Focal neurological deficit in acute anemia: Case reports and review of the literature

Introduction: Although anemia is not regarded as an usual vascular risk factor for stroke, it is one of the potential mechanism by which the brain does not re-ceive adequate oxygenation. Moreover, the relation-ship between drop of hemoglobin and acute focal neurological deficits is not clear. We report two pa-tients with cerebral infarction due to acute anemia. Case Reports: Case 1 was a 73-year-old man who complained an episode of loss of consciousness fol-lowed by right hemiparesis and dysarthria after few hours. The day after admission he presented melena caused by a duodenal ulcer bleeding. The hemoglo- bin dropped from 11.3 g/dl to 5.6 g/dl in 24 hours. Areas of acute infarctions were evident at diffusion- weighted imaging (DWI) of the brain. Case 2 was a 77-year-old man with a transient episode of aphasia, right lower limb paresis and mental confusion twelve hours after an intervention of PTA and stenting of the left internal carotid artery. Hemoglobin was 11.8 g/dl before intervention and 9 g/dl 48 hours later. DWI showed bilateral and widespread acute infarcts. Con-clusion: Anemia has to be considered as a potential factor in determining or worsening cerebral infarc-tion, especially in patients with carotid or intracranial stenosis, high cerebrovascular lesions load or insuffi-cient collateral supply. Acute or severe anemia may negatively impact the cerebral blood flow and de-crease oxygen-carrying capacity, promote rapid dete-rioration of ischemic penumbra. Brain DWI and treatment of the underlying etiology of acute anemia are crucial in early identification and recovery of cerebral infarctions.