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23-02-2023 | Stroke | Original Article

Recurrent embolic stroke associated with adenomyosis: A single case report and literature review

Authors: Yuto Morishima, Yuji Ueno, Akane Satake, Toko Fukao, Mai Tsuchiya, Takanori Hata, Tatsuyuki Ogawa, Naoki Oishi, Sho Nakajima, Shuji Hirata, Kazumasa Shindo, Yoshihisa Takiyama

Published in: Neurological Sciences | Issue 7/2023

Abstract

Introduction

Uterine adenomyosis is a benign disorder in which endometrial glands and stroma are present within the myometrium. There have been several case reports of cerebral infarction associated with adenomyosis, but their clinical characteristics, optimal treatment, and prognosis have not been systematically reviewed.

Methods

A case of cerebral infarction with adenomyosis is reported, and a comprehensive systematic literature search using the PubMed database was conducted.

Results

A 42-year-old woman, previously diagnosed with adenomyosis, developed multiple cerebral infarctions during menstruation. Her CA125 level was 293 U/mL, and treatment with edoxaban 30 mg was started. Seven days after hospital discharge, she had her subsequent menstrual period and then developed a recurrent stroke. Her CA125 level was 743 U/mL on readmission. A hysterectomy was performed, and the patient has had no further stroke recurrence. A systematic review identified 19 cases with cerebral infarction associated with adenomyosis, including the present case. The patients’ clinical characteristics included young age (44.7 ± 6.2 years), stroke development during menstruation (85%), multiple infarctions affecting ≥ 3 vessel territories (39%), and high levels of CA125 and D-dimer (810.6 ± 888.4 U/mL, and 10.3 ± 18.6 μg/mL, respectively). Antithrombotic therapy was given to 14 patients, but recurrent stroke occurred in 5 (36%) patients. Hysterectomy was conducted in 5 and 4 patients with initial and recurrent stokes, respectively, and there were no further recurrences thereafter.

Conclusion

Cerebral infarction associated with adenomyosis has specific clinical characteristics. Antithrombotic therapy was insufficient, and hysterectomy should particularly be considered in cases of recurrent stroke.

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Title: Recurrent embolic stroke associated with adenomyosis: A single case report and literature review
Authors: Yuto Morishima
Yuji Ueno
Akane Satake
Toko Fukao
Mai Tsuchiya
Takanori Hata
Tatsuyuki Ogawa
Naoki Oishi
Sho Nakajima
Shuji Hirata
Kazumasa Shindo
Yoshihisa Takiyama
Publication date: 23-02-2023
Publisher: Springer International Publishing
Keywords: Stroke
Edoxaban
Hysterectomy
GnRH Agonists
Published in: Neurological Sciences / Issue 7/2023
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI: https://doi.org/10.1007/s10072-023-06701-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Recurrent embolic stroke associated with adenomyosis: A single case report and literature review

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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