World Journal of Neuroscience, 2013, 3, 53-56 WJNS doi:10.4236/wjns.2013.32007 Published Online May 2013 (http://www.scirp.org/journal/wjns/ ) Focal neurological deficit in acute anemia: Case reports and review of the literature * Salvatore Giuffrida 1 , Giuseppe Carpinteri 2 , Daniela Modica 1 , Manuela Pennisi 3 , Alfio Catalano 1 , Rita Bella 1 , Giovanni Pennisi 1 , Carolin Cornelius 3 , Giuseppe Lanza 1# 1 Department “G. F. Ingrassia”, Section of Neurosciences, University of Catania, Catania, Italy 2 Medicina e Chirurgia d’Accettazione d’Urgenza, “Policlinico–Vittorio Emanuele” University Hospital, Catania, Italy 3 Department of Chemistry, School of Medicine, University of Catania, Catania, Italy Email: # giuseppelanza2003@yahoo.it Received 28 February 2013; revised 29 March 2013; accepted 21 April 2013 Copyright © 2013 Salvatore Giuffrida et al. This is an open access article distributed under the Creative Commons Attribution Li- cense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Introduction: Although anemia is not regarded as an usual vascular risk factor for stroke, it is one of the potential mechanism by which the brain does not re- ceive adequate oxygenation. Moreover, the relation- ship between drop of hemoglobin and acute focal neurological deficits is not clear. We report two pa- tients with cerebral infarction due to acute anemia. Case Reports: Case 1 was a 73-year-old man who complained an episode of loss of consciousness fol- lowed by right hemiparesis and dysarthria after few hours. The day after admission he presented melena caused by a duodenal ulcer bleeding. The hemoglobin dropped from 11.3 g/dl to 5.6 g/dl in 24 hours. Areas of acute infarctions were evident at diffusion- weighted imaging (DWI) of the brain. Case 2 was a 77-year-old man with a transient episode of aphasia, right lower limb paresis and mental confusion twelve hours after an intervention of PTA and stenting of the left internal carotid artery. Hemoglobin was 11.8 g/dl before intervention and 9 g/dl 48 hours later. DWI showed bilateral and widespread acute infarcts. Con- clusion: Anemia has to be considered as a potential factor in determining or worsening cerebral infarc- tion, especially in patients with carotid or intracranial stenosis, high cerebrovascular lesions load or insuffi- cient collateral supply. Acute or severe anemia may negatively impact the cerebral blood flow and de- crease oxygen-carrying capacity, promote rapid dete- rioration of ischemic penumbra. Brain DWI and treatment of the underlying etiology of acute anemia are crucial in early identification and recovery of cerebral infarctions. Keywords: Low Hemoglobin Level; Focal Neurological Sign; Brain Diffusion-Weighted Imaging; Cerebral Hemodynamic; Cerebral Infarction 1. INTRODUCTION Cerebral infarct results from acute interruption of oxy- genated blood flow due to thrombotic or embolic occlu- sion or marked deprivation of nutrients for the brain, such as oxygen or glucose. Whereas hypertension, dia- betes, smoking habit, old age and dyslipidemia are well- known vascular risk factors for stroke, the role of hemo- globin value is still up for debate [1]. In 1972, the Fram- ingham Study conducted on more than 5000 patients concluded that the pathogenetic, preventive and thera- peutic implications of the interrelationship between he- moglobin level and cerebral infarction would have re- quired further exploration [2]. The few studies investi- gating hematocrit value as a risk factor for stroke have produced conflicting findings [3-5] and they generally focused on the impact of a high haematocrit because of the well-known consequences on blood viscosity, oxy- gen-carrying capacity and possibly blood clotting char- acteristics [2,6]. Anemia as an independent risk factor for cerebrovas- cular events has mainly been described in children [7,8]. In adults, whereas the relevance of sickle cell anemia in cerebral infarction is well depicted [9], anemia in general is not considered as an usual and definite vascular risk factor for stroke because it has been thought that the physiologic regulation in cerebral hemodynamics and oxygenation would meet the brain oxygen requirement in most circumstances, even with profound anemia [10]. However, recent studies found a significant associa- tion between anemia at the time of stroke and larger in- farct territory, higher mortality over 1-year and worse * Conflict of interest: the authors do not have any conflict to disclose. # Corresponding author. Published Online May 2013 in SciRes. http://www.scirp.org/journal/wjns