SHM Converge Scientific Abstract ePoster Gallery-Multifocal Strokes in Essential Thrombocytosis: A Clinical Vignette

Pdf Summary

This case describes a 59-year-old man with hypertension who presented with 15 minutes of right arm weakness and slurred speech, then developed chest pain, diaphoresis, and bilateral amaurosis fugax. Exam showed right upper extremity weakness and slow speech, while initial CT head was negative. Labs revealed marked thrombocytosis (platelets 1000 x 10^9/L), elevated troponin, and mildly prolonged aPTT. EKG showed new ST elevation in V3 with hyperacute T waves in lateral leads. MRI brain demonstrated multifocal bilateral hemispheric infarcts involving the parietal lobes and left frontal lobe.<br /><br />He was found to be JAK2 positive, supporting a diagnosis of essential thrombocytosis, a myeloproliferative neoplasm typically associated with platelet counts above 450 x 10^9/L and mutations such as JAK2, MPL, or TPO receptor gene. Although essential thrombocytosis is more common in women in their 50s and 60s, it can cause both thrombosis and bleeding complications. In this patient, the hypercoagulable state likely contributed to both cerebrovascular and cardiac ischemic events.<br /><br />He was started on aspirin and hydroxyurea, with improvement in right arm weakness and vision loss. He was discharged with vascular neurology follow-up and ultimately achieved full symptom resolution.<br /><br />Key lessons from this case are that essential thrombocytosis can present with multifocal strokes and other thrombotic events, focal neurologic deficits warrant a broad differential diagnosis, and MRI is the most sensitive imaging study for detecting acute stroke within the first 24 hours.

Asset Subtitle

Tharaka Wijesinghe

Meta Tag

Author List Krystle T. Hernandez, Tharaka Wijesinghe

Category Clinical Vignettes

Concept Essential Thrombocytosis

Concept Thrombocytosis

Concept Thromboembolic Complication

Concept Ischemic Stroke

Concept Myeloproliferative Neoplasm

Distinguished Non-Finalist

Presenter Organization Mount Sinai Morningside/West

Presenting Author Tharaka Wijesinghe

Track Adult

Keywords

essential thrombocytosis

JAK2 mutation

thrombocytosis

multifocal stroke

myeloproliferative neoplasm

cerebrovascular ischemia

myocardial infarction

amaurosis fugax

hydroxyurea

MRI brain

Essential Thrombocytosis

Thrombocytosis

Thromboembolic Complication

Ischemic Stroke

Myeloproliferative Neoplasm