原发性血小板增多症中蛛网膜下腔出血伴缺血性卒中的特定机制：两例病例报告及文献综述
Specific mechanisms of subarachnoid hemorrhage accompanied by ischemic stroke in essential thrombocythemia: two case reports and a literature review.
摘要(中文译文)
JAK2 V617F突变增加血栓形成风险，而原发性血小板增多症（ET）中既可发生缺血性卒中，也可发生出血性卒中。ET相关缺血性卒中的机制多样，而出血性卒中在ET中罕有报道。在627例卒中患者中，对确诊为ET的患者进行了回顾性研究。同时，对PubMed数据库进行了全面的系统性文献检索。共提取出2例诊断为ET并发生蛛网膜下腔出血（SAH）继而发生缺血性卒中的病例。病例1为一名47岁女性，左侧大脑凸面高位发生SAH。11小时后，因右侧椎动脉夹层突然出现急性小脑梗死。病例2为一名70岁女性，右侧大脑凸面高位发生SAH。磁共振血管造影显示颅内动脉多灶性狭窄改变。3天后，她出现右侧大脑中动脉供血区急性脑梗死。8周后，多灶性狭窄病变改善。文献复习发现5例与ET相关的出血性卒中患者和40例缺血性卒中患者。发病年龄不一，以女性为主，JAK2 V617F突变频率较高。动脉粥样硬化性血管危险因素在缺血性卒中中更为常见，而在出血性卒中中则不然。本研究描述了ET继发SAH伴缺血性卒中的罕见病例，并对当前文献进行了复习，提示与JAK2 V617F突变相关的脑动脉病变可能存在特定机制。
Abstract
JAK2 V617F mutation increases the risk of thrombosis, and both ischemic and hemorrhagic strokes can occur in essential thrombocythemia (ET). The mechanisms underlying ischemic stroke in ET are diverse, and hemorrhagic stroke has rarely been reported in ET. Among 627 stroke patients, those identified as having ET were investigated retrospectively. A comprehensive systemic literature search of the PubMed database was also conducted. Two cases were extracted with the diagnosis of ET who developed SAH and then ischemic stroke. In Case 1, a 47-year-old woman developed SAH in the left high convexity. Eleven hours later, acute cerebellar infarction suddenly developed due to right vertebral artery dissection. In Case 2, a 70-year-old woman developed SAH in the right high convexity. Magnetic resonance angiography showed multifocal stenotic changes in intracranial arteries. Three days later, she developed acute brain infarcts in the right middle cerebral artery territory. Eight weeks later, multifocal stenotic lesions improved. The literature review revealed 5 patients with hemorrhagic stroke and 40 patients with ischemic stroke associated with ET. Age at onset varied, female gender predominated, and the frequency of JAK2 V617F mutation was high. Atherosclerotic vascular risk factors were more common in ischemic stroke, but not in hemorrhagic stroke. The current study describes rare cases of SAH accompanied by ischemic stroke secondary to ET along with a review of the current literature, implying specific mechanisms for cerebral artery disorders associated with JAK2 V617F mutation.
如何引用
AMA
Mizuho Sugiyama, Yuji Ueno, Hikaru Kamo, Yoko Edahiro, Nobukazu Miyamoto, Kazuo Yamashiro, et al. Specific mechanisms of subarachnoid hemorrhage accompanied by ischemic stroke in essential thrombocythemia: two case reports and a literature review.. Journal of neurology. 2019; doi:10.1007/s00415-019-09347-4.
APA
Mizuho Sugiyama, Yuji Ueno, Hikaru Kamo, Yoko Edahiro, Nobukazu Miyamoto, Kazuo Yamashiro, et al (2019). Specific mechanisms of subarachnoid hemorrhage accompanied by ischemic stroke in essential thrombocythemia: two case reports and a literature review.. Journal of neurology. https://doi.org/10.1007/s00415-019-09347-4
GB/T 7714
Mizuho Sugiyama, Yuji Ueno, Hikaru Kamo, Yoko Edahiro, Nobukazu Miyamoto, Kazuo Yamashiro, et al. Specific mechanisms of subarachnoid hemorrhage accompanied by ischemic stroke in essential thrombocythemia: two case reports and a literature review.[J]. Journal of neurology, 2019 doi:10.1007/s00415-019-09347-4.
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