Abstract Details

Title Ischemic Stroke due to Intracerebral Steal from Calvarial Metastasis: a Case Report

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P2 - Poster Session 2 (11:45 AM-12:45 PM)

Poster/Presentation
Number 6-001

Objective NA

Background Malignancy is an important risk factor for ischemic stroke. Various mechanisms may explain the association between cancer and ischemic stroke, including hypercoagulation, accelerated atherosclerosis, and toxic effects of chemotherapy and radiation. Here, we report a rare case in which a patient with known occlusive radiation vasculopathy (ORV) presented with ischemic strokes caused by an “intracerebral steal” phenomenon from new metastatic calvarial lesions.

Design/Methods NA

Results A 64-year-old woman with remote history of left neck squamous cell carcinoma and prior left frontal stroke from left common carotid artery (CCA) occlusion secondary to ORV presented to the emergency department with acute-onset right hemiparesis. Brain magnetic resonance imaging revealed scattered infarcts in the convexity of the left hemisphere as well as adjacent calvarial destruction. On functional and structural MRI, the calvarial lesion demonstrated increased vascularity and diffusion restriction. CT angiography redemonstrated complete occlusion of the left CCA and strong right-to-left collateral circulation across the anterior communicating artery. The remainder of the stroke workup, including echocardiogram, laboratory analyses,venous dopplers, and carotid ultrasound was unrevealing. CT scans of the chest, abdomen and pelvis revealed only lytic lesions in the T11 vertebra, left ilium and right sacrum, and biopsy of the latter revealed adenocarcinoma.

Conclusions

In this patient, neck radiation therapy had resulted in a chronic occlusion of the left CCA. Years later, a hypervascular skull metastasis drew from this limited blood supply, causing ischemic strokes in the parenchyma adjacent to the hypermetabolic calvarial metastasis. This case of an "intracerebral steal" phenomenon demonstrates how hypervascular extradural lesions may also lead to ischemia, particularly in cases of ipsilateral poor hemodynamic reserve.

Authors/Disclosures
Anjali Murthy PRESENTER	Miss Murthy has nothing to disclose.
Prateek Kumar, MD (University of Texas Health Science Center at Houston)	Dr. Kumar has nothing to disclose.
Fernando D. Testai, MD, PhD, FAAN (University of Illinois at Chicago)	Dr. Testai has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Testai has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Livingston, Barger, Brandt & Schroeder, L.L.P.. Dr. Testai has received publishing royalties from a publication relating to health care.
	No disclosure on file

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