脳梗塞を契機に診断に至った，卵巣癌に伴う非細菌性血栓性心内膜炎の１例

DOI 参考文献12件
  • 梅原 藤雄
    鹿児島大学大学院医歯学総合研究科神経内科・老年病学
  • 野元 三治
    鹿児島大学大学院医歯学総合研究科神経内科・人体がん病理学
  • 簗詰 伸太郎
    鹿児島大学大学院医歯学総合研究科神経内科・産婦人科

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  • A case of cerebral infarction due to nonbacterial thrombotic endocarditis associated with ovarian cancer

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We report a case of cerebral infarction due to nonbacterial thrombotic endocarditis (NBTE) associated with ovarian cancer. This 38-year-old woman hed begun to notice transient visual loss with pain in her right eye once a week since August 2002. Each episode continued for approximately 30 sec, and then spontaneously dissolved. In September, she had suddenly noticed difficulty in speaking. She consulted us in October 2002. Brain MRI revealed evidence of new acute ischemic strokes in the bilateral cerebrum. Transesophageal echo-cardiography demonstrated a mass on the mitral valve thought to represent a thrombus or vegetation. Pelvic MRI revealed massive ascites with an ovarian mass. Although empiric treatment with intravenous antibiotics and anti-coagulation therapy (warfarin and aspirin) was started, the size of mass attached to the mitral valve gradually enlarged. The patient then underwent surgery for removal of the mass on the mitral valve. De-bridement and plasty of the mitral valve were achieved with preservation of valvular function. Pathological examinations of the surgical material confirmed a diagnosis of NBTE. Two months after the cardiac operation, an operation for the ovarian mass was performed. The pathology revealed a poorly differentiated adenocarcinoma in the right ovary. Immunohistochemical studies for mucin showed that the tumor cells were positive for MUC1, MUC4, and MUC16, but negative for MUC2, MUC3, MUC5AC, and MUC6. NBTE associated with cancer should be considered as one of the causes of brain infarction.

収録刊行物

  • 脳卒中

    脳卒中 28 (2), 306-312, 2006

    一般社団法人 日本脳卒中学会

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