CHU Nancy, Service de Neurologie, Hopital Central, 29 avenue du Marechal de Lattre de Tassigny-CO, Nancy Cedex, France.
Eur J Neurol. 2011 Jul;18(7):995-8. doi: 10.1111/j.1468-1331.2010.03183.x. Epub 2010 Aug 16.
Essential thrombocythemia (ET) is considered as a rare cause of stroke, partially because of difficulties to identify it when platelet count is not greatly elevated. However, early detection of ET is important because, without adapted treatment, recurrent thromboses are frequent.
We collected, retrospectively, data from 14 cases of stroke patients with ET. Clinical characteristics, ischaemic stroke, laboratory data (platelet and leucocyte count, haemoglobin, JAK2 V617F mutation, culture of haematopoietic progenitors) and treatment were reviewed. Every patient has been interviewed by phone to evaluate outcome.
The population consisted of nine women and five men with ages ranging from 40 to 87 years. Most of the patients (12) had atherosclerotic risk factors and two presented a thrombus in the internal carotid. ET was diagnosed early after the onset of stroke except in two patients. The platelet count was under 600*10(9) /L for five patients. Mutation JAK2 V617F was found for eight patients. Thirteen patients were treated with an association between antiplatelet and cytoreductive treatment and did not present further thrombosis. Median follow-up is 2.8 years.
These cases emphasize the problems of diagnosing ET at the onset of the stroke. Complete blood count has to be carefully read and ET can be suspected even if platelet count is not greatly increased. Diagnosis must be confirmed by haematologist to initiate appropriate treatment.
特发性血小板增多症（ET）被认为是导致中风的罕见原因之一，部分原因是由于血小板计数未显著升高，导致难以识别。然而，早期发现 ET 非常重要，因为如果不进行适当治疗，复发血栓形成的风险很高。
我们回顾性收集了 14 例 ET 伴中风患者的数据。对临床特征、缺血性中风、实验室数据（血小板和白细胞计数、血红蛋白、JAK2 V617F 突变、造血祖细胞培养）和治疗进行了评估。通过电话对每位患者进行了访谈以评估预后。
该人群由 9 名女性和 5 名男性组成，年龄在 40 岁至 87 岁之间。大多数患者（12 例）有动脉粥样硬化危险因素，2 例患者存在颈内动脉血栓。除了 2 例患者，ET 在中风发作后早期得到诊断。5 例患者的血小板计数低于 600*10(9) /L。8 例患者发现 JAK2 V617F 突变。13 例患者接受了抗血小板和细胞减灭治疗的联合治疗，未出现进一步的血栓形成。中位随访时间为 2.8 年。
这些病例强调了在中风发作时诊断 ET 的问题。必须仔细阅读全血细胞计数，即使血小板计数未显著升高，也应怀疑 ET。应通过血液科医生确诊并启动适当的治疗。
