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Case Reports
. 2014 Aug 8:14:160.
doi: 10.1186/s12883-014-0160-9.

Co-occurrence of multiple cerebral infarctions due to hypercoagulability associated with malignancy and meningeal carcinomatosis as the initial manifestation of gastric cancer

Akiko Kawasaki, Keisuke Suzuki  1 , Hidehiro Takekawa, Toshiki Nakamura, Masanari Yamamoto, Yohei Asakawa, Madoka Okamura, Koichi Hirata
Affiliations
Case Reports

Co-occurrence of multiple cerebral infarctions due to hypercoagulability associated with malignancy and meningeal carcinomatosis as the initial manifestation of gastric cancer

Akiko Kawasaki et al. BMC Neurol. .

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.

Case presentation: 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.

Conclusion: 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.

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Figures

Figure 1
Figure 1
Brain magnetic resonance images. A, B; Diffusion-weighted images show high signal intensities in the right cerebellar hemisphere and in the deep white matter adjacent to the bilateral lateral ventricles and subcortices (arrowheads). C, D; Post-contrast T1-weighted images reveal no meningeal enhancement.
Figure 2
Figure 2
The results of CSF cytology. The cytology obtained from the CSF reveals adenocarcinoma.
See this image and copyright information in PMC

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