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

대한신경집중치료학회지 2020년 13권 2호 p.123 ~ 127
김경영, 정승욱, 윤창효, 정희정, 조은빈, 양태원, 김승주, Hwang Sean, 박기종,
소속 상세정보
김경영 ( Kim Kyong-Young ) - Gyeongsang National University Changwon Hospital Department of Internal Medicine
정승욱 ( Jung Seung-Uk ) - Gyeongsang National University Changwon Hospital Department of Neurology
윤창효 ( Yoon Chang-Hyo ) - Gyeongsang National University Changwon Hospital Department of Neurology
정희정 ( Jeong Hee-Jeong ) - Gyeongsang National University Changwon Hospital Department of Neurology
조은빈 ( Cho Eun-Bin ) - Gyeongsang National University Changwon Hospital Department of Neurology
양태원 ( Yang Tae-Won ) - Gyeongsang National University Changwon Hospital Department of Neurology
김승주 ( Kim Seung-Joo ) - Gyeongsang National University Changwon Hospital Department of Neurology
 ( Hwang Sean ) - Gyeongsang National University Changwon Hospital Department of Neurology
박기종 ( Park Ki-Jong ) - Gyeongsang National University Changwon Hospital Department of Neurology

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 <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.

키워드

Gestational trophoblastic disease; Stroke; Intracranial hemorrhage

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