CT-Proven Ischaemic Stroke as the First Manifestation of Occult Lung Cancer

摘要

Cancer is associated with a higher risk of stroke, and in rare cases stroke can be the first manifestation of occult neoplasia. We present the case of a 74-year-old woman hospitalized for ischaemic stroke with multiple cerebral infarctions in several vascular territories. The exclusion of other aetiologies and the simultaneous presence of thromboembolic events in other organs raised the suspicion of a hypercoagulable state, which upon investigation revealed occult neoplasia of the lung. There was rapid deterioration, with recurrent thrombotic events despite anticoagulation, which eventually led to the patient’s death.LEARNING POINTS class="unordered" style="list-style-type:disc">Stroke can be the first manifestation of occult neoplasia.In the presence of cryptogenic stroke, high D-dimers, multiple brain infarctions in different vascular territories and thromboembolic events in other organs, the possibility of hidden neoplasia should be considered.Anticoagulation in disseminated intravascular coagulation is insufficient if the primary disease is not treated. class="kwd-title">Keywords: Stroke, lung cancer, disseminated intravascular coagulation class="head no_bottom_margin" id="__sec2title">CASE PRESENTATIONA 74-year-old woman, with controlled hypertension and dyslipidaemia, presented to the emergency department due to altered speech, left-sided facial droop and decreased muscle strength on the right side of her body with 12 hours of evolution. Physical examination showed aphasia, central facial nerve palsy on the left side, slight right-sided hemiparesis, Babinski’s sign on the left and fever. Computed tomography of the head (head-CT) showed bilateral nucleocapsular and subcortical fronto-parietal ischaemic infarctions of unknown date. The electrocardiogram (ECG) showed sinus rhythm and the thorax x-ray a small left pleural effusion. Blood analysis showed 14,400 leucocytes/μl, increased C-reactive protein (217.8 mg/l), LDH 459 U/l and INR 1.57. The patient was medicated with aspirin and hospitalized with ischaemic stroke. Blood cultures were collected. Doppler ultrasonography of the neck vessels and a trans-thoracic echocardiogram showed no alterations. Magnetic resonance imaging (MRI) revealed multiple acute ischaemic infarctions scattered over both cerebellar and cerebral hemispheres, reflecting strokes in the posterior and anterior circulations ().Diffusion-weighted magnetic resonance of the brain showing multiple acute ischaemic lesions in the anterior and posterior circulations