好色先生

好色先生

Explore the latest content from across our publications
Join The AAN

Log In

Forgot Password?
Create New Account

Loading... please wait

Abstract Details

Hypoxic-ischemic Injury as a Rare Complication of Sudden Severe Anemia
General Neurology
P2 - Poster Session 2 (11:45 AM-12:45 PM)
2-004

We describe the case of a 46-year-old patient who presented with severe acute anemia and MRI findings consistent with hypoxic-ischemic injury in the absence of cardiopulmonary arrest. 

Hypoxic-ischemic injury is a known consequence of various states of cerebral metabolic failure, such as cardiac arrest, acute respiratory insufficiency, and severe hypoglycemia. It is possible that other mechanisms, such as severe anemia, may also contribute to a state of sudden and profoundly impaired cerebral metabolism. 

N/A
A 46-year-old male with end-stage renal disease on hemodialysis presented from home following a witnessed, brief, convulsive seizure. He was found to be hemorrhaging from a dialysis catheter, and laboratory testing was notable for a hemoglobin of 4.3g/dL (baseline 9.5 g/dL 4 weeks prior). Vital signs were notable for a pulse of 66, blood pressure of 102/77, and sinus rhythm on electrocardiogram. The patient was treated with levetiracetam, phenytoin, and packed red blood cell transfusion. Unenhanced computed tomography with angiography of the neck was unrevealing for parenchymal pathology or hemodynamically significant stenosis, however MRI brain was notable for extensive areas of restricted diffusion in the bilateral cerebral hemispheres, caudate nuclei, and the splenium of the corpus callosum with some corresponding edema on FLAIR sequences, suggesting anoxic brain injury. Electroencephalography was notable for left-sided epileptiform discharges. Lumbar puncture showed a protein of 119 mg/dL, 7 white blood cells, 5 red blood cells, and negative testing for HSV 1/2 by PCR, cryptococcal antigen, VDRL, as well as bacterial and fungal cultures. The absence of an acute cardiopulmonary event, or underlying central nervous system infection suggests that the brain MRI findings are most consistent with a hypoxic-ischemic injury secondary to reduced oxygen transport capacity. 
Sudden, severe anemia is a rare cause of hypoxic-ischemic injury. Patients with neurological deficits after hemorrhage may benefit from dedicated neuroimaging to assess for this.
Authors/Disclosures
Alexandre Mason Sharma, MD
PRESENTER 		Dr. Mason Sharma has nothing to disclose.
Nikhil B. Bhana Mr. Bhana has nothing to disclose.
James E. Siegler III, MD (University of Chicago) Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Siegler has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Bayer. Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Serb. Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Wallaby Phenox. Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke: Vascular and Interventional Neurology. Dr. Siegler has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for Precision Medicine, LLC. The institution of Dr. Siegler has received research support from Philips. The institution of Dr. Siegler has received research support from Medtronic.