Recurrent Stroke Due to Metastatic Pulmonary Tumor Emboli as an Important Clinical Entity
We present an autopsy case of repetitive stroke due to tumor emboli, indistinguishable from thromboembolism with a hypercoagulable state in its clinical course. A 72-year-old man diagnosed with stage IVA oropharyngeal squamous cell carcinoma received chemoradiotherapy. Follow-up imaging revealed med...
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| Veröffentlicht in: | Journal of stroke and cerebrovascular diseases 2017-06, Vol.26 (6), p.e108-e110 |
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| creator | Takasugi, Junji, MD Sakaguchi, Manabu, MD Oyama, Naoki, MD Gon, Yasufumi, MD Terasaki, Yasukazu, MD Sasaki, Tsutomu, MD Nakahara, Susumu, MD Ohshima, Kenji, MD Hori, Yumiko, MD Morii, Eiichi, MD Mochizuki, Hideki, MD |
| description | We present an autopsy case of repetitive stroke due to tumor emboli, indistinguishable from thromboembolism with a hypercoagulable state in its clinical course. A 72-year-old man diagnosed with stage IVA oropharyngeal squamous cell carcinoma received chemoradiotherapy. Follow-up imaging revealed mediastinal lymph nodes and pulmonary metastasis. One year later, the patient experienced right arm weakness, and brain magnetic resonance imaging showed acute ischemic lesions in multiple vascular territories. He was diagnosed with paradoxical cerebral embolism due to cancer-associated venous thrombosis and treated with rivaroxaban. However, newly developed cerebral infarcts were confirmed 1 month later. Then, rivaroxaban treatment was switched to subcutaneous unfractionated heparin injection. He was admitted again for stroke recurrence and died of respiratory failure 8 days after admission. Autopsy demonstrated pulmonary metastasis invading the veins and tumor emboli in the culprit cerebral arteries. D-dimer was kept constant at a slightly higher level, ranging from 1 to 3 µg/mL during the course of recurrence. We should consider tumor embolism in the differential diagnosis of recurrent stroke along with pulmonary tumor and resistance to heparin preparations with unchanged D-dimer levels. |
| doi_str_mv | 10.1016/j.jstrokecerebrovasdis.2017.03.012 |
| format | Article |
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A 72-year-old man diagnosed with stage IVA oropharyngeal squamous cell carcinoma received chemoradiotherapy. Follow-up imaging revealed mediastinal lymph nodes and pulmonary metastasis. One year later, the patient experienced right arm weakness, and brain magnetic resonance imaging showed acute ischemic lesions in multiple vascular territories. He was diagnosed with paradoxical cerebral embolism due to cancer-associated venous thrombosis and treated with rivaroxaban. However, newly developed cerebral infarcts were confirmed 1 month later. Then, rivaroxaban treatment was switched to subcutaneous unfractionated heparin injection. He was admitted again for stroke recurrence and died of respiratory failure 8 days after admission. Autopsy demonstrated pulmonary metastasis invading the veins and tumor emboli in the culprit cerebral arteries. D-dimer was kept constant at a slightly higher level, ranging from 1 to 3 µg/mL during the course of recurrence. We should consider tumor embolism in the differential diagnosis of recurrent stroke along with pulmonary tumor and resistance to heparin preparations with unchanged D-dimer levels.