Abstract
We describe here a patient with cerebral infarction induced by nonbacterial thrombotic endocarditis (NBTE) with cervical cancer. The patient was a 42-year-old woman who suffered from cerebral infarction in the territories of the left middle cerebral artery and right posterior cerebral artery. She was diagnosed as having cryptogenic stroke and was discharged from our hospital on Day 11, taking clopidogrel to prevent a second stroke. However, she suffered from recurrent cerebral infarction on Day 12, and was readmitted to our hospital on Day 13. Diffusion-weighted imaging on readmission (Day 13) revealed multiple high intensity areas in the territories of the bilateral middle cerebral artery and left posterior cerebral artery. Transthoracic echocardiography on admission demonstrated no vegetation; however, that on Day 14 showed vegetation (11 mm×8 mm) of the posterior mitral leaflet, while that on Day 35 showed no vegetation of the mitral valve. The patient was diagnosed as having cardioembolic stroke induced by NBTE. Intravenous infusion of heparin sodium was then started, while she continued to take clopidogrel. On Day 42, she was transferred to the Department of Obstetrics and Gynecology at our hospital for radiation therapy of her cervical cancer. Although NBTE induced by cervical cancer is rare, extensive workup for embolic sources including vegetation by transthoracic or transesophageal echocardiography should be repeated in such patients with cryptogenic stroke.
