{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T20:05:06Z","timestamp":1783627506078,"version":"3.55.0"},"reference-count":21,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T00:00:00Z","timestamp":1775174400000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Chronic hypoxemia in uncorrected TOF causes compensatory erythrocytosis and hyperviscosity, predisposing to cerebrovascular complications. Stroke in this context is rare but clinically significant, especially in resource\u2010limited settings where access to imaging and surgical correction is restricted. We report a 17\u2010year\u2010old male with unrepaired TOF and secondary polycythaemia who presented with recurrent headaches and dizziness following repeated phlebotomy. He subsequently developed acute right\u2010sided weakness and aphasia. Brain MRI revealed an acute ischemic infarction in the left basal ganglia and insular region. Echocardiography confirmed TOF anatomy without thrombus or new shunt changes. The patient was treated with supportive measures, antiplatelet therapy, and hydration; further phlebotomy was withheld. Neurologic improvement occurred with rehabilitation, though residual weakness persisted at discharge. This case highlights ischemic stroke as a rare but serious manifestation of hyperviscosity in cyanotic congenital heart disease. In resource\u2010limited settings, pragmatic diagnostic strategies and cautious hematologic management are vital. Early recognition of neurologic symptoms, avoidance of excessive phlebotomy, and timely referral for definitive TOF repair are essential to prevent recurrence and improve outcomes.<\/jats:p>","DOI":"10.1002\/ccr3.72415","type":"journal-article","created":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T01:58:46Z","timestamp":1775267926000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Hyperviscosity\u2010Related Ischemic Stroke in an Adolescent With Unrepaired Tetralogy of Fallot: A Case Report From a Resource\u2010Limited Setting"],"prefix":"10.1002","volume":"14","author":[{"given":"Ayenew A.","family":"Wolie","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine and Critical Care School of Medicine, College of Health Sciences, Addis Ababa University  Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0061-6458","authenticated-orcid":false,"given":"Chernet T.","family":"Mengistie","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Health Sciences, Addis Ababa University  Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4647-111X","authenticated-orcid":false,"given":"Biruk T.","family":"Mengistie","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Health Sciences, Addis Ababa University  Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elleni D.","family":"Mulatu","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and Critical Care School of Medicine, College of Health Sciences, Addis Ababa University  Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahel N.","family":"Teferi","sequence":"additional","affiliation":[{"name":"Department of Neurology, School of Medicine College of Health Sciences, Addis Ababa University  Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birhanu T.","family":"Andeta","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and Critical Care School of Medicine, College of Health Sciences, Addis Ababa University  Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gedefaw T.","family":"Minwagaw","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and Critical Care School of Medicine, College of Health Sciences, Addis Ababa University  Addis Ababa 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