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CAROTID DISEASE IN MYELOPROLIFERATIVE NEOPLASM - 3 CASES (IL BUONO, IL BRUTTO, IL CATTIVO)

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ESOC-2019

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Abstract

Background and Aims: Myeloproliferative neoplasms are associated with arterial thrombosis. Methods: Case reports Results: Case 1 – 35 years old woman with right-sided hemiparesis. CTA: occlusion of the left ICA, ECA and ACM. Thrombolysis and thromboendarterectomy with complete recanalization. A myeloproliferative neoplasm was suspected before the stroke, but not proven. We detected a mutation of the calreticulin-gene. Treatment with hydroxyurea and aspirine was initiated. At discharge the patient had only a mild paresis of the right hand. Case 2 – 56 years old woman with left-sided hemiparesis. CTA: extensive occlusion of the right ICA and ACM. Thrombolysis was ineffective. We also found bilateral pulmonary embolisms and occlusion of the superior mesenteric artery. Since the patient had a thombocytosis we performed sequencing of the jak2-gene with detection JAK2 V617F-mutation. Treatment with hydroxyurea and oral anticoagulant was initiated. At discharge the patient had a severe left-sided hemiparesis. Case 3 – 70 years old woman with mild paresis of the right hand. CTA/ ultrasound: free-floating thrombus in the ICA. After thrombendarterectomy only small ischemic strokes in cerebral MRI. Because of marked thrombocytosis and mild polyglobulia we performed sequencing of jak2 and detected a JAK2- V617F-mutation. Treatment with Hydroxyurea and aspirine was started, but after two weeks severe right-sided hemiparesis occured. CT-angiography and ultrasound demonstrated extensive thrombus formation of the CCA. A second thrombendarterectomy was performed without benefit. Follow-up imaging showed a large stroke. Treatment with interferon alpha was started. Conclusions: We present cases with carotid thrombosis, stroke and myeloproliferative neoplasm. we report the laboratory parameters, management and outcomes.

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