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Acute embolic cerebral ischemia as an initial presentation of polycythemia vera: a case report

Richard M Zoraster1 and Richard A Rison2*

Author Affiliations

1 Intercommunity Emergency Medical Group, 12401 Washington Blvd., Whittier, CA 90602, USA

2 Clinical Assistant Professor of Neurology, University of Southern California Keck School of Medicine, Medical Director PIH Health Stroke Program, 12401 Washington Boulevard, Whittier, CA, 90602, USA

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Journal of Medical Case Reports 2013, 7:131  doi:10.1186/1752-1947-7-131

Published: 19 May 2013



Patients with polycythemia vera are at high risk for vaso-occlusive events including cerebral ischemia. Although unusual, acute ischemic stroke may be an initial presentation of polycythemia vera. It had been previously assumed that cerebral ischemic events were due to increased blood viscosity and platelet activation within the central nervous system arterial vessels. However, there are now a few isolated case reports of probable micro-embolic events originating from outside of the brain. This suggests unique management issues for these patients.

Case presentation

We present the case of a 57-year-old right-handed Caucasian male in excellent health who presented to the Emergency Department with acute right-handed clumsiness. Hematologic investigations revealed a hyperviscous state and magnetic resonance imaging was consistent with cerebral emboli. Symptoms rapidly improved with phlebotomy and hydration.


The etiology of stroke in polycythemic patients is likely to be multifactorial. While hemodilution has been generally discredited for general stroke management, it is potentially beneficial for patients with polycythemia vera and euvolemic hemodilution should be considered for the polycythemic patient with acute cerebral ischemia.