PMC9052815_01
Radiological findings in case 1. Diffusion weighted imaging (DWI) showed
acute cerebral infarction nearby posterior horn of left lateral
ventricle as a result of the first episode of stroke (a). A hematoma
located in the right frontal lobe induced by the second episode of
stroke (b). Multiple scattered acute cerebral infarction lesions include
left basilar ganglion region, left posterior horn of lateral
ventricles,cingulate gyrus, left cerebral lobes and right centrum
semiovale in the third episode of stroke (b, c, d, e). Large acute
cerebral infarction lesion showed in the right occipitotemporal lobe in
the fourth episode of stroke (f). T2-weighted imaging of brain magnetic
resonance imaging(MRI) revealed massive white matter lesions in centrum
semiovale (g). Magnetic resonance angiography(MRA) indicated
intracranial cerebral atherosclerosis(h).
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PMC9052815_01_10.1177_17562864221092093-fig1.jpg
fig1-17562864221092093
Brain magnetic resonance imaging (MRI) showed acute infarction lesion nearby posterior horn of left lateral ventricle (Figure 1(a)). On March 9, 2020, he suddenly developed limb weakness without loss of consciousness and head computed tomography (CT) scan showed a hematoma in the right frontal lobe (Figure 1(b)). Head diffusion weighted imaging(DWI) revealed multiple scattered acute infarcts involved in left basilar ganglion region, left posterior horn of lateral ventrical, cingulate gyrus, left cerebral lobes and right centrum semiovale (Figure 1(b)-(e)). Unfortunately he developed left hemiplegia and lethargy on April 12 of 2020 and head MRI showed a large acute infarct in the right parietal lobe(Figure 1(f)). Magnetic resonance angiography (MRA) found intracranial cerebral atherosclerosis and stenosis in left anterior cerebral artery (ACA) (Figure 1(h)).
PMC9052815_02
Radiological and bone marrow biopsy findings in case 2. Brain computed
tomography (CT) after episode of myocardial infarction showed a massive
infarction lesion located in right temporoparieto-occipital lobe (a).
Subsequent diffusion weighted imaging (DWI) revealed acute multiple
acute infarcts scattered in frontoparietal lobe, bilateral occipital
lobes and right paraventricular (b, c, d). Magnetic resonance
angiography (MRA) indicated intracranial arteries are not remarkable.
Bone marrow biopsy showed obvious proliferation of the megakaryocytes
with enlarged, hyperlobulated and clustered ones on HE staining and
Wright's staining (f, g, h).
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We reviewed the medical record of local hospital and found that platelet counts > 759x109 /L during hospitalization; hypersensitive cardiac troponin T(cTnT), 641 ng/ml; electrocardiogram(EEG) indicated myocardial infarction and brain CT scanned after CPR showed cerebral infarction in temporo-parietal lobe (Figure 2(a)). Unfortunately, during hospitalization in our department cerebral infarction worsened again and brain diffusion weighted imaging (DWI) showed acute infarcts located in right frontal and parietal lobes, bilateral occipital lobes and bilateral periventricular (Figure 2(b)-(d)). The MRA and MRV were not remarkable (Figure 2(e)). Wright's staining (Figure 2(f)-(h)). Whole exome sequencing (WES) indicated CALR1 mutation.