Recurrent ischemic stroke of undetermined cause revealed an occult malignancy

Excerpt

A causal relationship between malignant cancer and thrombosis has been known since 1865, when Armand Trousseau described migratory thrombosis as the first manifestation of an occult malignancy, suggesting the existence of paraneoplastic hypercoagulable state [1]. The paraneoplastic hypercoagulability as a possible etiology of ischemic stroke is debated, also because there are no exams that may conclusively detect the thrombophilic state [2]. Guidelines for the diagnostic evaluation and treatment of ischemic stroke consider hypercoagulable state as an uncommon cause of ischemic stroke. Acknowledged hypercoagulable states include inherited thrombophilia, antiphospholipid antibodies syndrome, hyperhomocysteinemia, or the pregnancy, not mentioning the possibility of paraneoplastic thrombophilia [3]. The exact pathophysiology of paraneoplastic thrombophilia and the best diagnostic and therapeutic strategy remain unknown, especially in the presence of early recurrences. We describe the case of a patient with a first-ever ischemic stroke and early multiple stroke recurrences in different vascular territories as the clinical presentation of an occult neoplasm. …