2021 Volume 43 Issue 5 Pages 447-451
An 83-year-old man was admitted to our hospital with acute aphasia, left-sided conjugate eye deviation, and right hemiplegia. Brain computed tomography and diffusion-weighted magnetic resonance imaging were unremarkable; however, magnetic resonance angiography revealed proximal occlusion of the left middle cerebral artery (MCA). Blood test results showed severe macrocytic anemia with serum hemoglobin 3.8 g/dl and mean corpuscular volume 144 fl. The patient was not administered intravenous recombinant tissue plasminogen activator because active gastrointestinal bleeding could not be immediately ruled out. He underwent mechanical thrombectomy together with blood transfusion, leading to complete recanalization of the left MCA. Upper gastrointestinal endoscopy revealed chronic atrophic gastritis. Blood test results showed a low serum vitamin B12 level; therefore, the patient was diagnosed with severe macrocytic anemia secondary to pernicious anemia. He received anticoagulation and mecobalamin replacement therapy and was discharged on the 13th day without any sequelae. Clinicians should carefully evaluate underlying diseases, including anemia, before determining the indications for endovascular treatment in patients with acute ischemic stroke.
