Ischemic Stroke in a Patient with Essential Thrombocythemia (ET) at St. Francis Regional Referral Hospital, Ifakara, Tanzania: A Case Report

Abstract

Introduction: Essential Thrombocythemia (ET) is a slow-progressing myeloproliferative neoplasm characterized by persistent thrombocytosis and an increased risk of thrombotic and hemorrhagic events, including ischemic stroke, myocardial infarction, and venous thromboembolism. Thrombotic complications remain the leading cause of morbidity, particularly in elderly patients. Case Presentation: An 85-year-old male presented with sudden left-sided weakness, facial deviation, lower extremity numbness, and severe headache of one-day duration. He had a three-year history of ET, confirmed by bone marrow biopsy and JAK2 V617F mutation, and was on hydroxyurea 500 mg and low-dose aspirin. His medical history included well-controlled hypertension. On examination, he was conscious (GCS 11/15) with stable vitals, left-sided weakness (0/5), mouth deviation, and splenomegaly (18 cm below the costal margin). A non-contrast CT scan revealed a right parietal lobe ischemic infarct and senile atrophy. Laboratory tests showed platelets 988x10^3 per microliter, normal white blood cell count, and hemoglobin 10 g/dL Hydroxyurea and aspirin doses were adjusted, physiotherapy initiated, and the patient stabilized for discharge with follow-up plans. Conclusion: Despite cytoreductive and antiplatelet therapy, patients with ET remain at risk of thrombotic events. This case highlights the need for individualized management, close follow-up, and multidisciplinary care in elderly patients with ET to mitigate morbidity, and mortality from ischemic stroke.