Wu Yi-Hong, Li Tung-Chou
Department of Physical Medicine and Rehabilitation, Cathay General Hospital, Taipei, TWN.
School of Medicine, Fu Jen Catholic University, New Taipei City, TWN.
Cureus. 2025 Apr 10;17(4):e82001. doi: 10.7759/cureus.82001. eCollection 2025 Apr.
Cancer-related stroke is increasingly being recognized as a significant clinical entity. Multiple vascular territory involvement and elevated coagulation markers often serve as key indicators of the underlying malignancy in stroke patients, making their recognition crucial for early cancer detection. Here, we report a case of a 74-year-old woman who presented with progressive left-sided weakness developing over one week. Brain MRI revealed extensive multifocal acute infarcts involving bilateral cerebral and cerebellar hemispheres. Initial stroke workup showed no conventional risk factors. However, laboratory investigations revealed markedly elevated D-dimer (39.39 μg/mL), decreased fibrinogen (84.3 mg/dL), and elevated fibrinogen degradation product (109.91 μg/mL) levels, consistent with disseminated intravascular coagulopathy. Tumor screening demonstrated significantly elevated tumor markers (CA19-9: 28,960 U/mL, CA125: 394.6 U/mL), and imaging identified a hypervascular ovarian mass. Surgical resection confirmed right ovarian clear cell carcinoma. Postoperative follow-up showed improvement in coagulation parameters, and the patient remained stroke-free for six months under antiplatelet therapy. This case emphasizes the importance of maintaining clinical suspicion for occult malignancy in patients presenting with cryptogenic stroke, particularly when accompanied by multiple vascular territory involvement and elevated coagulation markers. Early recognition of these warning signs can lead to timely cancer diagnosis and appropriate management strategies, potentially improving patient outcomes.
癌症相关的中风越来越被视为一种重要的临床实体。多个血管区域受累和凝血指标升高通常是中风患者潜在恶性肿瘤的关键指标，因此对其识别对于早期癌症检测至关重要。在此，我们报告一例74岁女性病例，该患者在一周内逐渐出现进行性左侧肢体无力。脑部磁共振成像（MRI）显示双侧大脑半球和小脑半球广泛的多灶性急性梗死。初始中风检查未发现传统危险因素。然而，实验室检查显示D-二聚体显著升高（39.39μg/mL）、纤维蛋白原降低（84.3mg/dL）以及纤维蛋白原降解产物升高（109.91μg/mL），符合弥散性血管内凝血。肿瘤筛查显示肿瘤标志物显著升高（糖类抗原19-9：28,960U/mL，癌抗原125：394.6U/mL），影像学检查发现一个富血管性卵巢肿物。手术切除证实为右卵巢透明细胞癌。术后随访显示凝血参数有所改善，患者在接受抗血小板治疗的情况下六个月未再发生中风。该病例强调了对于隐源性中风患者，尤其是伴有多个血管区域受累和凝血指标升高时，保持对隐匿性恶性肿瘤临床怀疑的重要性。早期识别这些警示信号可导致及时的癌症诊断和适当的管理策略，有可能改善患者预后。
