Orthostatic syncope in a young woman with essential thrombocythemia found to be an initial sign of ischemic stroke – therapeutic concerns. Unusual case

Purpose
Essential thrombocythemia (ET) is characterised by an overproduction of platelets in the absence of the states that induce secondary thrombopoiesis. The most common and significant complication of ET is arterial and venous thrombosis. The most serious complication of ET is stroke.

Case description
We present a patient with a stroke that started with an unusual symptom – syncope, successfully treated with recombinant tissue plasminogen activator alteplase. Three years after the stroke, the patient lives an independent life but with cerebellar-stem symptoms. Further long-term treatment is supervised by a haematologist.

Comment
Syncope in ET may be the first sign of stroke. To assess brainstem and cerebellar stroke, magnetic resonance imaging should be performed. In ET, thrombolytic treatment of ischemic stroke may be a life-saving treatment. Long-term treatment involving a platelet-lowering medication, along with anti-aggregation drugs, is necessary to treat stroke patients with ET. Females with ET who have suffered from a stroke should not use oral contraception.