</description><identifier>ISSN: 1052-3057</identifier><identifier>EISSN: 1532-8511</identifier><identifier>DOI: 10.1016/j.jstrokecerebrovasdis.2017.03.012</identifier><identifier>PMID: 28366663</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Anticoagulants - therapeutic use ; Autopsy ; Biomarkers - blood ; Biopsy ; cancer-related stroke ; Carcinoma, Squamous Cell - complications ; Carcinoma, Squamous Cell - diagnostic imaging ; Carcinoma, Squamous Cell - secondary ; Carcinoma, Squamous Cell - therapy ; Cardiovascular ; Diffusion Magnetic Resonance Imaging ; Fatal Outcome ; Fibrin Fibrinogen Degradation Products - metabolism ; Head and Neck Neoplasms - complications ; Head and Neck Neoplasms - pathology ; Head and Neck Neoplasms - therapy ; Humans ; Intracranial Embolism - diagnosis ; Intracranial Embolism - drug therapy ; Intracranial Embolism - etiology ; Lung Neoplasms - complications ; Lung Neoplasms - secondary ; Lung Neoplasms - therapy ; Lymphatic Metastasis ; Male ; Neoplasm Staging ; Neoplastic Cells, Circulating - pathology ; Neurology ; Oropharyngeal Neoplasms - complications ; Oropharyngeal Neoplasms - pathology ; Oropharyngeal Neoplasms - therapy ; pulmonary metastases ; Recurrence ; Recurrent stroke ; Respiratory Insufficiency - etiology ; Squamous Cell Carcinoma of Head and Neck ; Stroke - diagnosis ; Stroke - drug therapy ; Stroke - etiology ; Treatment Outcome ; tumor embolism</subject><ispartof>Journal of stroke and cerebrovascular diseases, 2017-06, Vol.26 (6), p.e108-e110</ispartof><rights>National Stroke Association</rights><rights>2017 National Stroke Association</rights><rights>Copyright © 2017 National Stroke Association. Published by Elsevier Inc. 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A 72-year-old man diagnosed with stage IVA oropharyngeal squamous cell carcinoma received chemoradiotherapy. Follow-up imaging revealed mediastinal lymph nodes and pulmonary metastasis. One year later, the patient experienced right arm weakness, and brain magnetic resonance imaging showed acute ischemic lesions in multiple vascular territories. He was diagnosed with paradoxical cerebral embolism due to cancer-associated venous thrombosis and treated with rivaroxaban. However, newly developed cerebral infarcts were confirmed 1 month later. Then, rivaroxaban treatment was switched to subcutaneous unfractionated heparin injection. He was admitted again for stroke recurrence and died of respiratory failure 8 days after admission. Autopsy demonstrated pulmonary metastasis invading the veins and tumor emboli in the culprit cerebral arteries. D-dimer was kept constant at a slightly higher level, ranging from 1 to 3 µg/mL during the course of recurrence. We should consider tumor embolism in the differential diagnosis of recurrent stroke along with pulmonary tumor and resistance to heparin preparations with unchanged D-dimer levels.</description><subject>Aged</subject><subject>Anticoagulants - therapeutic use</subject><subject>Autopsy</subject><subject>Biomarkers - blood</subject><subject>Biopsy</subject><subject>cancer-related stroke</subject><subject>Carcinoma, Squamous Cell - complications</subject><subject>Carcinoma, Squamous Cell - diagnostic imaging</subject><subject>Carcinoma, Squamous Cell - secondary</subject><subject>Carcinoma, Squamous Cell - therapy</subject><subject>Cardiovascular</subject><subject>Diffusion Magnetic Resonance Imaging</subject><subject>Fatal Outcome</subject><subject>Fibrin Fibrinogen Degradation Products - metabolism</subject><subject>Head and Neck Neoplasms - complications</subject><subject>Head and Neck Neoplasms - pathology</subject><subject>Head and Neck Neoplasms - therapy</subject><subject>Humans</subject><subject>Intracranial Embolism - diagnosis</subject><subject>Intracranial Embolism - drug therapy</subject><subject>Intracranial Embolism - etiology</subject><subject>Lung Neoplasms - complications</subject><subject>Lung Neoplasms - secondary</subject><subject>Lung Neoplasms - therapy</subject><subject>Lymphatic Metastasis</subject><subject>Male</subject><subject>Neoplasm Staging</subject><subject>Neoplastic Cells, Circulating - pathology</subject><subject>Neurology</subject><subject>Oropharyngeal Neoplasms - complications</subject><subject>Oropharyngeal Neoplasms - pathology</subject><subject>Oropharyngeal Neoplasms - therapy</subject><subject>pulmonary metastases</subject><subject>Recurrence</subject><subject>Recurrent