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KMID : 1201420200130020123
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Journal of Neurocritical Care
2020 Volume.13 No. 2 p.123 ~ p.127
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Multiple embolic infarctions and intracranial hemorrhage in a patient with gestational trophoblastic disease
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Kim Kyong-Young
Jung Seung-Uk
Yoon Chang-Hyo
Jeong Hee-Jeong
Cho Eun-Bin
Yang Tae-Won
Kim Seung-Joo
Hwang Sean
Park Ki-Jong
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Abstract
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Background: Choriocarcinoma is a subtype of gestational trophoblastic disease (GTD) that can spread to multiple organs, including the central nervous system. Most cases of GTD affecting the central nervous system can cause intra- or extra-axial hemorrhages. Herein, we describe a rare case of multiple embolic infarctions and intracranial hemorrhages in a patient with GDT.
Case Report: A 36-year-old woman with sudden headache and right homonymous hemianopsia was admitted to our hospital 19 hours from symptom onset. Brain magnetic resonance imaging revealed small acute infarctions in the territories of the left posterior cerebral artery and both middle cerebral arteries. Furthermore, intracerebral hemorrhage in the left occipital lobe, small amounts of intraventricular hemorrhage, and subarachnoid hemorrhage were observed. In the past, she gave birth to her child through cesarean section 6 months ago. D-dimer level was elevated with a value of 1.61 μg/mL (reference range <0.5 μg/mL). Her urine beta-human chorionic gonadotropin (hCG) was positive, and her serum beta-hCG level was >1,000 IU/mL. She was diagnosed with GTD and underwent chemotherapy.
Conclusion: The precise pathogenesis of the coexistence of multiple embolic infarctions and intracranial hemorrhage remains unclear. Cancer-related coagulopathy, micro-tumor emboli, or both could be involved in the pathogenesis of the rare presentation of this patient.
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KEYWORD
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Gestational trophoblastic disease, Stroke, Intracranial hemorrhage
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