromic with erythrocytosis, anisocytosis, leukocytosis, neutrophilia, granulation, and vacuolization of neutrophils, and giant platelets. The patient was treated with antiplatelet therapy and showed clinical improvement. Case 2: A 56-year-old man presented with left hemiparesis, dysarthria, and facial asymmetry. Routine blood evaluation demonstrated severe erythrocytosis and leukocytosis, and brain CT revealed infarctions in the right frontal and parietal lobes. The patient underwent phlebotomy in addition to antiplatelet therapy, followed by referral for further evaluation and management. Both cases demonstrated symptomatic improvement after initial treatment. Antiplatelet therapy and phlebotomy as initial treatments contributed to patient improvement. Cerebral infarction may be the initial presentation of PV, highlighting the role of hyperviscosity-induced thrombosis. Further evaluation is required to establish the diagnosis and provide appropriate treatment.