A Rare Case of Stroke Secondary to Iron Deficiency Anemia in a Young Female Patient

Ischemic strokes occur when there is a sudden obstruction of an artery supplying blood flow to an area of the brain, leading to a focal neurological deficit. Strokes can be thrombotic or embolic in etiology and are associated with underlying conditions such as hypertension and atherosclerosis. Possible etiologies of strokes include cardioembolic disease, hematologic disorders, connective tissue disorders, and substance abuse or can be cryptogenic. Most stroke cases are seen in patients over 65 years of age. However, about one-fourth of strokes occur in young adults. Iron deficiency anemia (IDA) has been described as a known cause for strokes in children, but very few case reports describe this association in adults. We describe a 20-year-old female who presented with sudden onset left side weakness. Magnetic Resonance Imaging (MRI) of the brain demonstrated ischemic infarctions. Patient was also found to be severely anemic. Patient had a thorough work-up including Magnetic Resonance Angiography (MRA) of the brain, echocardiogram, and an extensive screen for thrombophilia disorders. This, however, did not demonstrate a clear etiology. As it has been suggested that IDA is a potential cause for stroke, it is possible the stroke in this young patient was attributable to severe IDA.

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The Consequence of Excessive Consumption of Cow’s Milk: Protein-Losing Enteropathy with Anasarca in the Course of Iron Deficiency Anemia—Case Reports and a Literature Review

Nutrients ◽

10.3390/nu13030828 ◽

2021 ◽

Vol 13 (3) ◽

pp. 828

Author(s):

Karolina Graczykowska ◽

Joanna Kaczmarek ◽

Dominika Wilczyńska ◽

Ewa Łoś-Rycharska ◽

Aneta Krogulska

Keyword(s):

Iron Deficiency ◽

Literature Review ◽

Iron Deficiency Anemia ◽

Case Reports ◽

Deficiency Anemia ◽

Cow’S Milk ◽

Milk Consumption ◽

Protein Losing Enteropathy ◽

Cow's Milk ◽

Excessive Consumption

Cow’s milk is a key component of a child’s diet. While the consumption of even trace amounts can result in allergy to its proteins and/or hypolactasia, excessive cow’s milk consumption can result in numerous health complications, including iron deficiency, due to the diet being improperly balanced. Although the incidence of iron deficiency has declined, it remains the most widespread nutritional deficiency globally and the most common cause of anemia. One rare consequence of anemia caused by iron deficiency is protein-losing enteropathy; however, the mechanisms of its development are unclear. The following manuscript, based on a literature review, presents two rare cases of children, a 16-month-old boy and a 2.5-year-old girl, who developed severe microcytic anemia, enteropathy with hypoalbuminemia, and anasarca as a result of excessive cow’s milk consumption. It highlights the possible relationship between excessive consumption of cow’s milk in children and severe iron deficiency anemia with accompanying hypoalbuminemia; it may also result in serious clinical conditions, even in children that do not demonstrate food hypersensitivity.

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Oral manifestations in iron deficiency anemia: case reports

STOMATOLOGY EDU JOURNAL ◽

10.25241/stomaeduj.2017.4(2).art.4 ◽

2017 ◽

Vol 4 (2) ◽

pp. 114-125

Author(s):

Mihaela Florina Loredana Cojanu ◽

◽

Dana Nicoleta Antonescu ◽

Iulia Constantinescu ◽

Anca Săsăreanu ◽

...

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Case Reports ◽

Deficiency Anemia ◽

Oral Manifestations

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Magnetic resonance enterography in refractory iron deficiency anemia: A pictorial overview

World Journal of Gastroenterology ◽

10.3748/wjg.v20.i38.14004 ◽

2014 ◽

Vol 20 (38) ◽

pp. 14004 ◽

Cited By ~ 4

Author(s):

Ismet Cengic

Keyword(s):

Magnetic Resonance ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Magnetic Resonance Enterography ◽

Deficiency Anemia

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Studying iron deficiency anemia during pregnancy in the mother and the fetus via magnetic resonance imaging.

