Recurrent Strokes as the First Presentation of Occult Pancreatic Cancer; Trousseau Syndrome: A Case Report

Abstract Cerebrovascular disorders (CVDs) are widespread in cancer patients, exacerbating their condition and lowering their prognosis. Approximately 15% of cancer patients have a coexisting CVD. Stroke may occur after the initial cancer diagnosis or before the diagnosis of malignant disease. The un...

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Bibliographic Details
Published in:Case reports in oncology 2021-12, Vol.14 (3), p.1741-1747
Main Authors: Al Nidawi, Firas, Mohamed, Mohamed Wael, Taha, Fatima, Alarab, Daher, Hussein, Amr Elsayed M.
Format: Article
Language:English
Subjects:
Abdomen
Cancer therapies
Case Report
Case reports
Embolisms
Endocarditis
Ischemia
Magnetic resonance imaging
Medical imaging
Medical prognosis
Pancreatic cancer
Patients
recurrent strokes
Stroke
Thromboembolism
Thrombosis
Tomography
trousseau syndrome
Tumors
Veins & arteries
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Summary:Abstract Cerebrovascular disorders (CVDs) are widespread in cancer patients, exacerbating their condition and lowering their prognosis. Approximately 15% of cancer patients have a coexisting CVD. Stroke may occur after the initial cancer diagnosis or before the diagnosis of malignant disease. The underlying causes of stroke in cancer patients are distinct from those in noncancer patients and are related to both cancer itself and the type of treatment. Cardio-embolism, large vessel atherosclerosis, and small vessel occlusion have all been identified as important causes of ischemic stroke, but nonbacterial thrombotic endocarditis has been documented only infrequently. We present a case of a 64-year-old female with recurrent ischemic stroke of unknown cause and involving different arterial territories, who was discovered to have metastatic pancreatic cancer. The initial workup with brain imaging revealed multiple acute/subacute ischemic strokes and a negative cardiac assessment. Accordingly, she underwent a whole-body positron emission tomography-computed tomography which revealed a hypermetabolic mass lesion in the pancreaticoduodenal area. Our case indicates that cancer-associated stroke should be seriously evaluated. It demonstrates the critical nature of contemplating hidden cancer in survivors of ischemic stroke and identifies factors that may necessitate further investigation as part of a comprehensive approach to ischemic stroke, especially embolic stroke of unknown sources.
ISSN:1662-6575
1662-6575
DOI:10.1159/000520759