Spinal cord infarction during physical exertion due to polycythemia vera and aortoiliac occlusive disease: A case report.

ABSTRACT:

Rationale

Spinal cord infarction is rarely caused by hypercoagulable states. Polycythemia vera (PV) is a myeloproliferative neoplasm that can contribute to thrombotic events due to increased blood viscosity. We report a case of spinal cord infarction due to extensive aortic thrombosis caused by PV.

Patient concerns

A 56-year-old man presented with acute paraplegia and urinary retention during heavy physical exertion.

Diagnoses

Imaging studies revealed spinal cord infarction at the T9 to T12 levels and aortoiliac occlusive disease. PV was diagnosed during workup for elevated hemoglobin level INTERVENTIONS:: The patient received intravenous hydration and anticoagulation for spinal cord infarction. PV was managed with phlebotomy and hydroxyurea. Courses of inpatient and outpatient rehabilitation programs were also given.

Outcomes

The patient became urinary catheter-free 5 months after disease onset, and was able to walk with walker. The American Spinal Injury Association Impairment scale also improved from C at diagnosis to D during last follow-up.

Lessons

Etiologic workup is important for patients with spinal cord infarction to direct specific treatment strategies. Physical exertion may act as a trigger for infarction in patients at risk for thrombotic events, and monitoring of neurologic status during and after periods of exercise is warranted.

SUBMITTER: Lin WP 

PROVIDER: S-EPMC6392751 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature