Meningeal vein and subarachnoid FLAIR hyperintensities in polycythaemia vera

Correspondence to Professor Eric Thouvenot; eric.thouvenot@chu-nimes.fr Description A man in his fifties without medical history or cardiovascular risk factors presented with aquagenic pruritus since 3 months, fluctuating visual disturbance and headache since 1 week, followed by acute dysarthria and right-sided motor deficit. PV can result in acute brain infarction in more than 15%, probably related to increased blood viscosity, prothrombotic state (endothelial dysfunction and platelet activation are thought to be underlying mechanisms precipitating thrombus formation) and/or microemboli. Increased density on CT of cerebral venous sinuses (correlating with haematocrit and haemoglobin levels) in PV patients have been reported in earlier studies.2–4 The reversible vascular and subarachnoid FLAIR hyperintensities observed in our PV patient were most likely related to low flow in the meningeal veins due to increased blood viscosity, whereas perfusion deficit was attributed to venous congestion (related to reduced outflow, identical to earlier report observed in patients with cerebral venous thrombosis).5 Patient’s perspective I hope this publication will help young neurologists, radiologists and haematologists have a new perspective at my disease.