Acharya, AyushmaYogi, PrajwalaSingh, PramodBhattarai, Tulsi Ram2026-03-162026-03-162021https://hdl.handle.net/20.500.14572/5144Ayushma Acharya Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal https://orcid.org/0000-0002-4955-2397 Prajwala Yogi Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal Pramod Singh Faisalabad Medical University, Punjab, Pakistan https://orcid.org/0000-0001-6350-6293 Tulsi Ram Bhattarai Department of Internal Medicine, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, NepalAbstract: Paroxysmal nocturnal hemoglobinuria can rarely present as cerebral ischemia and stroke due to arterial thrombosis. However, it should be considered in a young patient with bone marrow failure features, systemic thromboses, and hemolysis. The variants of paroxysmal nocturnal hemoglobinuria pose a diagnostic challenge and hence are important to recognize. We report a case of a 28-years-old female with Herlyn Werner Wunderlich Syndrome who presented with an ischemic cerebrovascular accident, pancytopenia, hemoglobinuria, and widespread abdominal thromboses suggestive of paroxysmal nocturnal hemoglobinuria. The patient was managed symptomatically and referred to a hematologist.en-UScerebral ischemiaaroxysmal nocturnal hemoglobinuriastrokeArticle