Acute Ischemic Stroke due to Undifferentiated Sarcoma: A Case Report and Literature Review (original) (raw)
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Journal of Neuroendovascular Therapy
We report a case of acute middle cerebral artery (MCA) occlusion caused by tumor embolism. Case Presentation: A 64-year-old man with lung cancer presented with sudden onset left-sided hemiparesis and sensory disturbance. Diffusion-weighted imaging (DWI) revealed hyper-intense foci in the right MCA territory and magnetic resonance angiography (MRA) demonstrated right MCA M2 segment occlusion. Mechanical thrombectomy (MT) was performed with Thrombolysis in Cerebral Infarction 2B recanalization. On histopathology, thrombus composed of fibrin and squamous cell carcinoma was observed. We diagnosed him with tumor embolism from lung cancer that invaded the pulmonary vein and the left atrium. Conclusion: Tumor cells may be confirmed by pathological examination regardless of the morphology of the embolus. Pathological examination of the cerebral embolus is useful for the accurate diagnosis of ischemic stroke subtypes.
IHJ Cardiovascular Case Reports (CVCR), 2099
This report describes a 60 years old hypertensive and diabetic woman presenting with acute anterior myocardial infarction accompanied by electrocardiographic changes and raised cardiac enzymes. Her coronary angiography revealed a distal left anterior descending artery block; but at this stage the patient rapidly developed unconsciousness with loss of movement in all 4 limbs. Magnetic resonance imaging of the brain revealed massive multiple bilateral infarcts and transthoracic echocardiography subsequently done demonstrated a large mobile mass in the left atrium that prolapsed into the mitral annulus. This mass was heterogeneous with a satellite nodule. The patient had to be shifted to the intensive care unit where she initially required endotracheal intubation and temporary mechanical ventilation. The patient continues to be in coma and is being managed conservatively in the intensive care unit as the attendant refused to give consent for surgical removal of the left atrial tumor. There are less than a handful case report narrating simultaneous acute anterior myocardial and bilateral large cerebral infarctions subsequent to embolization from a probable left atrial myxoma.
Histology of Thrombectomy Specimen Reveals Cardiac Tumor Embolus in Cryptogenic Young Stroke
Journal of Stroke and Cerebrovascular Diseases, 2018
A 25-year-old woman presented with acute onset of right hemiplegia and global aphasia with National Institutes of Health Stroke Scale score of 19. Computed tomography angiography demonstrated occlusion of the left proximal middle cerebral artery. She was thrombolysed with intravenous recombinant tissue plasminogen activator (0.6 mg/kg) within 3 hours of onset of symptoms and was taken up for mechanical thrombectomy. The retrieved specimen appeared pale white and soft; histopathologic examination revealed a papillary neoplasm composed of papillae with hyalinized cores lined by endothelium, consistent with papillary fibroelastoma of cardiac origin. Transesophageal echocardiography showed no abnormalities, which can be explained by complete embolization of the mass into the cerebral circulation. On follow-up after 5 months, the patient recovered with only minimal aphasia and no cardiac symptoms. Our experience with this case highlights the importance of histopathologic examination of the mechanical thrombectomy specimen, as it provided the only clue to the etiology of stroke.
Journal of Clinical Images and Medical Case Reports
Primary cardiac tumours are rare; 75% of primaries are benign mesenchymal, mostly myxomas. Primary sarcomas are the second most frequent type. Only a few hundred primary cardiac sarcomas have been reported, most diagnosed by autopsy. Sarcomas of the intima are polypoid mesenchymal masses anchored to a vessel or the cardiac wall. To our knowledge, there is a unique report of primary cardiac Sarcoma complicated with cerebral infarction and cerebral metastatic disease. Metastases show a preference for lung, liver, and mediastinum, but the brain is usually a sanctuary. We describe a female in her forty’s with recurrent stroke associated with a cardiac sarcoma, also presenting brain metastases, who died a year after starting the problem by pulmonary thromboembolism.
Excision of rare carotid body tumour without preembolisation: Case report and literature review
International Journal of Surgery Case Reports, 2018
Introduction: Carotid body tumors also known as parganglioma or chemodactomas are one of the rare tumors of head and neck which present as slow growing masses in the neck region. We present a case of 40 years female with painless slow growing mass over left side of her neck for 6 months. Diagnosis was made on basis of clinical history, examination and radiological findings. Tumor was graded as Shamblin grade II. She was managed with excision of the tumor without preoperative embolisation. Intraoperative and postoperative periods were uneventful. Case presentation: A forty years female presented with left sided painless neck swelling∼5 × 4 cm 2 over left anterior triangle for 6 months with no history of dysphagia, odynophagia, change in voice, shortness of breath, palpitations, tremors or syncopal attacks. She underwent USG neck and CT angiogram. Based upon the radiological and clinical findings, she was diagnosed asCarotid body tumor. She was managed with excision of the tumor without preembolisation. Her diagnosis was confirmed with histopathology. Conclusion: Carotid body tumours are rare entities of head and neck region. They are mostly benign in nature. Though mostly bening, increasing size might result in grave complications. Thus, the recommended treatment for carotid body tumors is early excision with or without pre-embolisation. In our case preembolisation was not performed. Though some studies have suggested the use of preoperative embolisation in large sized tumors, more studies are yet required to justify the choice of preembolisation despite the dreaded complications.
Pseudoaneurysm of internal carotid artery after carotid body tumor excision
The Indian journal of radiology & imaging, 2013
The common causes of pseudoaneurysms of internal carotid artery (ICA) in the neck are penetrating trauma, head and neck surgeries, carotid endarterectomies, infiltrating metastatic lymph nodes and neoplasms. We report a young male patient who presented with a swelling in left upper neck diagnosed as carotid body tumor with ultrasonography and magnetic resonance imaging. Subadventitial excision of the tumor was done. The patient developed dense right hemiplegia in the immediate postoperative period. Doppler study of neck revealed left ICA dissection with partial thrombosis of the lumen. Computed tomography of the brain revealed nonhemorrhagic left capsuloganglionic infarct and he was managed conservatively with heparin. Follow-up Doppler study done 2 weeks later revealed pseudoaneurysm of the ICA. Attempts to obliterate the pseudoaneurysm by interventional procedures failed due to the narrow neck of the pseudoaneurysm. Heparin was stopped and patient was maintained only on oral aspir...