Abstract
BackgroundAlthough 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 presentationA 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.ConclusionsThis case highlights the importance of having a high threshold of suspicion for malignancy as a cause of stroke.
Highlights
There is an established association between cancer and stroke, the role of malignancy as a causative agent or comorbidity is not always clear
Malignancy is a prothrombotic and hypercoagulable state, and it frequently presents as venous thrombosis
The risk of strokes is higher in the early stages of these malignancies, reflecting a markedly increased immediate risk of arterial thromboembolism [4]
Summary
There is an established association between cancer and stroke, the role of malignancy as a causative agent or comorbidity is not always clear. Some studies suggest that around 10% of all patients with ischemic stroke have comorbid cancer. Discussion and conclusions Our patient was a middle-aged woman with a stroke of undetermined mechanism found to have a metastatic malignancy of unknown primary. The major mechanisms through which cancer can lead to stroke are hypercoagulability, nonbacterial thrombotic endocarditis (NBTE), direct compression of cranial blood vessels by the tumor, or cancer treatment [6].
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