Stroke in malignancy: Complexities of diagnosis and management: A case report

Pakeeran Siriratnam, Thomas Kraemer, Ramesh Sahathevan

Research output: Contribution to journalArticle

Abstract

Background: Although there is an established association between cancer and stroke, the role of malignancy as a causative agent or comorbidity is not always clear. Moreover, there are no established guidelines on the acute treatment of cancer-associated stroke or optimal anticoagulation. This case report illustrates the significance of these practice gaps. Case presentation: A 62-year-old Caucasian woman presented to our institute with acute neurological deficits and was found to have an occluded left middle cerebral artery on a computed tomographic angiogram. She was administered intravenous alteplase and underwent unsuccessful endovascular clot retrieval. Besides smoking and her age, she had no cerebrovascular risk factors, and the results of baseline investigations for the cause of stroke were negative. Subsequent computed tomography of the chest, abdomen, and pelvis showed metastatic malignancy, and in the context of a significantly elevated serum cancer antigen 19-9, we suspected a pancreatic primary cancer. A transthoracic echocardiogram demonstrated mitral regurgitation but no visible vegetation. The patient died of her illness. We made a diagnosis of cancer-associated stroke, specifically a likely case of nonbacterial thrombotic endocarditis. Conclusions: This case highlights the importance of having a high threshold of suspicion for malignancy as a cause of stroke.

Original languageEnglish
Article number260
JournalJournal of Medical Case Reports
Volume13
Issue number1
DOIs
Publication statusPublished - 20 Aug 2019

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Case Management
Stroke
Neoplasms
Second Primary Neoplasms
Middle Cerebral Artery
Mitral Valve Insufficiency
Tissue Plasminogen Activator
Endocarditis
Pelvis
Pancreatic Neoplasms
Abdomen
Comorbidity
Angiography
Thorax
Smoking
Tomography
Guidelines
Antigens
Serum

ASJC Scopus subject areas

  • Medicine(all)

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Stroke in malignancy : Complexities of diagnosis and management: A case report. / Siriratnam, Pakeeran; Kraemer, Thomas; Sahathevan, Ramesh.

In: Journal of Medical Case Reports, Vol. 13, No. 1, 260, 20.08.2019.

Research output: Contribution to journalArticle

Siriratnam, Pakeeran ; Kraemer, Thomas ; Sahathevan, Ramesh. / Stroke in malignancy : Complexities of diagnosis and management: A case report. In: Journal of Medical Case Reports. 2019 ; Vol. 13, No. 1.
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