Highlights
- •Severe anemia, a novel etiology of asterixis with frequent falls, was reported.
- •Asterixis with metabolic causes are typically asymptomatic but occasionally mimics transient ischemic attack.
- •Anemia-related asterixis could coexist with misleading anemia-related brain ischemic lesions.
- •There is a pitfall: adverse stroke treatment for anemia-related asterixis.
Abstract
As most cases of asterixis with metabolic causes are asymptomatic, they have not been
considered in the differential diagnosis of stroke. However, an asterixis occasionally
resembles a transient ischemic attack (TIA). On the other hand, reports have indicated
that anemia is an independent risk factor for brain ischemia. Therefore, both asterixis
and anemia are important considerations for stroke diagnosis. A 79-year-old man with
frequent leg palsy was initially diagnosed with recurrent TIA at the anterior cerebral
artery (ACA) with a tiny callosal infarction and aspirin was prescribed immediately.
However, subsequent careful physical examination revealed asterixis at both the wrist
and knee joints. Laboratory testing and colonoscopy revealed severe anemia secondary
to colon cancer. Blood transfusion immediately improved the asterixis and gait, thus
confirming that anemia contributed to the patient's symptoms. This novel etiology
of asterixis may be accompanied by misleading anemia-induced brain ischemic lesions
detectable on magnetic resonance imaging (MRI). Anemia-induced asterixis should be
considered as a novel differential diagnosis of a stroke to avoid pitfalls leading
to unnecessary stroke treatment for patients with anemia.
Keywords
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References
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Article info
Publication history
Published online: January 13, 2023
Accepted:
January 10,
2023
Received in revised form:
January 9,
2023
Received:
October 26,
2022
Footnotes
Grant support: We have no grant support from any institutions or individuals.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2023.106994
Copyright
© 2023 Elsevier Inc. All rights reserved.
