Nonbacterial Thrombotic Endocarditis and Adenocarcinoma in Acute Stroke
Date
2016
Authors
Sahathevan, R
Patel, Ronak
Haque, Sameen
Weerasinghe, Dinushi
Po, Kieren
Zhai, S
Jones, B
Siracusa, E
Hunter, Arnagretta
Gawarikar, Yash
Journal Title
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Volume Title
Publisher
S. Karger AG
Abstract
Background and Rationale: Nonbacterial thrombotic endocarditis
is a complication of mucin-producing adenocarcinoma.
Aseptic valvular vegetations formed on valves are friable and frequently
result in stroke. Immune mediated valvular endothelial
damage and hypercoagulability have a role to play. Mucin, is also
likely to increase the formation of intravascular thrombi. Treatment
is difficult and requires use of anti-coagulant. Evidence of
superiority of unfractionated heparin over low molecular wt heparin
will be discussed.
Methods: We conducted a retrospective review of the hospital
stroke registry to identify patients diagnosed with embolic
stroke secondary to Nonbacterial thrombotic endocarditis (NBTE).
Individual patient records were then examined for patients’ demographics,
imaging and confirmation of underlying malignancy.
Results: Three patients were identified from the registry data
for the period January to December 2015. All the patients were
male and magnetic resonance imaging showed evidence of multiple
ischemic infarcts across arterial territories, suggestive of an
underlying embolic mechanism. All patients were confirmed to
have disseminated malignancy and histopathology confirmed adenocarcinoma
based on biopsies of isolated pulmonary lesions. In
all patients, echocardiography (ECHO) and carotids ultrasound
(CUS) showed no evidence of thrombi. Coagulation studies were
normal.
Conclusion: We describe three patients with NBTE and underlying
adenocarcinoma. Blood investigations showed no evidence
of hypercoagulability based on conventional assessments of
coagulation. The diagnosis of ischemic stroke secondary to emboli
was based on the MRI findings and despite normal ECHO,
which is common in NBTE. Patients were treated with Low molecular
weight heparin (LMWH) and suffered recurrent stroke. Unfortunately
all three patients succumbed to their illness.
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Cerebrovascular Diseases
Type
Conference paper
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Free Access via publisher website
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Restricted until
2099-12-31
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