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Recurrent Ischemic Stroke in Paroxysmal Nocturnal Hemoglobinuria: Paroxysmal Nocturnal Hemoglobinuria or Missed Patent Foramen Ovale?
J Stroke Cerebrovasc Dis
  • Ramon Tiu, MD
  • Hussam A. Yacoub, MD, Lehigh Valley Health Network
  • Jaroslaw Maciejewski, MD, PhD
  • Cathy A Sila, MD
Publication/Presentation Date
Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired bone-marrow disorder characterized by hemolytic anemia, hemoglobinuria, and cytopenia. Most patients die from venous thrombotic events. Stroke is a common cause of morbidity and mortality in PNH and it is almost exclusively a result of cerebral venous thrombosis. Case reports of ischemic stroke complicating PNH have implicated a similar propensity for arterial events caused by the disease. We present a case of recurrent cerebral infarctions complicating PNH initially attributed to arterial thrombosis but ultimately determined to be a result of the disease and a concomitant patent foramen ovale identified only after repeated evaluations. This case emphasizes the pitfalls of diagnostic testing and the importance of a persistent search for a venous cause for cerebral embolic events in patients with hematologic diseases not classically known to involve the arterial system.
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Citation Information

Tiu, R., Yacoub, H., Maciejewski, J., & Sila, C. A. (2009). Recurrent ischemic stroke in paroxysmal nocturnal hemoglobinuria: paroxysmal nocturnal hemoglobinuria or missed patent foramen ovale?. Journal Of Stroke And Cerebrovascular Diseases: The Official Journal Of National Stroke Association, 18(5), 409-410. doi:10.1016/j.jstrokecerebrovasdis.2008.12.002