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Bilateral visual loss and cerebral infarction after spleen embolization in a trauma patient with idiopathic thrombocytopenic purpura: A case report.

Abstract Splenic artery embolization (SAE) is a common procedure in trauma patients with blunt splenic injuries. We report a case of acute ischemic stroke following orthopedic surgery in a patient with post-SAE reactive thrombocytosis.
PMID
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Authors

Mayor MeshTerms

Blindness, Cortical

Brain Ischemia

Embolization, Therapeutic

Spleen

Stroke

Keywords
Journal Title medicine
Publication Year Start




PMID- 29668582
OWN - NLM
STAT- MEDLINE
DCOM- 20180425
LR  - 20180503
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 16
DP  - 2018 Apr
TI  - Bilateral visual loss and cerebral infarction after spleen embolization in a
      trauma patient with idiopathic thrombocytopenic purpura: A case report.
PG  - e0332
LID - 10.1097/MD.0000000000010332 [doi]
AB  - RATIONALE: Splenic artery embolization (SAE) is a common procedure in trauma
      patients with blunt splenic injuries. We report a case of acute ischemic stroke
      following orthopedic surgery in a patient with post-SAE reactive thrombocytosis. 
      PATIENT CONCERNS: A 37-year-old woman with idiopathic thrombocytopenic purpura
      (ITP) suffered from multiple trauma scheduled for open reduction and internal
      fixation for right tibial and left radius fracture five days after SAE. The
      patient did not have any thromboembolic complications, although the platelet
      counts increased from 43 x 10/L to 568 x 10/L within two days after SAE. Surgery 
      was completed under general anesthesia with tracheal intubation without
      complications. The patient complained of visual loss followed by limb weakness on
      the fourth and eighth hour postoperatively. DIAGNOSES: Magnetic resonance imaging
      (MRI) of head demonstrated ischemic change over bilateral basal ganglia, and
      occipital areas, suggesting the diagnosis of cortical blindness. INTERVENTIONS:
      To suppress platelet count and avoid platelet hyper-aggregation, anti-platelet
      drug (i.e., oral aspirin 100 mg daily), hydration, and hydroxyurea (i.e., 20
      mg/kg daily) were used for the treatment of reactive thrombocytosis. OUTCOMES:
      Although right-sided hemiparesis persisted, the patient reported mild visual
      recovery. She was discharged four months after SAE with active rehabilitation.
      LESSONS: Our report highlights an increased risk of acute arterial thromboembolic
      events in patients with reactive thrombocytosis, especially those undergoing
      surgery.
FAU - Wang, Wei-Ting
AU  - Wang WT
AD  - Department of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung.
FAU - Li, Yu-Yu
AU  - Li YY
AD  - Department of Anesthesiology, Chi Mei Medical Center, Tainan.
FAU - Lin, Wan-Ching
AU  - Lin WC
AD  - Department of Neuroradiology, E-Da Hospital, I-Shou University, Kaohsiung.
FAU - Chen, Jen-Yin
AU  - Chen JY
AD  - Department of Anesthesiology, Chi Mei Medical Center, Tainan.
AD  - Department of the Senior Citizen Service Management, Chia Nan University of
      Pharmacy and Science, Tainan.
FAU - Lan, Kuo-Mao
AU  - Lan KM
AD  - Department of Anesthesiology, Chi Mei Medical Center, Tainan.
FAU - Sun, Cheuk-Kwan
AU  - Sun CK
AD  - Department of Emergency Medicine, E-Da Hospital, School of Medicine for
      International Students, I-Shou University, Kaohsiung, Taiwan R.O.C.
FAU - Hung, Kuo-Chuan
AU  - Hung KC
AD  - Department of Anesthesiology, Chi Mei Medical Center, Tainan.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - R16CO5Y76E (Aspirin)
SB  - AIM
SB  - IM
MH  - Adult
MH  - Aspirin/*administration & dosage
MH  - *Blindness, Cortical/diagnosis/drug therapy/etiology
MH  - *Brain Ischemia/etiology/physiopathology
MH  - *Embolization, Therapeutic/adverse effects/methods
MH  - Female
MH  - Humans
MH  - Magnetic Resonance Imaging/methods
MH  - Multiple Trauma/complications/surgery
MH  - Orthopedic Procedures/adverse effects
MH  - Platelet Aggregation Inhibitors/administration & dosage
MH  - Platelet Count/methods
MH  - Purpura, Thrombocytopenic, Idiopathic/*complications
MH  - *Spleen/blood supply/injuries
MH  - Splenic Artery/diagnostic imaging/pathology
MH  - *Stroke/etiology/physiopathology
MH  - Thrombocytosis/diagnosis/*drug therapy/etiology
MH  - Treatment Outcome
MH  - Wounds, Nonpenetrating/*therapy
PMC - PMC5916660
EDAT- 2018/04/19 06:00
MHDA- 2018/04/26 06:00
CRDT- 2018/04/19 06:00
PHST- 2018/04/19 06:00 [entrez]
PHST- 2018/04/19 06:00 [pubmed]
PHST- 2018/04/26 06:00 [medline]
AID - 10.1097/MD.0000000000010332 [doi]
AID - 00005792-201804200-00008 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 Apr;97(16):e0332. doi: 10.1097/MD.0000000000010332.