Case 1: 58 year old female with 0.5 PPD smoking history presented after TIA two days prior with right ACA and MCA AIS secondary to right ICA occlusion (initial NIHSS = 7). CTA revealed mid-cervical right ICA occlusion without atherosclerotic disease in remaining intra or extracranial vessels. Hemoglobin and hematocrit on admission were 17.8/52.9%, erythropoietin 3.0, and JAK2 negative. Remaining labs were significant for HbA1c 5.4% and LDL 57. Given her fluctuating symptoms, she underwent right ICA stenting with clinical improvement upon discharge (NIHSS = 0).
Case 2: 59 year old male with 2 PPD smoking history presented with right MCA AIS (initial NIHSS = 15) with completed infarction, outside of the window for cerebrovascular intervention. MRA revealed proximal right M2 occlusion without atherosclerotic disease in remaining vessels. Hemoglobin and hematocrit on admission were 20.6/58.0%, erythropoietin 3.9, and JAK2 negative. Remaining labs were significant for HbA1C 4.8% and LDL 67. After Hematology consultation, the patient was phlebotomized during hospitalization with clinical improvement upon discharge (NIHSS = 9).
No obvious source of cardioembolism was found in either case on prolonged telemetry or echocardiography.