Abstract
Little has been known about the relationship between iron deficiency anemia (IDA) and acute ischemic stroke. We present a case of patient with acute ischemic infarction with bilateral MCA stenosis complicated by severe IDA, which resolved rapidly after correcting IDA. A 67-year-old woman was referred to emergency department with right hemiparesis on wake-up. On examination she had MRC grade 3 weakness of the right upper and lower extremities with a NIH Stroke Scale score (NIHSS) of 4. DWI showed multifocal diffusion restriction foci involving Lt. temporal, both parietal and occipital lobes. MRA revealed segmental severe stenosis at both proximal MCA. Her haemoglobin level of 1.9 g/dL, which rose to 4.0 g/dL after RBC transfusion. In 2 hours, her neurologic symptoms improved to NIHSS 1. Gastrofiberscopy, colonoscopy, and CT scan of the chest and abdomen revealed no signs of malignancy or acute internal bleeding. The results of hematological and biochemical studies were compatible with the diagnosis of IDA. Follow-up MRA on 5th days showed remarkably improved bilateral MCA stenosis compared with baseline MRA. Results of the baseline and follow-up TCD also suggested improved MCA stenosis. She was discharged with a haemoglobin level of 7.8 g/dL and without significant neurologic deficit. We report an acute ischemic stroke patient with bilateral MCA stenosis and severe IDA. Stroke severity and the degree MCA stenosis improved promptly by correcting anemia with RBC transfusion. Severe anemia may be a trigger factor for aggravating stenosis of intracranial arteries and stroke symptoms.
Published Version
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