Goddard James K, Nussbaum Eric S, Madison Michael, Lassig Jeff, Torok Collin, Giannakidis Dimitrios, Hanson Sandra, McDonald William, Kallmes Kevin M, Nussbaum Leslie A
1 St Paul Radiology, St Paul, USA.
2 Department of Neurosurgery, National Brain Aneurysm and Tumor Center, Twin Cities, USA.
Interv Neuroradiol. 2019 Aug;25(4):403-406. doi: 10.1177/1591019918817224. Epub 2019 Feb 20.
Although cardiac myxomas have been known to cause acute ischemic stroke and other cerebrovascular complications, intracranial embolization of metastatic tumor fragments is rare. This is likely because venous emboli generally cause pulmonary embolism. Pulmonary vein metastases and patent foramen ovales have previously shown to propagate intracranial embolic carcinomas, but these events are very uncommon, and are not well characterized. We report a rare case of large-cell, high-grade neuroendocrine lung cancer embolus occluding the basilar artery, which likely detached into the bloodstream from the lung after intruding into a pulmonary vein. The embolus was treated with endovascular aspiration, and achieved modified Thrombolysis In Cerebral Infarction 2c revascularization. After initial neurological recovery, the patient suffered respiratory arrest and support was withdrawn 48 h later. We discuss the tumor characteristics and implications for treatment of acute ischemic stroke in patients with cancer diagnoses.
尽管已知心脏黏液瘤可导致急性缺血性中风和其他脑血管并发症，但转移性肿瘤碎片的颅内栓塞却很罕见。这可能是因为静脉栓子通常会导致肺栓塞。肺静脉转移和卵圆孔未闭先前已被证明会促使颅内发生癌栓，但这些情况非常罕见，且特征尚不明确。我们报告了一例罕见病例，一名大细胞、高级别神经内分泌肺癌栓子阻塞了基底动脉，该栓子可能是在侵入肺静脉后从肺部脱落进入血液循环的。通过血管内抽吸对栓子进行了治疗，并实现了改良脑梗死溶栓2c级再灌注。在最初的神经功能恢复后，患者出现呼吸骤停，48小时后停止了支持治疗。我们讨论了肿瘤特征以及对癌症诊断患者急性缺血性中风治疗的影响。
