Multiple embolic infarctions and intracranial hemorrhage in a patient with gestational trophoblastic disease

Abstract

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 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.

Keywords

• gestational trophoblastic disease
• stroke
• intracranial hemorrhage