Multiple embolic cerebral infarcts can serve as the initial clinical manifestation of occult metastatic ovarian cancer.
Embolic strokes may prompt malignancy evaluation; this case extends the differential for cryptogenic emboli but leaves practice unchanged.
A 36-year-old woman presented to the emergency department with a 3-day history of an occipital headache associated with transient visual impairment and short-term memory loss. MRI of the brain showed innumerable focal embolic infarcts of differing ages, for which a cause could not be determined. The patient was discharged and readmitted 7 weeks later with acute aphasia and a right-sided hemiplegia. CT of the abdomen revealed a right-sided ovarian mass and prominent retroperitoneal nodes, which cytology confirmed to be metastatic ovarian cancer.
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Bond et al. (2015) studied this question.
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