stroke</subject><subject>Respiratory Insufficiency - etiology</subject><subject>Squamous Cell Carcinoma of Head and Neck</subject><subject>Stroke - diagnosis</subject><subject>Stroke - drug therapy</subject><subject>Stroke - etiology</subject><subject>Treatment Outcome</subject><subject>tumor embolism</subject><issn>1052-3057</issn><issn>1532-8511</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqVkUFv1DAQhS0EoqXwF5CPCCnBY6-T9IIEy9JWWtSKlgMna9aZlZwm8WI7lfbf47ALh6oX5uI5PL_R-x5j70GUIKD60JVdTMHfk6VAm-AfMLYullJAXQpVCpDP2CloJYtGAzzPu9CyUELXJ-xVjJ0QALrRL9mJbFSVR52yn9_JTiHQmPjtH2_-ZSKePP9GCWPC5Cy_mfrBjxj2_G4afOCrYeN7xzFyHPnVsPMhYf6_7N3oLPZ8NSaX9q_Ziy32kd4c3zP24-vqbnlZrK8vrpaf1oXVUqeClCSkFiqhzreEWIvzGnFbiQZ0mwMAarmpwFb1AmrbVqLFRtWWSCBKJUGdsXcH313wvyaKyQwuWup7HMlP0UDTqGYhFguZpZ8PUht8jIG2ZhfckIMZEGZGbDrzFGIzIzZCmYw4m7w93ps2A7X_LP4yzYL1QUA59YOjYKJ1NFpqXSCbTOvd_937-MjOHkHf055i56cwZr4GTJRGmNu59LlzqNXct1a_AT3zsM4</recordid><startdate>20170601</startdate><enddate>20170601</enddate><creator>Takasugi, Junji, MD</creator><creator>Sakaguchi, Manabu, MD</creator><creator>Oyama, Naoki, MD</creator><creator>Gon, Yasufumi, MD</creator><creator>Terasaki, Yasukazu, MD</creator><creator>Sasaki, Tsutomu, MD</creator><creator>Nakahara, Susumu, MD</creator><creator>Ohshima, Kenji, MD</creator><creator>Hori, Yumiko, MD</creator><creator>Morii, Eiichi, MD</creator><creator>Mochizuki, Hideki, MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20170601</creationdate><title>Recurrent Stroke Due to Metastatic Pulmonary Tumor Emboli as an Important Clinical Entity</title><author>Takasugi, Junji, MD ; Sakaguchi, Manabu, MD ; Oyama, Naoki, MD ; Gon, Yasufumi, MD ; Terasaki, Yasukazu, MD ; Sasaki, Tsutomu, MD ; Nakahara, Susumu, MD ; Ohshima, Kenji, MD ; Hori, Yumiko, MD ; Morii, Eiichi, MD ; Mochizuki, Hideki, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c525t-e32eaed16039feaa7097aaf60815d1051a52b61c67417cd60da837cee0aa23213</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Anticoagulants - therapeutic use</topic><topic>Autopsy</topic><topic>Biomarkers - blood</topic><topic>Biopsy</topic><topic>cancer-related stroke</topic><topic>Carcinoma, Squamous Cell - complications</topic><topic>Carcinoma, Squamous Cell - diagnostic imaging</topic><topic>Carcinoma, Squamous Cell - secondary</topic><topic>Carcinoma, Squamous Cell - therapy</topic><topic>Cardiovascular</topic><topic>Diffusion Magnetic Resonance Imaging</topic><topic>Fatal Outcome</topic><topic>Fibrin Fibrinogen Degradation Products - metabolism</topic><topic>Head and Neck Neoplasms - complications</topic><topic>Head and Neck Neoplasms - pathology</topic><topic>Head and Neck Neoplasms - therapy</topic><topic>Humans</topic><topic>Intracranial Embolism - diagnosis</topic><topic>Intracranial Embolism - drug therapy</topic><topic>Intracranial Embolism - etiology</topic><topic>Lung Neoplasms - complications</topic><topic>Lung Neoplasms - secondary</topic><topic>Lung Neoplasms - therapy</topic><topic>Lymphatic Metastasis</topic><topic>Male</topic><topic>Neoplasm Staging</topic><topic>Neoplastic Cells, Circulating - pathology</topic><topic>Neurology</topic><topic>Oropharyngeal Neoplasms - complications</topic><topic>Oropharyngeal Neoplasms - pathology</topic><topic>Oropharyngeal Neoplasms - therapy</topic><topic>pulmonary metastases</topic><topic>Recurrence</topic><topic>Recurrent stroke</topic><topic>Respiratory Insufficiency - etiology</topic><topic>Squamous Cell Carcinoma of Head and Neck</topic><topic>Stroke - diagnosis</topic><topic>Stroke - drug therapy</topic><topic>Stroke - etiology</topic><topic>Treatment Outcome</topic><topic>tumor