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Neurologic Manifestations of Essential Thrombocythemia

JOSEPH JABAILY, Ph.D., M.D.; HARRY J. ILAND, M.B., B.S.; JOHN LASZLO, M.D.; E. WAYNE MASSEY, M.D.; GUY B. FAGUET, M.D.; JEAN BRIÈRE, M.D.; STEPHEN A. LANDAW, M.D.; and ANTHONY V. PISCIOTTA, M.D.
[+] Article and Author Information

*Indicates patient contribution to this study.

Grant support: in part by Public Health Services grants CA-10728 and CA-11265 from the National Cancer Institute, Department of Health and Human Services. Dr. Iland is the recipient of a New South Wales State Cancer Council Clinical Fellowship and Travel Grant-in-Aid.

▸Requests for reprints should be addressed to John Laszlo, M.D.; Box 3835, Duke University Medical Center; Durham, NC 27710.


Durham, North Carolina; Augusta, Georgia; Brest, France; Syracuse, New York; and Milwaukee, Wisconsin


© 1983 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1983;99(4):513-518. doi:10.7326/0003-4819-99-4-513
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Essential thrombocythemia is a clonal myeloproliferative disorder, characterized predominantly by a markedly elevated platelet count without known cause. We report a case that was recognized during investigation of a transient ischemic attack, and review the neurologic findings in 33 patients with unequivocal essential thrombocythemia under prospective study by the Polycythemia Vera Study Group. Twenty-one patients had neurologic manifestations at some point during their course, including headache (13 patients), paresthesiae (10), posterior cerebral circulatory ischemia (9), anterior cerebral circulatory ischemia (6), visual disturbances (6) and epileptic seizures (2). All patients with neurologic symptoms responded satisfactorily to treatment, although continuous or repeated treatment was often required. Therapeutic recommendations include plateletpheresis for major thrombo-hemorrhagic phenomena, or megakaryocyte suppression with radioactive phosphorus, alkylating agents (such as melphalan), or hydroxyurea; minor symptoms may respond to platelet antiaggregating agents.

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