Document Detail


Cerebral infarction in POEMS syndrome: incidence, risk factors, and imaging characteristics.
MedLine Citation:
PMID:  19841383     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To determine the risk factors and incidence of cerebral infarction associated with POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) syndrome.
METHODS: The Mayo Clinic dysproteinemia database was queried to identify patients with coded diagnosis of POEMS syndrome. Patients with cerebral infarction, occurring after the onset of POEMS-related symptoms, were selected. A retrospective observational study design was used to evaluate potential predictors of stroke in patients with POEMS syndrome.
RESULTS: A total of 9 patients (10%; 95% confidence interval 5.4-17.9) with cerebral infarction were identified (2 women, 22%). Traditional stroke risk factors were not significantly different between the stroke and nonstroke subgroups, but hematologic abnormalities such as elevated platelet count and bone marrow plasmacytosis differed between the 2 groups. Cerebral infarction occurrence after successful treatment of the underlying condition was not observed. CT and MRI data demonstrated a wide spectrum of infarct topography in these patients. Common stroke etiologies comprised suspected vascular structural abnormalities leading to vessel dissection and stenosis, in addition to embolism from a proximal source.
CONCLUSIONS: The 5-year risk of cerebral infarction in patients with POEMS syndrome is 13.4%. Evidence of plasma cell proliferation within the bone marrow and elevated serum platelet count led to increased risk of cerebral infarction in this population. We conclude that known modifiable stroke risk factors should be aggressively managed. Treatment of thrombocytosis should be considered in patients without a contraindication. Treatment of the syndrome may be the best approach to decreasing risk of cerebral infarction in these patients.
Authors:
S A Dupont; A Dispenzieri; M L Mauermann; A A Rabinstein; R D Brown
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Neurology     Volume:  73     ISSN:  1526-632X     ISO Abbreviation:  Neurology     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-10-20     Completed Date:  2009-11-10     Revised Date:  2013-05-31    
Medline Journal Info:
Nlm Unique ID:  0401060     Medline TA:  Neurology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1308-12     Citation Subset:  AIM; IM    
Affiliation:
Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA. dupont.stefan@mayo.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Bone Marrow / pathology,  physiopathology
Brain / pathology,  radiography
Cell Proliferation
Cerebral Infarction / epidemiology*,  etiology,  pathology*
Cohort Studies
Databases, Factual
Female
Humans
Incidence
Magnetic Resonance Imaging
Male
Middle Aged
POEMS Syndrome / epidemiology*,  pathology*
Plasma Cells / pathology,  physiology
Platelet Count
Retrospective Studies
Risk Factors
Stroke / epidemiology*,  etiology,  pathology*
Tomography, X-Ray Computed
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