embolism</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Takasugi, Junji, MD</creatorcontrib><creatorcontrib>Sakaguchi, Manabu, MD</creatorcontrib><creatorcontrib>Oyama, Naoki, MD</creatorcontrib><creatorcontrib>Gon, Yasufumi, MD</creatorcontrib><creatorcontrib>Terasaki, Yasukazu, MD</creatorcontrib><creatorcontrib>Sasaki, Tsutomu, MD</creatorcontrib><creatorcontrib>Nakahara, Susumu, MD</creatorcontrib><creatorcontrib>Ohshima, Kenji, MD</creatorcontrib><creatorcontrib>Hori, Yumiko, MD</creatorcontrib><creatorcontrib>Morii, Eiichi, MD</creatorcontrib><creatorcontrib>Mochizuki, Hideki, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of stroke and cerebrovascular diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Takasugi, Junji, MD</au><au>Sakaguchi, Manabu, MD</au><au>Oyama, Naoki, MD</au><au>Gon, Yasufumi, MD</au><au>Terasaki, Yasukazu, MD</au><au>Sasaki, Tsutomu, MD</au><au>Nakahara, Susumu, MD</au><au>Ohshima, Kenji, MD</au><au>Hori, Yumiko, MD</au><au>Morii, Eiichi, MD</au><au>Mochizuki, Hideki, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Recurrent Stroke Due to Metastatic Pulmonary Tumor Emboli as an Important Clinical Entity</atitle><jtitle>Journal of stroke and cerebrovascular diseases</jtitle><addtitle>J Stroke Cerebrovasc Dis</addtitle><date>2017-06-01</date><risdate>2017</risdate><volume>26</volume><issue>6</issue><spage>e108</spage><epage>e110</epage><pages>e108-e110</pages><issn>1052-3057</issn><eissn>1532-8511</eissn><abstract>We present an autopsy case of repetitive stroke due to tumor emboli, indistinguishable from thromboembolism with a hypercoagulable state in its clinical course. A 72-year-old man diagnosed with stage IVA oropharyngeal squamous cell carcinoma received chemoradiotherapy. Follow-up imaging revealed mediastinal lymph nodes and pulmonary metastasis. One year later, the patient experienced right arm weakness, and brain magnetic resonance imaging showed acute ischemic lesions in multiple vascular territories. He was diagnosed with paradoxical cerebral embolism due to cancer-associated venous thrombosis and treated with rivaroxaban. However, newly developed cerebral infarcts were confirmed 1 month later. Then, rivaroxaban treatment was switched to subcutaneous unfractionated heparin injection. He was admitted again for stroke recurrence and died of respiratory failure 8 days after admission. Autopsy demonstrated pulmonary metastasis invading the veins and tumor emboli in the culprit cerebral arteries. D-dimer was kept constant at a slightly higher level, ranging from 1 to 3 µg/mL during the course of recurrence. We should consider tumor embolism in the differential diagnosis of recurrent stroke along with pulmonary tumor and resistance to heparin preparations with unchanged D-dimer levels.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28366663</pmid><doi>10.1016/j.jstrokecerebrovasdis.2017.03.012</doi></addata></record> |
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| subjects | Aged Anticoagulants - therapeutic use Autopsy Biomarkers - blood Biopsy cancer-related stroke Carcinoma, Squamous Cell - complications Carcinoma, Squamous Cell - diagnostic imaging Carcinoma, Squamous Cell - secondary Carcinoma, Squamous Cell - therapy Cardiovascular Diffusion Magnetic Resonance Imaging Fatal Outcome Fibrin Fibrinogen Degradation Products - metabolism Head and Neck Neoplasms - complications Head and Neck Neoplasms - pathology Head and Neck Neoplasms - therapy Humans Intracranial Embolism - diagnosis Intracranial Embolism - drug therapy Intracranial Embolism - etiology Lung Neoplasms - complications Lung Neoplasms - secondary Lung Neoplasms - therapy Lymphatic Metastasis Male Neoplasm Staging Neoplastic Cells, Circulating - pathology Neurology Oropharyngeal Neoplasms - complications Oropharyngeal Neoplasms - pathology Oropharyngeal Neoplasms - therapy pulmonary metastases Recurrence Recurrent stroke Respiratory Insufficiency - etiology Squamous Cell Carcinoma of Head and Neck Stroke - diagnosis Stroke - drug therapy Stroke - etiology Treatment Outcome tumor embolism |
| title | Recurrent Stroke Due to Metastatic Pulmonary Tumor Emboli as an Important Clinical Entity |
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