[Cerebral infarction due to polycythaemia as the initial manifestation of renal cell carcinoma]. / Herseninfarct door polycytemie als eerste uiting van een niercelcarcinoom.

ABSTRACT

A 65-year-old man with known diabetes mellitus and hypertension (cardiovascular risk factors) presented to the Emergency Clinic with a transient language disorder and motor- and cognitive-function disorders that had been present for the past half a year. Brain imaging revealed multiple white-matter lesions and a recent infarction. Routine blood tests revealed polycythaemia. Further tests revealed an elevated erythropoietin level and bilateral renal tumours. The cognitive functions improved after repeated phlebotomies and surgical resection of the renal-cell carcinomas. Before surgery, transcranial ultrasound had shown very low cerebral flow velocities, which became normal after correction of the haematocrit. This case emphasises the importance of routine blood tests in patients with suspected cerebral infarction. To our knowledge, this is the first case of cerebral infarction as the first manifestation ofa renal-cell carcinoma.