Abstract Details

Title Fatal Embolic Stroke Due to Non-Atherothrombotic Mobile Thrombi in the Carotid Artery during Gastric Cancer Chemotherapy: An Autopsy Case Report

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P01 - (-)

Poster/Presentation
Number 255

Objective

Background BACKGROUND: There has been accumulating evidence for cerebrovascular complications of malignancy, also known as Trousseau's syndrome. Although a clear correlation is not completely understood, a neoplasm-related hypercoagulability likely plays an important role in the formation of thrombi in the middle sized arteries regardless of the presence of atherosclerosis.

Design/Methods DESIGN/METHODS: Case: A 57 year-old male with gastric cancer (Type 3 cT4N3M1 stage IV) undergoing chemotherapy developed acute left hemiparesis and dysarthria. Initial MRI showed multiple cerebral infarctions in the right middle cerebral artery (MCA) territory. Doppler ultrasonography identified a 4 cm-long mobile thrombus in the right internal carotid artery (ICA). Because of the possible risk for bleeding, we treated him with Edarabon alone. His neurological exam deteriorated subsequently and follow-up images showed massive MCA territorial stroke. He died secondary to brain edema and herniation. An autopsy revealed the mobile echogenic thrombus as fibrin clots attached to the vessel wall of the right ICA. Pathological examination could not disclose any other possible embolic sources, including anatomical anomalies, right-to-left shunt, atherosclerotic changes and intracardiac thrombi.

Results RESULTS: Discussion: Thrombophilia is well-known sequelae in cancer patients. Venous thrombosis, cardioembolic stroke and pulmonary tumor thrombotic microangiopathy are common presentations. Endothelial dysfunction and chemotherapy effect are likely involved in its pathophysiology. Anticoagulation therapy is rarely indicated because of the difficulty in its management. To our knowledge, this is the first report of the pathologically defined mobile ICA thrombus in the fatal embolic stroke complicated with gastric cancer chemotherapy.

Conclusions CONCLUSIONS: Multiple etiologies for ischemic stroke may exist in cancer patients. A mobile thrombus in the carotid artery should be considered as a possible mechanism for arteriogenic stroke in the clinical settings of malignancy with hypercoagulability. Doppler ultrasonography is the most practical tool to identify these conditions.

Authors/Disclosures
Aori Yamada, MD PRESENTER	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Jun Gotoh, MD, PhD (Saiseikai Yokohamashi Tobu Hospital)	No disclosure on file
Ludwig Kappos, MD, FAAN (RC2NB, University Hospital Basel)	Dr. Kappos has nothing to disclose.
Makoto Takagi (Saiseikai Central Hospital)	No disclosure on file

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