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Rare disease
Cerebral infarction due to smoker’s polycythemia
  1. Kiran Teresa Thakur1,
  2. M Brandon Westover2
  1. 1Massachusetts General Hospital, Department of Neurology, Boston, Massachusetts, United States
  2. 2Partners (Brigham & Women’s Hospital/Massachusetts General Hospital), Department of Neurology, Boston, Massachusetts, United States
  1. Correspondence to Dr M Brandon Westover, mwestover{at}


A 65-year-old man presented with fluctuating focal neurological deficits and neuroimaging findings of multiple small cerebral infarctions. His medical investigation revealed a >100 pack/year smoking history, and a haematocrit >60. Subsequent investigations led to a diagnosis of cerebral infarction due to smoker’s polycythemia, the third such case reported in the medical literature. The patient’s neurological deficits resolved completely with subsequent haematocrit reduction. This brief report reviews the differential diagnosis of polycythemia, current knowledge of the mechanisms by which smoker’s polycythemia may lead to ischemic stroke, and recommendations for management.

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  • Competing interests None.

  • Patient consent Obtained.

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