Background: Anemia may be an important cardiovas-cular risk factor, having a straight connection with cen-tral nervous system, blood flow and tissue oxygenation. Anemia represents a hyperkinetic state, which disturbs the endothelial function and which may lead to strokes in the absence of other risk factors.

Material and methods: We present the clinical case of a 73-year-old woman, never smoker, with impor-tant hiatal hernia, complicated by severe hypochromic microcytic hyposideremic anemia, with necessary of erythrocyte mass transfusions, with pronounced fati-gue, symptoms which forced the patient to present to the emergency room. The evolution during the hospitalization worsened by confusional state and left ho-monymous hemianopsia, without motor or sensitive deficiencies. The imagistic findings (computed tomo-graphy and magnetic resonance imaging) shows mul-tiple acute strokes in the right parietal territory, being affected posterior cerebral artery and medial cerebral artery, without visualization of intraarterial thrombi or unstable atherosclerosis plaques. The carotidian athe-rosclerosis involment had been ruled out, as well as the transthoracic and transesophageal echocardiography showed no thrombi, aortic plaque ulcerations or intra-cardiac shunt. Also, there were no atrial fibrillation epi-sodes on 24 hours ecg holter monitoring nor intestinal/ gynaecological bleedings.

Results: The most probable cause of the multiple acute strokes in the 73-year-old woman is the hypochromic microcytic hyposideremic anemia, with chronic blee-ding of the severe hiatal hernia. There were no other causes like unstable carotid atherosclerosis plaques, in-tracerebral thrombi or intracardiac shunt; it couldn’t be revealed other bleeding source.

Conclusions: Iron deficiency anemia may be the ca-use of strokes by reduced cerebral oxygenation and by affecting endothelial function, leading to the brain tissue ischemia – anemic hypoxia. Occasionally, the hypercoagulable state due to thrombocytosis produce the formation of intracarotid thrombi.