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Recurrent Embolic Strokes of Undetermined Source in A Patient with A Remote History of Endometrial Cancer: A Case Report

子宮內膜癌病史個案反覆發生不明原因之栓塞性中風:一病例報告

摘要


Objective: Cerebral infarction is relatively common in patients with active cancer. However, evaluation and management of cryptogenic stroke in patients with a remote history of cancer are challenging. Case report: We present the case of a 58-year-old woman with a history of endometrial cancer in complete remission who experienced two episodes of embolic stroke of undetermined source. Warfarin was prescribed for stroke prevention. Three months later she presented to the emergency department with left chest pain, and a moderate pleural effusion was found. Multiple masses were discovered in the left pleura, and pleural fluid cytology revealed malignant cells. Recurrence of endometrial cancer with distant metastasis was suspected. Blood tests indicated elevated D-dimer. During hospitalization, there was acute infarction of the thalamus bilaterally. Recombinant tissue plasminogen activator was administered with improvement of neurological deficits. Recurrent multifocal cerebral infarctions and hemorrhage occurred afterwards, however, and the patient eventually died. Conclusion: In patients with a remote history of cancer, unexplained embolic stroke and elevated D-dimer level should raise suspicion of cancer recurrence even when imaging study and tumor marker results are negative. In cancer-associated stroke patients, an elevated D-dimer level also implies poor survival.

並列摘要


背景:針對有癌症病史但尚無證據證明其癌症復發的個案若發生不明原因中風,處置仍具相當挑戰性。在具癌症病史發生不明原因中風的病人當中,高D-雙合蛋白血中濃度及多發性與多血管性病灶可能反映出癌症的存在或復發。病例報告:58歲女性先前有子宮內膜癌及兩次不明原因栓塞性中風之病史。當時使用warfarin作為預防中風的主軸藥物。此次因胸痛、惡性肋膜積水及血中D-雙合蛋白濃度上升住院治療。在住院期間,發生兩側丘腦梗塞故施打靜脈血栓溶解劑。然而,數次多發性栓塞性腦部缺血性梗塞及出血卻接踵發生,最後這名病人病逝。結論:儘管規則腫瘤追蹤皆為正常,包含電腦斷層掃描及腫瘤指數,但兩次無法解釋之栓塞性中風及D-雙合蛋白輕微上升都可能暗示一個潛藏癌症之存在。更全面性的腫瘤檢查如正子掃描應及早考慮。在癌症相關之中風個案中,高D-雙合蛋白也反映出預後不佳。低分子量肝素或許為目前二度預防癌症相關之中風的首選藥物。

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