Essential thrombocytosis 40 years after splenectomy

Description

A 69-year-old man presented at our Department of Neurology in December 2016 with acute aphasia. His medical history was notable of splenectomy after a spleen rupture due to a car accident at the age of 25, a subarachnoidal haemorrhage (SAH) without evidence of cerebral aneurysm at the age of 35 and a non-ST elevation myocardial infarction at the age of 63. For this vascular event, a drug-eluting stent was placed into the ramus interventricularis anterior, followed by combined antiplatelet treatment for 2 years, and up to admission acetylsalicylic acid was given at a dose of 100 mg per day.

Now MRI revealed a left hemispheric ischaemic stroke (figure 1A). No major vascular risk factors were found. The only pathological finding was a thrombocytosis of 1700x10³ per µL, reference value 150–450x10³ per µL. A post-splenectomy syndrome was suspected. However, previous thrombocyte levels as documented during the SAH...

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