Hemorrhagic Stroke in a 24-Year-Old Male With Polycythemia Vera: A Case Report and Literature Review

Stroke is the second leading cause of death worldwide, according to the latest report by the World Health Organization (WHO). Intracerebral hemorrhage comprises 20-25% of the stroke in the young, with incidence rates of three to six in 100,000 people per year. One of the most common and important causes of hemorrhagic stroke in the general population is hypertension. Polycythemia vera (PV) can manifest with both cranial thrombosis and hemorrhage. We report a 24-year-old male, known hypertensive, who presented as a pontine hemorrhage. Further examination with imaging and laboratory tests demonstrated a diagnosis of PV. In PV, platelet dysfunction and acquired Von Willebrand syndrome are predisposing factors to bleeding. Associated blood viscosity and the proinflammatory state cause vascular remodeling, leading to hypertension. These mechanisms have collectively been described to cause hemorrhagic stroke in PV.