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Multiple hemorrhagic strokes from DIC associated with occult large cell carcinoma
Matthew A Koenig1, Joseph Maleszewski, Brad Winters
1Division of Neurosciences Critical Care, Johns Hopkins Hospital, Baltimore, MD, USA. mkoenin1@jhmi.edu
Neurocritical Care
|February 10, 2007
Summary
Disseminated intravascular coagulation (DIC) can manifest as recurrent strokes. This case highlights occult large cell carcinoma as a cause of paraneoplastic DIC presenting with hemorrhagic strokes.
Area of Science:
- Neurology
- Oncology
- Hematology
Background:
- Paraneoplastic disseminated intravascular coagulation (DIC) is a rare complication of cancer.
- Adenocarcinoma is the most common malignancy associated with paraneoplastic DIC.
Observation:
- A 77-year-old man presented with vision disturbances, hemiparesis, and encephalopathy.
- Imaging revealed multiple strokes of varying ages, with subsequent hemorrhagic conversion.
- The patient experienced recurrent ischemic strokes and intracerebral hemorrhages despite anticoagulation and coagulopathy management.
Findings:
- Laboratory tests indicated DIC.
- Autopsy revealed occult large cell carcinoma in hilar lymph nodes and multiple intravascular thrombi.
- This case demonstrates DIC associated with large cell carcinoma, a less common cause.
Implications:
- Recurrent hemorrhagic strokes and DIC can be an initial presentation of occult malignancy.
- Large cell carcinoma should be considered in the differential diagnosis of paraneoplastic DIC.
- Early detection of underlying malignancy is crucial for managing paraneoplastic DIC and improving patient outcomes.
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