Placenta ◽

10.1016/j.placenta.2021.07.066 ◽

2021 ◽

Vol 112 ◽

pp. e20

Author(s):

Lital Ben Moyal ◽

Talia Harris ◽

Hagit Dafni ◽

Michal Neeman

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Deficiency Anemia ◽

Resonance Imaging ◽

Anemia During Pregnancy

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Acute Ischemic Stroke Secondary to Iron Deficiency Anemia: A Case Report

Case Reports in Neurological Medicine ◽

10.1155/2012/487080 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 6

Author(s):

Preema J. Mehta ◽

Sherita Chapman ◽

Annapurni Jayam-Trouth ◽

Mohankumar Kurukumbi

Keyword(s):

Ischemic Stroke ◽

Iron Deficiency ◽

Acute Ischemic Stroke ◽

Iron Deficiency Anemia ◽

Thrombus Formation ◽

Deficiency Anemia ◽

Low Oxygen ◽

Hypoxic Conditions ◽

Stroke In Young Adults ◽

The Brain

A rare case of acute ischemic stroke in a young patient with iron deficiency anemia (IDA) is reported. IDA has been suggested to have an association with stroke, but few cases have proven it thus far. Three physiological mechanisms explaining IDA to ischemic stroke include a hypercoagulable state secondary to IDA, thrombocytosis secondary to IDA, and anemic hypoxia induced by IDA. Our paper shows an example of a hypoxia-induced stroke secondary to IDA in a young woman with menorrhagia. Thrombus formation was ruled out as the Magnetic Resonance Angiogram (MRA) showed no evidence. As all other known causes for stroke were ruled out, the patient's IDA is a reasonable cause for her stroke. Iron deficiency decreases the amount of hemoglobin, which consequently decreases the amount of oxygen in the blood resulting in low-oxygen delivery to the brain. This causes hypoxic conditions in the brain, leading to death of brain tissue. Thus, we suggest a possible relationship between IDA and ischemic stroke in young adults. Considering IDA as one of the risk factors for ischemic stroke and treating with timely transfusions would be an important step one can take to prevent stroke.

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Iron deficiency anemia presenting as pancytopenia in an adolescent girl

International Journal of Adolescent Medicine and Health ◽

10.1515/ijamh.2011.012 ◽

2011 ◽

Vol 23 (1) ◽

Cited By ~ 4

Author(s):

Rajat Jhamb ◽

Ashok Kumar

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Adolescent Girl ◽

Leukocyte Count ◽

Young Female ◽

Normal Serum ◽

Deficiency Anemia ◽

Common Disease ◽

Iron Replacement ◽

Normal Leukocyte

AbstractIron deficiency anemia is commonly associated with thrombocytosis and normal leukocyte count. Thrombocytopenia has occasionally been reported in iron deficiency anemia, but pancytopenia is very rare. We present a case of a young female who presented with iron deficiency anemia associated with pancytopenia that improved with iron replenishment after initial deterioration, the mechanism of which is also discussed in this case report. This case illustrates two uncommon associations of a very common disease: severe iron deficiency can be associated with pancytopenia and can be initially worsened by iron replacement despite normal serum B12and folic acid levels.

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The Prevalence of Reactive Thrombocytosis and Thromboembolic Events in Arab Population with Iron Deficiency Anemia (a retrospective study)

Blood ◽

10.1182/blood-2020-135923 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 16-17

Author(s):

Rita Wafik Ahmad ◽

Ashraf Tawfiq Soliman ◽

Vincenzo Desanctis ◽

Lina A Okar ◽

Mustafa A Al-Tikrity ◽

...

