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J Neurol (2010) 257:20442051 DOI 10.1007/s00415-010-5657-6
ORIGINAL COMMUNICATION
Cerebral infarction in acute anemia
Chung-Fen Tsai Ping-Keung Yip
Chao-Ching Chen Shin-Joe Yeh Shih-Tze Chung
Jiann-Shing Jeng
Received: 1 March 2010 / Revised: 24 June 2010 / Accepted: 1 July 2010 / Published online: 16 July 2010 Springer-Verlag 2010
Abstract There are few previous studies on the relationship between cerebral infarction and acute anemia. This study presents patients with cerebral infarction in acute anemia due to marked blood loss and aims to clarify the stroke nature and possible mechanism. Patients with acute cerebral infarction and anemia following marked blood loss without systemic hypotension were recruited from 2001 to 2009. Clinical characteristics, particularly hemoglobin level, and neuroimaging ndings were reviewed in detail to analyze the stroke nature and verify the possible pathogenesis. Twelve patients (males 8; mean age 74.9 years) were included. Eleven patients had cerebral infarction after acute massive gastrointestinal bleeding, and one had cerebral infarction following postoperative extensive hematoma during hospitalization. In all patients, borderzone infarction was the most characteristic nding: six had unilateral and six had bilateral borderzone infarction. Mean hemoglobin at infarction after acute blood loss was 5.8 g/dl, with 46% reduction from baseline. Of nine patients receiving detailed extracranial and intracranial vascular studies, none had
severe carotid stenosis and six had intracranial stenosis. The arterial borderzones are the most vulnerable regions to a fall in cerebral perfusion. Acute anemia may produce cerebral blood ow insufciency, reduce oxygen-carrying capacity, and result in distal-eld tissue ischemic injury when hemoglobin level decreases below a critical level, especially in patients with intracranial stenosis.
Keywords Infarction Stroke Bleeding Anemia
Introduction
Cerebral infarction is considered to result from acute interruption of oxygenated blood ow. It can occur due to blockage of blood ow caused by either thrombotic or embolic occlusion, or marked focal deprivation of nutrients such as oxygen or glucose for the central nervous system. Despite numerous studies that have reported conventional risk factors [1, 2], anemia is not considered a usual vascular risk factor for cerebral infarction. Previously, several researchers have noted a link between anemia and cerebral infarction, yet this relationship was not clear and the matter was not studied adequately [3, 4].
Herein, we present a series of patients with cerebral infarction who had no...