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The First Sign of an Impending Disaster? Headache in a Patient with Severe Hypertriglyceridemia - the Need for Preventive Plasmapheresis

Hypertriglyceridemian has been shown with accumulating evidence to contribute to ischemic stroke through many pathologic processes such as endothelial dysfunction, atherosclerosis and production of prothrombotic state, in addition to hypergoagulability and slugging [1]. Recent evidence suggests that hypertriglyceridemia may correlate with increased risk of cardiovascular disease, especially when associated with decreased HDL- C, increased LDL- C levels, or both [2]. However the debate remains whether Hypertriglyceridemia is an independent risk factor for ischemic stroke. Case Report: We present a case of 44 year old male patient with history of hypertriglyceridemia, who presented with severe headache, worsening over the last few days before admission. His triglycerides level was 10308 on admission. The headache was alarming and was considered as a sign of hyper viscosity with subsequent vaso- occlusive disease. He was started on IV insulin drip initially with minimal change in his triglycerides level over a 3- day period. With persistence of headache, the patient was started on plasmapheresis with dramatic resolution of the headache as the triglyceride levels dropped markedly. Conclusion: The use of plasmapheresis should be considered in patients with severe persistent hypertriglyceridemia, especially in patients who have persistent alarming headaches or signs if impending cerebral vaso- occlusive disease. Plasmapheresis should be considered primarily for stroke prevention in this population.