PT  - JOURNAL ARTICLE
AU  - Giselle Alexandra Suero-Abreu
AU  - Jia Zhen Cheng
AU  - Ryna Karina Then
TI  - Multiple recurrent ischaemic strokes in a patient with cancer: is there a role for the initiation of anticoagulation therapy for secondary stroke prevention?
AID  - 10.1136/bcr-2016-218105
DP  - 2017 Jun 03
TA  - BMJ Case Reports
PG  - bcr-2016-218105
VI  - 2017
4099  - http://casereports.bmj.com/content/2017/bcr-2016-218105.short
4100  - http://casereports.bmj.com/content/2017/bcr-2016-218105.full
AB  - A 52-year-old woman with a medical history of cervical and thyroid cancer, hypertension, dyslipidaemia, uncontrolled diabetes and heavy smoking was diagnosed with a new metastatic cholangiocarcinoma. While undergoing palliative chemotherapy, she developed dysarthria and left-sided weakness. Imaging studies showed multiple bilateral ischaemic strokes. On hospital days 2 and 5, she developed worsening neurological symptoms and imaging studies revealed new areas of ischaemia on respective days. Subsequent workup did not revealed a clear aetiology for the multiple ischaemic events and hypercoagulability studies were only significant for a mildly elevated serum D-dimer level. Although guidelines are unclear, full-dose anticoagulation with low molecular weight heparin was initiated given her high risk of stroke recurrence. She was discharged to acute rehabilitation but, within a month, she experienced complications of her malignant disease progression and a new pulmonary thromboembolism. The patient died soon after being discharged home with hospice care.