Keyword(s):

Platelet Count ◽

Iron Deficiency ◽

Carotid Artery ◽

Iron Deficiency Anemia ◽

Case Reports ◽

Deficiency Anemia ◽

Thromboembolic Events ◽

Arab Population ◽

Reactive Thrombocytosis ◽

Thrombocyte Count

INTRODUCTION Iron deficiency is the most prevalent nutritional deficiency worldwide. Iron deficiency anemia (IDA) is the most common type of anemia, its prevalence is 1 out of 5 of the population. IDA is a well-known cause of reactive thrombocytosis which is mostly asymptomatic. Only few observational studies and case reports have described thromboembolic events in the context of this reactive thrombocytosis in the absence of other hypercoagulable states OBJECTIVES To assess the frequency of thromboembolic events in Arab patients with reactive thrombocytosis secondary to iron deficiency anemia (IDA). METHODS We retrospectively reviewed thromboembolic events in iron-deficient patients with reactive thrombocytosis. Our study sample included female patients who received iron replacement for IDA between April 2018 and March 2020 at Hamad Medical Corporation, Doha, Qatar. We excluded pregnant, non-Arab patients and patients under 18 or over 65 years of age. Reactive thrombocytosis was defined as thrombocyte count of more than or equal to 450 x 109 /L in the presence of iron deficiency anemia and ferritin level less than 30µg/l. RESULTS Out of 1567 patients (mean age =50 +/- 8.66 years) with the diagnosis of IDA, 292 (18.63%) had thrombocytosis. They had a mean platelet count = 534 +/- 121 x 109 /L). None of them had any symptom or sign of thromboembolic events. Discussion Thrombocytosis can be categorized into primary causes such as primary bone marrow disorders and myeloproliferative neoplasms, and secondary causes including infection, inflammation or drug-induced. Iron deficiency anemia leads to reactive thrombocytosis in a mechanism that is yet to be fully understood. The clinical impact of increased platelet counts is not well recognized in literature, and it has not been studied in the Arab population. Although reactive thrombocytosis has been generally considered benign, few case reports described thromboembolic events in patients with IDA reactive thrombocytosis. Few cases in the literature described thromboembolic events in reactive thrombocytosis with IDA. H. Z. Batur Caglayan et al published a case report of a 41-year-old Turkish female patient who presented with transient ischemic attack (TIA) due to intraluminal carotid artery thrombus, which was attributed to IDA-associated thrombocytosis. Another case series by P T Akins et al described three women with severe IDA and thrombocytosis secondary to menorrhagia who developed carotid artery thrombi. The mechanism by which low iron can affect thrombocyte count is still unknown. One study in mice and humans demonstrated that iron deficiency caused reduced megakaryocyte proliferation but increased ploidy independent of thrombopoietin. However, another study failed to identify the exact mechanism by which iron deficiency leads to increased platelet count. CONCLUSION Our study did not find any thromboembolic incident in a large number of patients with reactive thrombocytosis secondary to IDA diagnosed over two years in our Arab population. Disclosures No relevant conflicts of interest to declare.

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The Use of Magnetic Resonance Imaging with High-Resolution CT in the Evaluation of Facial Paralysis

Otolaryngology ◽

10.1177/019459988910100408 ◽

1989 ◽

Vol 101 (4) ◽

pp. 449-458 ◽

Cited By ~ 16

Author(s):

Mitchell K. Schwaber ◽

David Zealear ◽

James L. Netterville ◽

Michael Seshul ◽

Robert H. Ossoff

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

High Resolution ◽

Facial Nerve ◽

Facial Paralysis ◽

Case Reports ◽

Resonance Imaging ◽

High Resolution Computed Tomography ◽

Magnetic Resonance Imaging Mri ◽

The Brain

Magnetic resonance imaging (MRI) has been widely used in the evaluation of suspected acoustic neuroma, but has not received the same attention with respect to facial paralysis. High-resolution computed tomography (HRCT) has been the radiologic test of choice to evaluate the facial nerve. The necessary HRCT projections, slices, and enhancement techniques to visualize each segment have been outlined. We have developed a radiologic protocol that uses MRI in conjunction with HRCT, applying the strengths of each to evaluate the facial nerve. We have evaluated 15 patients and have found that MRI is the better study to evaluate the brain stem/cerebellopontine angle segment of the facial nerve and better evaluates bone-soft tissue Interfaces. HRCT is better in the evaluation of the intratemporal segment of the facial nerve and the assessment of the anatomic perspectives of a lesion within the temporal bone. The results are discussed and case reports Illustrate the efficacy of this approach.

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