Key result
Whole-body PET-CT reveals occult metastatic pancreatic cancer in a patient with recurrent ischemic strokes.
Why the study?
Cerebrovascular disorders frequently complicate malignancy, and stroke can precede a cancer diagnosis with distinct underlying causes such as nonbacterial thrombotic endocarditis.
Case Report (n=1)
Recurrent ischemic strokes of unknown cause, especially those involving different arterial territories, should prompt investigation for occult malignancy such as pancreatic cancer.
Case report of distinct cancer-related stroke mechanisms warrants tailored evaluation; hypothesis-generating and requires prospective validation.
Cerebrovascular disorders (CVDs) are widespread in cancer patients, exacerbating their condition and lowering their prognosis. Approximately 15% of cancer patients have a coexisting CVD. Stroke may occur after the initial cancer diagnosis or before the diagnosis of malignant disease. The underlying causes of stroke in cancer patients are distinct from those in noncancer patients and are related to both cancer itself and the type of treatment. Cardio-embolism, large vessel atherosclerosis, and small vessel occlusion have all been identified as important causes of ischemic stroke, but nonbacterial thrombotic endocarditis has been documented only infrequently. We present a case of a 64-year-old female with recurrent ischemic stroke of unknown cause and involving different arterial territories, who was discovered to have metastatic pancreatic cancer. The initial workup with brain imaging revealed multiple acute/subacute ischemic strokes and a negative cardiac assessment. Accordingly, she underwent a whole-body positron emission tomography-computed tomography which revealed a hypermetabolic mass lesion in the pancreaticoduodenal area. Our case indicates that cancer-associated stroke should be seriously evaluated. It demonstrates the critical nature of contemplating hidden cancer in survivors of ischemic stroke and identifies factors that may necessitate further investigation as part of a comprehensive approach to ischemic stroke, especially embolic stroke of unknown sources.
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Nidawi et al. (2021) conducted a case report in Recurrent ischemic stroke and occult pancreatic cancer (n=1). Occult pancreatic cancer was evaluated on Diagnosis of metastatic pancreatic cancer. A 64-year-old female presenting with recurrent ischemic strokes of unknown cause was diagnosed with metastatic pancreatic cancer after whole-body PET-CT imaging.
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