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Open Access Case report

Co-occurrence of multiple cerebral infarctions due to hypercoagulability associated with malignancy and meningeal carcinomatosis as the initial manifestation of gastric cancer

Akiko Kawasaki1, Keisuke Suzuki1*, Hidehiro Takekawa1, Toshiki Nakamura2, Masanari Yamamoto1, Yohei Asakawa1, Madoka Okamura1 and Koichi Hirata1

Author Affiliations

1 Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga 321-0293, Tochigi, Japan

2 Department of Neurology, Rehabilitation Amakusa Hospital, Koshigaya, Saitama, Japan

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BMC Neurology 2014, 14:160  doi:10.1186/s12883-014-0160-9

Published: 8 August 2014

Abstract

Background

Meningeal carcinomatosis and hypercoagulability associated with malignancy are typical late stage complications in cancer patients. The co-occurrence of meningeal carcinomatosis and cerebral infarction related to hypercoagulability associated with malignancy in an individual as the initial manifestation of malignancy has not been previously reported.

Case presentation

Herein, we report the case of an 80-year-old patient who presented with meningeal carcinomatosis and hypercoagulability related to malignancy as the initial manifestation of occult gastric cancer. The patient displayed consciousness disturbance, mild left facial paralysis, and bilateral positive Babinski’s sign. Using brain magnetic resonance imaging, the patient was diagnosed as having acute multiple cerebral infarctions. Cerebrospinal fluid (CSF) cytology showed adenocarcinoma and upper gastrointestinal endoscopy disclosed scirrhous gastric cancer. The patient presented with headache, fever, and meningeal irritation with a subacute course. Tuberculous or fungal meningitis was initially suspected; however, cytological evidence of adenocarcinoma in the CSF led to the diagnosis of meningeal carcinomatosis.

Conclusion

The comorbidity of hypercoagulability associated with malignancy and meningeal carcinomatosis should be considered in a patient presenting with multiple cerebral infarctions, progressive disturbance of consciousness, fever, and meningeal irritation.

Keywords:
Multiple cerebral infarctions; Disturbance of consciousness; Meningeal irritation; Trousseau’s syndrome; Meningeal carcinomatosis; Gastric cancer