{
  "abstract": "Background Paroxysmal Nocturnal Haemoglobinuria (PNH) results in a rare complication of middle cerebral artery stenosis with associated strokes. CD59 deficiency has been known to cause recurrent brain infarctions.Case A 35-year-old woman initially presented to her General Practitioner (GP) for assessment of her month-long history of intermittent headaches. A magnetic resonance (MR) brain scan found multiple acute and subacute infarctions in the right middle cerebral artery (MCA) territory. Her only background medical history was of iron deficiency anaemia. Extensive vasculitic and procoagulant testing was performed. Flow cytometry for PNH revealed a PNH clone comprising 61% of granulocytes and 61% of monocytes. Stenoses of bilateral MCAs was seen on MR angiogram consistent with moyamoya-like vasculopathy. Her initial management included apixaban and aspirin. She was referred to the haematology team and started on ravulizumab, a humanized monoclonal antibody that binds to complement 5 and prevents the formation of the terminal complement complex. After control of her PNH, she was then changed to aspirin only, as protection for her PNH-associated moyamoya-like vasculopathy. Her repeat cerebral vascular imaging showed improved calibre of the right MCA.Conclusion This is a rare case of stroke associated with PNH. The PNH had also resulted in changes to the cerebral vasculature. Treatment had shown disease response and improvement of the vasculature.",
  "authors": [
    {
      "affiliations": [
        "Princess Alexandra Hospital, Woolloongabba, QLD, Australia"
      ],
      "name": "Rahul Pradhan"
    },
    {
      "affiliations": [
        "Princess Alexandra Hospital, Woolloongabba, QLD, Australia"
      ],
      "name": "Duncan Maddox"
    },
    {
      "affiliations": [
        "Princess Alexandra Hospital, Woolloongabba, QLD, Australia"
      ],
      "name": "Anthony Mills"
    },
    {
      "affiliations": [
        "Princess Alexandra Hospital, Woolloongabba, QLD, Australia"
      ],
      "name": "Michael Devlin"
    }
  ],
  "title": "3669 Cerebral vasculopathy associated with paroxysmal nocturnal haemoglobinuria",
  "uid": "31c2a5e8-748c-5696-937b-bf9c4b7b6d10"
}