Abstract
Background
JAK2 V617F mutation increases the risk of thrombosis, and both ischemic and hemorrhagic strokes can occur in essential thrombocythemia (ET). The mechanisms underlying ischemic stroke in ET are diverse, and hemorrhagic stroke has rarely been reported in ET.
Methods
Among 627 stroke patients, those identified as having ET were investigated retrospectively. A comprehensive systemic literature search of the PubMed database was also conducted.
Results
Two cases were extracted with the diagnosis of ET who developed SAH and then ischemic stroke. In Case 1, a 47-year-old woman developed SAH in the left high convexity. Eleven hours later, acute cerebellar infarction suddenly developed due to right vertebral artery dissection. In Case 2, a 70-year-old woman developed SAH in the right high convexity. Magnetic resonance angiography showed multifocal stenotic changes in intracranial arteries. Three days later, she developed acute brain infarcts in the right middle cerebral artery territory. Eight weeks later, multifocal stenotic lesions improved. The literature review revealed 5 patients with hemorrhagic stroke and 40 patients with ischemic stroke associated with ET. Age at onset varied, female gender predominated, and the frequency of JAK2 V617F mutation was high. Atherosclerotic vascular risk factors were more common in ischemic stroke, but not in hemorrhagic stroke.
Conclusions
The current study describes rare cases of SAH accompanied by ischemic stroke secondary to ET along with a review of the current literature, implying specific mechanisms for cerebral artery disorders associated with JAK2 V617F mutation.
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References
Tefferi A (2013) Polycythemia vera and essential thrombocythemia: 2013 update on diagnosis, risk-stratification, and management. Am J Hematol 88:507–516
Kralovics R, Passamonti F, Buser AS, Teo SS, Tiedt R, Passweg JR, Tichelli A, Cazzola M, Skoda RC (2005) A gain-of-function mutation of JAK2 in myeloproliferative disorders. N Engl J Med 352:1779–1790
Fabris F, Randi ML (2009) Essential thrombocythemia: past and present. Intern Emerg Med 4:381–388
Lussana F, Caberlon S, Pagani C, Kamphuisen PW, Buller HR, Cattaneo M (2009) Association of V617F Jak2 mutation with the risk of thrombosis among patients with essential thrombocythaemia or idiopathic myelofibrosis: a systematic review. Thromb Res 124:409–417
Carobbio A, Thiele J, Passamonti F, Rumi E, Ruggeri M, Rodeghiero F, Randi ML, Bertozzi I, Vannucchi AM, Antonioli E, Gisslinger H, Buxhofer-Ausch V, Finazzi G, Gangat N, Tefferi A, Barbui T (2011) Risk factors for arterial and venous thrombosis in WHO-defined essential thrombocythemia: an international study of 891 patients. Blood 117:5857–5859
Richard S, Perrin J, Baillot PA, Lacour JC, Ducrocq X (2011) Ischaemic stroke and essential thrombocythemia: a series of 14 cases. Eur J Neurol 18:995–998
Kato Y, Hayashi T, Sehara Y, Deguchi I, Fukuoka T, Maruyama H, Horiuchi Y, Nagamine Y, Sano H, Tanahashi N (2015) Ischemic stroke with essential thrombocythemia: a case series. J Stroke Cerebrovasc Dis 24:890–893
Adam R, Priglinger M, Harrington T, Gottlieb D, Krause M (2014) An unusual cause of cerebellar hemorrhage in a young patient: essential thrombocythemia. J Stroke Cerebrovasc Dis 23:e373–e374
Freilinger T, Saam T, Duering M, Dichgans M, Peters N (2011) Internal carotid artery dissection and ischemic cerebral infarction in the setting of essential thrombocythemia. Clin Appl Thromb Hemost 17:E138–E140
D’Ambrosio D, Della-Morte D, Gargiulo G, Rossetti M, Rundek T, Rengo F, Abete P (2008) Intrapetrous internal carotid artery dissection and essential thrombocythemia: what relationship? A case report. Cases J 1:354
Miller TD, Farquharson MH (2010) Essential thrombocythaemia and its neurological complications. Pract Neurol 10:195–201
Bogousslavsky J, Van Melle G, Regli F (1988) The Lausanne Stroke Registry: analysis of 1,000 consecutive patients with first stroke. Stroke 19:1083–1092
Choi KD, Jo JW, Park KP, Kim JS, Lee TH, Kim HJ, Jung DS (2007) Diffusion-weighted imaging of intramural hematoma in vertebral artery dissection. J Neurol Sci 253:81–84
Kato A, Shinohara Y, Yamashita E, Fujii S, Miyoshi F, Kuya K, Ogawa T (2015) Usefulness of R2* maps generated by iterative decomposition of water and fat with echo asymmetry and least-squares estimation quantitation sequence for cerebral artery dissection. Neuroradiology 57:909–915
