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Article
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
9-1-2009
Abstract
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.
PubMedID
19717030
Document Type
Article
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