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.
Highlights
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
We report two patients with cerebral infarction due to acute anemia
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
Summary
Cerebral infarct results from acute interruption of oxygenated blood flow due to thrombotic or embolic occlusion or marked deprivation of nutrients for the brain, such as oxygen or glucose. Whereas the relevance of sickle cell anemia in cerebral infarction is well depicted [9], anemia in general is not considered as an usual and definite vascular risk factor for stroke because it has been thought that the physiologic regulation in cerebral hemodynamics and oxygenation would meet the brain oxygen requirement in most circumstances, even with profound anemia [10]. A recent study showed that both low and high hemoglobin levels were each associated with increased odds and worse severity of neglect, independent of stroke size [14]. These aspects have only been scarcely studied in large cohorts of ischemic stroke patients and the relationship between drop of hemoglobin level and acute focal neurological deficits warrants further studies. We report two patients with cerebral infarction due to acute anemia caused by upper gastrointestinal bleeding (Case 1) and in the context of a percutaneous transluminal angioplasty (PTA) and stenting for carotid artery stenosis (Case 2)
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