title: Multiple Cerebral Infarctions in a Patient with Adenomyosis on Hormone Replacement Therapy: A Case Report.
abstract: A 59-year-old woman was admitted to our hospital because of repeated episodes of bilateral hand weakness. She had a 10-year history of combined estrogen-progestin therapy for menopausal symptoms. Magnetic resonance imaging on admission showed multiple hyperintense lesions in bilateral cerebral and cerebellar cortices on diffusion-weighted imaging. Transesophageal echocardiography showed thrombus formation on the aortic valve and moderate aortic insufficiency. Laboratory test demonstrated elevated CA125 (334.8 U/mL) and D-dimer (7.0 µg/mL) levels. Trousseau's syndrome (cancer-related hypercoagulation) was considered, but various examinations showed only uterine adenomyosis and no evidence of cancer. Multiple cerebral infarctions were considered to be caused by Trousseau's syndrome-like condition associated with uterine adenomyosis. CA125 and coagulation markers should be measured in adenomyosis patients treated with hormone replacement therapy, because a mucinous tumor and coagulation markers may be good markers for the risk of thromboembolism in such patients.
authors: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
authors: Nanako
authors: N
authors: Hijikata
authors: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan. Electronic address: ysakamoto02@gmail.com.
authors: Yuki
authors: Y
authors: Sakamoto
authors: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
authors: Chikako
authors: C
authors: Nito
authors: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
authors: Noriko
authors: N
authors: Matsumoto
authors: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
authors: Arata
authors: A
authors: Abe
authors: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
authors: Akane
authors: A
authors: Nogami
authors: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
authors: Takahiro
authors: T
authors: Sato
authors: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
authors: Hiroyuki
authors: H
authors: Hokama
authors: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
authors: Seiji
authors: S
authors: Okubo
authors: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
authors: Kazumi
authors: K
authors: Kimura
mesh_terms: D062788:Adenomyosis / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation / Q000187:drug effects; D018394:CA-125 Antigen / Q000097:blood; D002544:Cerebral Infarction / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D038524:Diffusion Magnetic Resonance Imaging; D017548:Echocardiography, Transesophageal; D015914:Estrogen Replacement Therapy / Q000009:adverse effects; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006225:Hand / Q000294:innervation*; D006801:Humans; D008565:Membrane Proteins / Q000097:blood; D008875:Middle Aged; D018908:Muscle Weakness; D019851:Thrombophilia / Q000097:blood / Q000175:diagnosis / Q000209:etiology*
chemical_list: D015415:Biomarkers; D018394:CA-125 Antigen; D005338:Fibrin Fibrinogen Degradation Products; C451759:MUC16 protein, human; D008565:Membrane Proteins; C036309:fibrin fragment D
keywords: Ischemic stroke; adenomyosis; hormone replacement therapy; hypercoagulability; nonbacterial thrombotic endocarditis