Multiple brain infarcts and Balint syndrome in aortic arch angiosarcoma

Area of Science:

• Cardiovascular Pathology
• Neurology
• Oncology

Background:

• Angiosarcomas are rare malignant vascular tumors.
• Aortic arch angiosarcomas are exceptionally rare, with most aortic involvement occurring in the abdominal aorta.
• Vascular tumors can present with diverse clinical manifestations.

Observation:

• A 50-year-old woman presented with Balint syndrome (cognitive decline, impaired eye movements, simultanagnosia), left arm hypotension, and left finger clubbing.
• Brain imaging revealed multiple acute infarcts, suggesting embolic events.
• Transesophageal echocardiography identified a thickened aortic wall and an intraluminal aortic arch mass.

Findings:

• Surgical resection of the aortic arch mass confirmed angiosarcoma.
• The angiosarcoma was the source of embolic infarcts leading to neurological deficits.
• This represents the second reported case of aortic arch angiosarcoma presenting with stroke.

Implications:

• This case underscores the importance of considering rare vascular tumors in the differential diagnosis of cryptogenic stroke, particularly in younger patients or those with atypical findings.
• Early diagnosis and surgical intervention are crucial for managing aortic angiosarcoma.
• Further research into the pathogenesis and optimal treatment strategies for aortic angiosarcoma is warranted.