Ducros A (2012) Reversible cerebral vasoconstriction syndrome. Lancet Neurol 11:906–917
Ducros A, Boukobza M, Porcher R, Sarov M, Valade D, Bousser MG (2007) The clinical and radiological spectrum of reversible cerebral vasoconstriction syndrome. A prospective series of 67 patients. Brain 130:3091–3101
Arboix A, Besses C, Acin P, Massons JB, Florensa L, Oliveres M, Sans-Sabrafen J (1995) Ischemic stroke as first manifestation of essential thrombocythemia. Report of six cases. Stroke 26:1463–1466
Verdure P, Lefaucheur R, Guegan-Massardier E, Triquenot-Bagan A, Gerardin E, Maltete D (2012) Bilateral vertebral artery dissection and essential thrombocythemia with JAK2 mutation. Rev Neurol (Paris) 168:543–544
Posfai E, Marton I, Szoke A, Borbenyi Z, Vecsei L, Csomor A, Sas K (2014) Stroke in essential thrombocythemia. J Neurol Sci 336:260–262
Trifan G, Shafi N, Testai FD (2018) Implications of Janus Kinase 2 Mutation in Embolic Stroke of Unknown Source. J Stroke Cerebrovasc Dis 27:2572–2578
Charles M, Fontoura R, Sugalski G (2016) Early recognition of intraventricular hemorrhage in the setting of thrombocytosis in the emergency department. Open Access Emerg Med 8:29–33
Baek JW, Kim YD (2014) Cerebral dissecting aneurysms in patients with essential thrombocythemia. J Korean Neurosurg Soc 56:257–260
Kondlapudi J, O’Connor RJ, Mawer S (2009) Cerebral haemorrhage as the presenting feature of myeloproliferative disorder. BMJ Case Rep 2009
Michiels JJ, Berneman Z, Schroyens W, Finazzi G, Budde U, van Vliet HH (2006) The paradox of platelet activation and impaired function: platelet-von Willebrand factor interactions, and the etiology of thrombotic and hemorrhagic manifestations in essential thrombocythemia and polycythemia vera. Semin Thromb Hemost 32:589–604
Schievink WI (2001) Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med 344:898–906
Arellano-Rodrigo E, Alvarez-Larran A, Reverter JC, Villamor N, Colomer D, Cervantes F (2006) Increased platelet and leukocyte activation as contributing mechanisms for thrombosis in essential thrombocythemia and correlation with the JAK2 mutational status. Haematologica 91:169–175
Falanga A, Marchetti M, Evangelista V, Vignoli A, Licini M, Balicco M, Manarini S, Finazzi G, Cerletti C, Barbui T (2000) Polymorphonuclear leukocyte activation and hemostasis in patients with essential thrombocythemia and polycythemia vera. Blood 96:4261–4266
Etheridge SL, Roh ME, Cosgrove ME, Sangkhae V, Fox NE, Chen J, Lopez JA, Kaushansky K, Hitchcock IS (2014) JAK2V617F-positive endothelial cells contribute to clotting abnormalities in myeloproliferative neoplasms. Proc Natl Acad Sci U S A 111:2295–2300
Solberg LA Jr, Tefferi A, Oles KJ, Tarach JS, Petitt RM, Forstrom LA, Silverstein MN (1997) The effects of anagrelide on human megakaryocytopoiesis. Br J Haematol 99:174–180
Gisslinger H, Gotic M, Holowiecki J, Penka M, Thiele J, Kvasnicka HM, Kralovics R, Petrides PE, Group AS (2013) Anagrelide compared with hydroxyurea in WHO-classified essential thrombocythemia: the ANAHYDRET Study, a randomized controlled trial. Blood 121:1720–1728
Storen EC, Tefferi A (2001) Long-term use of anagrelide in young patients with essential thrombocythemia. Blood 97:863–866
Alvarez-Larran A, Cervantes F, Pereira A, Arellano-Rodrigo E, Perez-Andreu V, Hernandez-Boluda JC, Ayats R, Salvador C, Muntanola A, Bellosillo B, Vicente V, Hernandez-Nieto L, Burgaleta C, Xicoy B, Besses C (2010) Observation versus antiplatelet therapy as primary prophylaxis for thrombosis in low-risk essential thrombocythemia. Blood 116:1205–1210 (quiz 1387)
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This study was conducted in accordance with the Declaration of Helsinki. The independent ethics committee at Juntendo University Hospital approved this study (19-034).
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Sugiyama, M., Ueno, Y., Kamo, H. et al. Specific mechanisms of subarachnoid hemorrhage accompanied by ischemic stroke in essential thrombocythemia: two case reports and a literature review. J Neurol 266, 1869–1878 (2019). https://doi.org/10.1007/s00415-019-09347-4
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DOI: https://doi.org/10.1007/s00415-019-09347-4