WJNS  Vol.3 No.2 , May 2013
Focal neurological deficit in acute anemia: Case reports and review of the literature
ABSTRACT

Introduction: Although anemia is not regarded as an usual vascular risk factor for stroke, it is one of the potential mechanism by which the brain does not receive adequate oxygenation. Moreover, the relationship between drop of hemoglobin and acute focal neurological deficits is not clear. We report two patients with cerebral infarction due to acute anemia. Case Reports: Case 1 was a 73-year-old man who complained an episode of loss of consciousness followed by right hemiparesis and dysarthria after few hours. The day after admission he presented melena caused by a duodenal ulcer bleeding. The hemoglobin dropped from 11.3 g/dl to5.6 g/dl in 24 hours. Areas of acute infarctions were evident at diffusion-weighted imaging (DWI) of the brain. Case 2 was a 77-year-old man with a transient episode of aphasia, right lower limb paresis and mental confusion twelve hours after an intervention of PTA and stenting of the left internal carotid artery. Hemoglobin was11.8 g/dl before intervention and9 g/dl 48 hours later. DWI showed bilateral and widespread acute infarcts. Conclusion: Anemia has to be considered as a potential factor in determining or worsening cerebral infarction, especially in patients with carotid or intracranial stenosis, high cerebrovascular lesions load or insufficient collateral supply. Acute or severe anemia may negatively impact the cerebral blood flow and decrease oxygen-carrying capacity, promote rapid deterioration of ischemic penumbra. Brain DWI and treatment of the underlying etiology of acute anemia are crucial in early identification and recovery of cerebral infarctions.


Cite this paper
Giuffrida, S. , Carpinteri, G. , Modica, D. , Pennisi, M. , Catalano, A. , Bella, R. , Pennisi, G. , Cornelius, C. and Lanza, G. (2013) Focal neurological deficit in acute anemia: Case reports and review of the literature. World Journal of Neuroscience, 3, 53-56. doi: 10.4236/wjns.2013.32007.
References
[1]   Tegos, T.J., Kalodiki, E., Daskalopoulou, S.S. and Nicolaides, A.N. (2000) Stroke: Epidemiology, clinical picture, and risk factors-Part I of III. Angiology, 51, 793-808. doi:10.1177/000331970005101001

[2]   Kannel, W.B., Gordon, T., Wolf, P.A. and McNamara, P. (1972) Hemoglobin and the risk of cerebral infarction: The Framingham study. Stroke, 3, 409-420. doi:10.1161/01.STR.3.4.409

[3]   Herold, S., Brozovic, M., Gibbs, J., Lammertsma, A.A., Leenders, K.L., Carr, D., Fleming, J.S. and Jones, T. (1986) Measurement of regional cerebral blood flow, blood volume and oxygen metabolism in patients with sickle cell disease using positron emission tomography. Stroke, 17, 692-698. doi:10.1161/01.STR.17.4.692

[4]   Akins, P.T., Glenn, S., Nemeth, P.M. and Derdeyn, C.P. (1996) Carotid artery thrombus associated with severe iron-deficiency anemia and thrombocytosis. Stroke, 27, 1002-1005. doi:10.1161/01.STR.27.5.1002

[5]   Shahar, A. and Sadeh, M. (1991) Severe anemia associated with transient neurological deficits. Stroke, 22, 1201-1202. doi:10.1161/01.STR.22.9.1201

[6]   LaRue, L., Alter, M., Lai, S.M., Friday, G., Sobel, E., Levitt, L., McCoy, R. and Isack, T. (1987) Acute stroke, hematocrit, and blood pressure. Stroke, 18, 565-569. doi:10.1161/01.STR.18.3.565

[7]   Young, R.S., Rannels, D.E., Hilmo, A., Gerson, J.M. and Goodrich, D. (1983) Severe anemia in childhood presenting as transient ischemic attacks. Stroke, 14, 622-623. doi:10.1161/01.STR.14.4.622

[8]   Ganesan, V., Prengler, M., McShane, M.A., Wade, A.M. and Kirkham, F.J. (2003) Investigation of risk factors in children with arterial ischemic stroke. Annals of Neurology, 53, 167-173. doi:10.1002/ana.10423

[9]   Gebreyohanns, M. and Adams, R.J. (2004) Sickle cell disease: Primary stroke prevention. CNS Spectrums, 9, 445-449.

[10]   Hsiao, K.Y., Hsiao, C.T., Lin, L.J., Shiao, C.J. and Chen, I.C. (2008) Severe anemia associated with transient ischemic attacks involving vertebrobasilar circulation. American Journal of Emergency Medicine, 26, 382.e3-382.e4.

[11]   Nybo, M., Kristensen, S.R., Mickley, H. and Jensen, J.K. (2007) The influence of anaemia on stroke prognosis and its relation to N-terminal pro-brain natriuretic peptide. European Journal of Neurology, 14, 477-482. doi:10.1111/j.1468-1331.2006.01591.x

[12]   Huang, W.Y., Chen, I.C., Meng, L., Weng, W.C. and Peng, T.I. (2009) The influence of anemia on clinical presentation and outcome of patients with first-ever atherosclerosis-related ischemic stroke. Journal of Clinical Neuroscience, 16, 645-649. doi:10.1016/j.jocn.2008.08.014

[13]   Tanne, D., Molshatzki, N., Merzeliak, O., Tsabari, R., Toashi, M. and Schwammenthal, Y. (2010) Anemia status, hemoglobin concentration and outcome after acute stroke: A cohort study. BMC Neurology, 10, 1-7.

[14]   Gottesman, R.F., Bahrainwala, Z., Wityk, R.J. and Hillis, A.E. (2010) Neglect is more common and severe at extreme hemoglobin levels in right hemispheric stroke. Stroke, 41, 1641-1645. doi:10.1161/STROKEAHA.110.585265

[15]   Tsai, C.F., Yip, P.K., Chen, C.C., Yeh, S.J., Chung, S.T. and Jeng, J.S. (2010) Cerebral infarction in acute anemia. Journal of Neurology, 257, 2044-2051. doi:10.1007/s00415-010-5657-6

[16]   Kim, J.S. and Kang, S.Y. (2000) Bleeding and subsequent anemia: A precipitant for cerebral infarction. European Neurology, 43, 201-208. doi:10.1159/000008176

[17]   Yamauchi, H., Fukuyama, H., Nagahama, Y., Shiozaki, T., Nishizawa, S., Konishi, J., Shio, H. and Kimura, J. (1999) Brain arteriolosclerosis and hemodynamic disturbance may induce leukoaraiosis. Neurology, 53, 1833-1838. doi:10.1212/WNL.53.8.1833

[18]   Dexter, F. and Hindman, B.J. (1997) Effect of hemoglobin concentration on brain oxygenation in focal stroke: A mathematical modeling study. British Journal of Anaesthesia, 79, 346-351. doi:10.1093/bja/79.3.346

[19]   Terao, S., Sobue, G., Daimaru, O., Hibino, K., Izumi, M. and Mitsuma, T. (1994) Hemodynamic TIA associated with severe anemia-a case report. No to Shinkei, 46, 879-883

 
 
Top