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

doi:10.1097/MD.0000000000010332

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Title:	Bilateral visual loss and cerebral infarction after spleen embolization in a trauma patient with idiopathic thrombocytopenic purpura A case report
Authors:	Wang, Wei-Ting Li, Yu-Yu Lin, Wan-Ching Chen, Jen-Yin Lan, Kuo-Mao Sun, Cheuk-Kwan Hung, Kuo-Chuan
Contributors:	I Shou Univ, E Da Hosp, Dept Anesthesiol Chi Mei Med Ctr, Dept Anesthesiol I Shou Univ, E Da Hosp, Dept Neuroradiol Chia Nan Univ Pharm & Sci, Dept Senior Citizen Serv Management I Shou Univ, Sch Med Int Students, E Da Hosp, Dept Emergency Med
Keywords:	reactive thrombocytosis splenic artery embolization stroke visual loss
Date:	2018-04
Issue Date:	2019-11-15 15:45:57 (UTC+8)
Publisher:	LIPPINCOTT WILLIAMS & WILKINS
Abstract:	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(9)/L to 568 x 10(9)/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 100mg daily), hydration, and hydroxyurea (i.e., 20mg/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.
???metadata.dc.relation.uri???:	http://dx.doi.org/10.1097/MD.0000000000010332
Relation:	Medicine, v.97, n.16, e0332
Appears in Collections:	[Dept. of Senior Service and Health Management] Periodical Articles

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