Ischemic stroke as the first manifestation of hepatic epithelioid hemangioendothelioma.
A 38-year-old obese woman, with a past medical history of cholecystectomy and dyslipidaemia, presented with acute occipital headache, vomiting and rotational vertigo which lasted 8 hours. On admission neurological examination was unremarkable, however general physical examination revealed hepatomegaly. Routine blood tests showed abnormal liver function tests. MRI scan indicated an acute ischemic infarct in the right cerebellum. Extensive investigation was negative. However, liver MRI revealed multiple lesions in both liver lobes. Ultrasound guided liver biopsy and histopathological analysis confirmed the diagnosis of hepatic hemangioendothelioma. In conclusion, hypercoaguable state related to hepatic epithelioid hemangioendothelioma can lead to an ischemic stroke, as a rare first manifestation of the disease.
Department of Neurology, Evangelismos General Hospital, Athens, Greece. Electronic address: takiszis@gmail.com.
Panagiotis
P
Zis
Fourth Department of Internal Medicine, Evangelismos General Hospital, Athens, Greece.
Avraam
A
Assi
Department of Neurology, Evangelismos General Hospital, Athens, Greece.
Dimitrios
D
Kravaritis
Fourth Department of Internal Medicine, Evangelismos General Hospital, Athens, Greece.
Vassilios A
VA
Sevastianos
D000328:Adult; D001777:Blood Coagulation; D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D018323:Hemangioendothelioma, Epithelioid / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D061705:Image-Guided Biopsy; D019934:International Normalized Ratio; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000150:complications* / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D009765:Obesity / Q000150:complications; D011237:Predictive Value of Tests; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology*; D019851:Thrombophilia / Q000097:blood / Q000175:diagnosis / Q000209:etiology*
Cryptogenic stroke; Trousseau syndrome; cancer; hepatic epithelioid hemangioendothelioma; hypercoagulable state