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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Recurrent Stroke Due to Metastatic Pulmonary Tumor Emboli as an Important Clinical Entity
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Recurrent Stroke Due to Metastatic Pulmonary Tumor Emboli as an Important Clinical Entity

机译：由于转移性肺肿瘤栓子作为重要临床实体，复发性卒中

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摘要

We present an autopsy case of repetitive stroke due to tumor emboli, indistinguishable from thromboembolism with a hypercoagulable state in its clinical course. A 72-year-old man diagnosed with stage IVA oropharyngeal squamous cell carcinoma received chemoradiotherapy. Follow-up imaging revealed mediastinal lymph nodes and pulmonary metastasis. One year later, the patient experienced right arm weakness, and brain magnetic resonance imaging showed acute ischemic lesions in multiple vascular territories. He was diagnosed with paradoxical cerebral embolism due to cancer-associated venous thrombosis and treated with rivaroxaban. However, newly developed cerebral infarcts were confirmed 1 month later. Then, rivaroxaban treatment was switched to subcutaneous unfractionated heparin injection. He was admitted again for stroke recurrence and died of respiratory failure 8 days after admission. Autopsy demonstrated pulmonary metastasis invading the veins and tumor emboli in the culprit cerebral arteries. D-dimer was kept constant at a slightly higher level, ranging from 1 to 3 mu g/mL during the course of recurrence. We should consider tumor embolism in the differential diagnosis of recurrent stroke along with pulmonary tumor and resistance to heparin preparations with unchanged D-dimer levels.
机译：由于肿瘤栓子，我们提出了一种重复行程的尸检案例，在其临床课程中与血栓栓塞中难以区分。一名72岁的男子被诊断出患有阶段IVA口咽鳞状细胞癌接受化学疗法。后续成像显示纵隔淋巴结和肺转移。一年后，患者经历了右臂的弱点，脑磁共振成像显示出多个血管领域的急性缺血病变。由于癌症相关的静脉血栓形成，他被诊断出患有矛盾的脑栓塞，并用柠檬树治疗。然而，新开发的脑梗死1月后确认。然后，将亚甲氧基兰处理切换到皮下未分割的肝素注射液。他再次被卒中复发，并在入院后8天死于呼吸衰竭。尸检证明患有罪魁祸首脑动脉中的脉络和肿瘤栓塞的肺转移。 D-二聚体在稍高的水平下保持恒定，在复发过程中为1至3μg/ ml。我们应该考虑肿瘤栓塞在经常性卒中的鉴别诊断中，以及肺肿瘤和肝素制剂的抗肺肿瘤，具有不变的D-二聚体水平。

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