Clinical analysis of occult malignant tumors with acute cerebral infarction as the first manifestation / 中国脑血管病杂志

ABSTRACT

Objective To guide clinicians to strengthen tumor screening in patients with acute cerebral infarction by analyzing the clinical manifestation,laboratory examinations and imaging features of patients with acute cerebral infarction as the first manifestation of occult malignant tumors. Methods From January 2013 to January 2015,1139 patients with acute cerebral infarction admitted to the Department of Neurology,Peking University Third Hospital were collected. Eight of them (0. 7% )were found to have somatic malignancy during hospitalization. The clinical manifestations,risk factors,imaging changes,Ddimer levels and other laboratory results and prognosis were reviewed,and the related literature was reviewed and discussed. Results Eight patients with cerebral infarction as the first manifestation of malignant tumor,their ages were 58 -78 (70 ±3)years old,6 were males,2 were female. Five of them were lung cancer. Intrahepatic cholangiocarcinoma,colon cancer and prostate cancer were in 1 case respectively. Three patients who had multiple cerebral infarctions died of respiratory failure during hospitalization,and the intervals between diagnosis and death were 49,95 and 28 d,respectively. Five patients improved the Ddimer test,including 2 of them had elevated levels of D-dimer (0. 73 μg/ L and 3. 0 μg/ L respectively);in 8 patients with improved creatine kinase isoenzyme MB (CK-MB)test,the CK-MB levels were elevated in 2 patients (31 U/ L and 49 U/ L respectively),and one of the patients was diagnosed as acute myocardial infarction. All the patients improved head magnetic resonance imaging (MRI)diffusion-weighted imaging (DWI)and cerebral vascular examination,and only one patient with cerebral infarction was consistent with the stenotic vessels. Six patients had bilateral cerebral hemisphere infarctions,and multiple cerebral infarction occurred in the anterior and posterior circulation simultaneously,and MRI-DWI indicated that the cerebral infarction lesions were numerous small or large area cerebral infarctions in multiple vessels. Conclusion In patients with multiple cerebral infarction with unknown etiology,especially those with early recurrent stroke,attention should be paid to the possibility of somatic malignancy,and the early recurrence of acute cerebral infarction suggests poor prognosis.