MCA Territorial Infarction With Iron Deficiency Anemia and Thrombocytosis

BACKGROUND: As a complication of iron deficiency anemia, only a few cases of the infarction involving major cerebral artery territory area have been reported. Although the reactive thrombocytosis secondary to iron-deficiency anemia may be suggested as a cause, the exact mechanism is unclear. Until now, the sole possible level of thrombocytosis associated with iron deficiency anemia for cerebrovascular accident has been reported as more than 8.0 x 105/mm3. Case Description : We present a case of young woman with mild reactive thrombocytosis(5.95 x 105/mm3) secondary to iron deficiency anemia who developed left middle cerebral artery territorial infarction. We did not find any other precipitating factors despite of all possible etiological evaluations including cerebral angiography. After the treatment of iron supplement and antiplatelet agent, the recovery was relatively good and no definite neurological deficits were remained. CONCLUSION: We suggest that this large territorial infarction might be related to the severe iron deficiency anemia and the reactive thrombocytosis associated with iron deficiency anemia and the correction of anemia and antiplatelet therapy is a reasonable approach.

The 30-day mortality rate and the causes of death following acute ischemic stroke

BACKGROUND: Most stroke-related deaths occur shortly after the onset of symptoms. Analysis of early deaths after stroke is important, since some deaths may be preventable. It also helps to improve the quality of stroke management. We investigated the early mortality and the causes of death in acute ischemic stroke patients. METHODS: We reviewed the medical records of six hundred fifty-one consecutive acute ischemic stroke patients who admitted to HLMC (Hallym University Medical Center) between January 1993 and December 1996. The 30-day mortality rate and the cause of death in each case were assessed. RESULTS: Fifty patients (mean age, 67.7 years, male : female=1 : 1.3) of total 651 patients (mean age, 65.4 years, male : female=1:0.78) died within 30 days (7.7%). Thirty-three (7%) patients of the 471 patients who had supratentorial lesion and sixteen (10.5%) of the 151 patients who had infratentorial lesion died within 30 days. The 30-day mortality rate according to each stroke subtype were 8.2% in large-artery atherosclerosis (n=21), 26.4% in cardioembolism (n=14), 1.2% in small-vessel occlusion (n=3), 33.3% in strokes with other determined etiology (n=1), 12.1% in strokes with undetermined etiology (n=11). Twenty-eight patients (56%) died due to direct stroke-related causes such as herniation, evolving stroke and massive hemorrhagic transformation. Twenty-two patients (44%) died from indirect stroke-complicated causes such as sepsis (n=7, 14%), heart disease (n=6, 12%), pneumonia (n=5, 10%), massive bleeding at tracheostomy site (n=1, 2%), pulmonary edema (n=1, 2%) and unknown cause (n=2, 4%). Forty patients (80%) died in the first 10 days and the main causes of death were herniation and evolving stroke. After the first 10 days, ten patients (20%) died of relative immobility (pneumonia, sepsis, pulmonary embolism). CONCLUSION: To reduce the early mortality within the first 10 days after the onset, aggressive control of IICP with the amelioration of brain edema must be emphasized. Whilst, to reduce the early mortality after the first 10 days, vigorous efforts to prevent and treat complications, such as pneumonia, pulmonary embolism and sepsis should be done.