title: Co-occurrence of multiple cerebral infarctions due to hypercoagulability associated with malignancy and meningeal carcinomatosis as the initial manifestation of gastric cancer.
abstract: BACKGROUND
  Meningeal carcinomatosis and hypercoagulability associated with malignancy are typical late stage complications in cancer patients. The co-occurrence of meningeal carcinomatosis and cerebral infarction related to hypercoagulability associated with malignancy in an individual as the initial manifestation of malignancy has not been previously reported.
  
  
  METHODS
  Herein, we report the case of an 80-year-old patient who presented with meningeal carcinomatosis and hypercoagulability related to malignancy as the initial manifestation of occult gastric cancer. The patient displayed consciousness disturbance, mild left facial paralysis, and bilateral positive Babinski's sign. Using brain magnetic resonance imaging, the patient was diagnosed as having acute multiple cerebral infarctions. Cerebrospinal fluid (CSF) cytology showed adenocarcinoma and upper gastrointestinal endoscopy disclosed scirrhous gastric cancer. The patient presented with headache, fever, and meningeal irritation with a subacute course. Tuberculous or fungal meningitis was initially suspected; however, cytological evidence of adenocarcinoma in the CSF led to the diagnosis of meningeal carcinomatosis.
  
  
  CONCLUSIONS
  The comorbidity of hypercoagulability associated with malignancy and meningeal carcinomatosis should be considered in a patient presenting with multiple cerebral infarctions, progressive disturbance of consciousness, fever, and meningeal irritation.
authors.forename: Akiko
authors.initials: A
authors.lastname: Kawasaki
authors.affiliation: Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga 321-0293, Tochigi, Japan. keisuke@dokkyomed.ac.jp.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Suzuki
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Takekawa
authors.forename: Toshiki
authors.initials: T
authors.lastname: Nakamura
authors.forename: Masanari
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Yohei
authors.initials: Y
authors.lastname: Asakawa
authors.forename: Madoka
authors.initials: M
authors.lastname: Okamura
authors.forename: Koichi
authors.initials: K
authors.lastname: Hirata
mesh_terms: D000230:Adenocarcinoma / Q000150:complications* / Q000556:secondary; D000369:Aged, 80 and over; D002544:Cerebral Infarction / Q000209:etiology*; D006801:Humans; D055756:Meningeal Carcinomatosis / Q000150:complications* / Q000556:secondary; D013274:Stomach Neoplasms / Q000150:complications* / Q000473:pathology; D019851:Thrombophilia / Q000150:complications*
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