Recurrent embolic stroke associated with adenomyosis: A single case report and literature review.

Autor: Morishima Y; Department of Neurology, Graduate School of Medical Sciences, University of Yamanashi, 1110 Shimokato, Chuo-Shi, Yamanashi, 409-3898, Japan., Ueno Y; Department of Neurology, Graduate School of Medical Sciences, University of Yamanashi, 1110 Shimokato, Chuo-Shi, Yamanashi, 409-3898, Japan. uenoy@yamanashi.ac.jp., Satake A; Department of Neurology, Graduate School of Medical Sciences, University of Yamanashi, 1110 Shimokato, Chuo-Shi, Yamanashi, 409-3898, Japan.; Department of Neurology, Fuefuki Central Hospital, Yamanashi, Japan., Fukao T; Department of Neurology, Graduate School of Medical Sciences, University of Yamanashi, 1110 Shimokato, Chuo-Shi, Yamanashi, 409-3898, Japan.; Department of Neurology, Fuefuki Central Hospital, Yamanashi, Japan., Tsuchiya M; Department of Neurology, Graduate School of Medical Sciences, University of Yamanashi, 1110 Shimokato, Chuo-Shi, Yamanashi, 409-3898, Japan., Hata T; Department of Neurology, Graduate School of Medical Sciences, University of Yamanashi, 1110 Shimokato, Chuo-Shi, Yamanashi, 409-3898, Japan., Ogawa T; Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, University of Yamanashi, Yamanashi, Japan., Oishi N; Department of Pathology, Graduate School of Medical Sciences, University of Yamanashi, Yamanashi, Japan., Nakajima S; Department of Neurology, Graduate School of Medical Sciences, University of Yamanashi, 1110 Shimokato, Chuo-Shi, Yamanashi, 409-3898, Japan., Hirata S; Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, University of Yamanashi, Yamanashi, Japan., Shindo K; Department of Neurology, Graduate School of Medical Sciences, University of Yamanashi, 1110 Shimokato, Chuo-Shi, Yamanashi, 409-3898, Japan., Takiyama Y; Department of Neurology, Graduate School of Medical Sciences, University of Yamanashi, 1110 Shimokato, Chuo-Shi, Yamanashi, 409-3898, Japan.; Department of Neurology, Fuefuki Central Hospital, Yamanashi, Japan.
Jazyk: angličtina
Zdroj: Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology [Neurol Sci] 2023 Jul; Vol. 44 (7), pp. 2421-2429. Date of Electronic Publication: 2023 Feb 23.
DOI: 10.1007/s10072-023-06701-3
Abstrakt: Introduction: Uterine adenomyosis is a benign disorder in which endometrial glands and stroma are present within the myometrium. There have been several case reports of cerebral infarction associated with adenomyosis, but their clinical characteristics, optimal treatment, and prognosis have not been systematically reviewed.
Methods: A case of cerebral infarction with adenomyosis is reported, and a comprehensive systematic literature search using the PubMed database was conducted.
Results: A 42-year-old woman, previously diagnosed with adenomyosis, developed multiple cerebral infarctions during menstruation. Her CA125 level was 293 U/mL, and treatment with edoxaban 30 mg was started. Seven days after hospital discharge, she had her subsequent menstrual period and then developed a recurrent stroke. Her CA125 level was 743 U/mL on readmission. A hysterectomy was performed, and the patient has had no further stroke recurrence. A systematic review identified 19 cases with cerebral infarction associated with adenomyosis, including the present case. The patients' clinical characteristics included young age (44.7 ± 6.2 years), stroke development during menstruation (85%), multiple infarctions affecting ≥ 3 vessel territories (39%), and high levels of CA125 and D-dimer (810.6 ± 888.4 U/mL, and 10.3 ± 18.6 μg/mL, respectively). Antithrombotic therapy was given to 14 patients, but recurrent stroke occurred in 5 (36%) patients. Hysterectomy was conducted in 5 and 4 patients with initial and recurrent stokes, respectively, and there were no further recurrences thereafter.
Conclusion: Cerebral infarction associated with adenomyosis has specific clinical characteristics. Antithrombotic therapy was insufficient, and hysterectomy should particularly be considered in cases of recurrent stroke.
(© 2023. Fondazione Società Italiana di Neurologia.)
Databáze: MEDLINE
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