Abstract:
Cancer-associated stroke is an evolving subgroup of embolic strokes of undetermined source. A man in his mid-20s with progressive follicular variant acinic cell carcinoma of the parotid was admitted because of new onset left-sided weakness. Neuroimaging confirmed a right middle cerebral artery infarction. After extensive diagnostics, stroke aetiology was deemed from cancer-induced hypercoagulability. Questions which arose regarding his management included (1) What was the best antithrombotic for secondary stroke prevention? (2) What was his risk for intracranial or tumorous bleeding once antithrombotics had been started? (3) How many days post-stroke could the antithrombotic be initiated? and (4) When could he be cleared for palliative chemotherapy and whole brain irradiation? The approach to address the abovementioned questions in the management of a rare cancer complicated by stroke is presented. Although treatments are guided by known pathomechanisms, additional studies are needed to further support current treatment strategies for this subgroup of patients.
摘要:
癌症相关卒中是一个不断发展的来源不明的栓塞性卒中的亚组。由于新发作的左侧无力,一名20多岁的男子因腮腺进行性滤泡变性腺细胞癌而入院。神经影像学检查证实右侧大脑中动脉梗死。经过广泛的诊断,卒中的病因被认为是癌症引起的高凝状态.关于他的治疗出现的问题包括:(1)什么是二级预防中风的最佳抗血栓药物?(2)一旦开始使用抗血栓药物,他的颅内或肿瘤出血的风险是多少?(3)中风后几天可以开始抗血栓治疗?(4)何时可以进行姑息化疗和全脑放疗?提出了解决上述问题的方法。尽管治疗是由已知的病理机制指导的,需要更多的研究来进一步支持目前针对此亚组患者的治疗策略.