Antiphospholipid syndrome-induced ischemic stroke following pembrolizumab: Case report and systematic review.

Immune checkpoint inhibitors (ICI) improve the prognosis of patients with advanced non-small cell lung cancer. However, clinicians should be aware of potentially life-threatening immune-related adverse events (irAEs). We report a case of a 67-year-old man with lung adenocarcinoma who developed an acute ischemic stroke after the second administration of pembrolizumab. The patient benefited from thrombolysis and mechanical thrombectomy with improved neurological outcome. An anti-phospholipid syndrome (APS) was diagnosed. Simultaneously, he developed a grade IV autoimmune hepatitis. Bothmanifestations were considered irAEs and the ICI treatment was discontinued. Steroids were initiated resulting in irAEs resolution. Remarkably, the patient achieved a complete oncological response and persistent remission after one year follow-up despite early discontinuation of pembrolizumab. Of note, APS is rarely reported as irAE. To our knowledge, this is the first case reported in the context of lung cancer. A systematic review of the literature is provided.

A rare vascular complication of Eagle syndrome highlight by CTA with neck flexion.

We report a case of a 53-year-old woman admitted to the emergency department with left hemiplegia, tinnitus and palpitations. A cerebral and cervical computed tomography angiography revealed an acute large ischemic stroke on the right Sylvian territory, which was related to a dissection of the right internal carotid. Moreover, a left internal carotid pseudo-aneurysm was observed. These two injuries were presumably imputable to a bilateral Eagle Syndrome. Indeed, the temporal styloid processes were measured at 31mm on both sides. To support our hypothesis of a stylocarotid impingement, a cervical CTA with hyperflexion (45°) of the neck was performed. It clearly revealed the bilateral impingement between the styloid processes and internal carotids. It seems important to know that Eagle syndrome may lead to disabling diseases or even death as well as an ischemic stroke. The vascular impingement with bilateral vascular injuries was never described. To our knowledge, our "neck flexion cervical CTA" to reveal the stylocarotid impingement has never been described before. This approach could lead to a new investigation technique, to better identify this underestimated pathology in the medical doctors community.