Recurrent embolic strokes and cardiac valvular disease in a patient with non-small cell adenocarcinoma of lung.
The etiology and mechanisms of stroke could differ in cancer compared to non-cancer patients due to altered blood coagulability and/or non-bacterial thrombotic endocarditis (NBTE). These conditions could be either missed by using inappropriate diagnostic methods or misinterpreted. For instance, certain techniques (transthoracic echocardiography, TTE) may provide false-negative results and delay appropriate therapy. On the other hand, these patients, by having atypical findings, may challenge the differential between bacterial and sterile valvular heart disease. Cerebrovascular disease in cancer patients is often aggressive with tendency to recurrent events and rapid neurological devastation. Timely diagnosis is crucial. Current treatment approach to NBTE includes anticoagulation. We report a case of multiple embolic strokes in a patient diagnosed with lung cancer. Primary and secondary stroke prevention is discussed with relevant review of the literature.
Royter
Vladimir
V
Division of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Vladimir.Royter@cshs.org
Cohen
Stanley N
SN
D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications* / Q000175:diagnosis; D017548:Echocardiography, Transesophageal / Q000379:methods; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications* / Q000175:diagnosis; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D010808:Physical Examination / Q000379:methods; D012008:Recurrence; D020521:Stroke / Q000175:diagnosis / Q000209:etiology*