Stroke as the first manifestation of concealed cancer

Stroke is commonly occurring in a patient with known cancer. Stroke is seldom occur as the first manifestation of a cancer. The majority of these strokes were a consequence of hypercoagulability. We investigated the clinical, laboratory and radiological features of patients whose cancer was firstly diagnosed after time of stroke presentation. We reviewed the clinical, laboratory and radiological records of consecutive stroke patients, whose cancers were diagnosed at stroke presentation. Cancer-related stroke was defined if no definite cause for stroke was confirmed and malignancy was detected within 6 months of first stroke onset without cancer-related treatment. All patients underwent clinical, laboratory and radiological investigations including brain diffusion-weighted MRI [DWI], MR angiography, and echocardiography. The sizes, numbers, and locations of all hyperintense lesions in the DWI were noted. 10 patients were finally analyzed. Lung cancer [40%] and prostate cancer [20%] were the commonest underlying malignancy, they were often of advanced stage. All patients has elevated D-dimer 100%, 5 of them [50%] has highly elevated D-dimer [50%]. 9 of 10 cases [90%] showed bihemispheric numerous and variable size lesions in multiple territories in DWI. Consider a concealed cancer in multiple bihemispheric infarctions in DWI and an unknown etiology

Central nervous system involvement in chronic inflammatory demyelinating polyradiculoneuropathy: a clinical, neurophysiological and radiological study

The frequency of the association between CIDP and CNS lesions is probably underestimated. To assess the frequency of CNS involvement in CIDP patients, and to study the characteristics of this possible association. Forty patients [20 males, and 20 females] aged between 19 and 50 years [mean 33.12 +/- 9.3 years] fulfilling the clinical, neurophysiological and CSF criteria of INCAT for the diagnosis of CIDP were submitted to complete general and neurological assessment, laboratory investigations, CSF analysis, neurophysiological evaluation [NC studies, evoked potentials [VEPs, BAEPs, SSEPs]], and MRI brain and spinal cord. Clinical evidences of CNS involvement were recorded in 12 patients [30%] of CIDP patients, abnormally delayed VEPs latencies were recorded in 16 patients [40%], abnormal BAEP latencies in 12 patients [30%], abnormal SSEP latencies in 22 patients [55%], and abnormal latencies in more than one modality in 13 patients [32.5%], MRIs brain and spinal cord were abnormal in 10 patients [25%]. CIDP patients with clinical and/or radiological evidences of CNS involvement had a significantly younger age of disease onset, more frequent relapsing-remitting pattern of the disease course, more prolonged disease duration, and less favorable response to therapy than those without evidences of CNS involvement. CIDP patients with delayed evoked potentials' latencies and/or MRI demyelinating lesions were more frequent in CIDP patients with clinical evidences of CNS involvement. Moreover, MRI lesions were more frequent in those having abnormal visual evoked potential responses. Finally, there was a percentage of CIPD patients who showed a subclinical central neurophysiological and/or radiological abnormalities. CIDP is frequently associated with various clinical, neurophysiological and radiological evidences of CNS involvement. MRI and evoked potentials are useful non-invasive techniques for demonstrating this association