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Medical Science Monitor Basic Research


Frequent Ischemic Stroke as First Manifestation of Occult Colon Cancer: A Rare Case

Unusual clinical course, Educational Purpose (only if useful for a systematic review or synthesis), Rare coexistence of disease or pathology

Chia-Chan Tsai, Meng-Ni Wu

Taiwan Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

Am J Case Rep 2015; 16:723-727

DOI: 10.12659/AJCR.895130

Available online: 2015-10-12

Published: 2015-10-12


BACKGROUND: It is rare that occult cancer presents with frequent ischemic stroke as the sole manifestation.
CASE REPORT: We report the case of a 46-year-old man with frequent stroke in different vascular areas, with diabetes and hypercholesterolemia identified as risk factors. The results of biochemistry, young stroke profiles, trans-cranial and extra-cranial carotid Doppler, and 24-h Holter electrocardiogram were within normal limits. The reports of transthoracic echocardiography (TTE) were unremarkable. Finally, a multi-detector computed tomography (MDCT) demonstrated a thrombus in the posterior-lateral aspect of the left atrium and non-bacterial thrombotic endocarditis (NBTE) was suspected. The results motivated the survey for occult cancer, and adenocarcinoma of the ascending colon was confirmed on colonoscopy pathology.
CONCLUSIONS: We suggest that evaluating the possibility of occult cancer should be emphasized in patients of frequent stroke refractory to therapy, whether risk factors are already identified or not. Furthermore, we assume MDCT can be an alternative way to detect cardiogenic embolic sources in stroke patients.

Keywords: Brain Ischemia - etiology, Adenocarcinoma - diagnosis, Colonic Neoplasms - diagnosis, Fatal Outcome, Recurrence, Tomography, X-Ray Computed