Adenomyosis-associated recurrent acute cerebral infarction mimicking Trousseau’s syndrome: A case study and review of literature
- Department of Neurosurgery, Takashimadaira Central General Hospital, Itabashiku, Tokyo, Japan.
Nobuhiko Arai, Department of Neurosurgery, Takashimadaira Central General Hospital, Itabashiku, Tokyo, Japan.
DOI:10.25259/SNI_252_2022Copyright: © 2022 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Nobuhiko Arai, Kazunari Yachi, Ryutaro Ishihara, Takao Fukushima. Adenomyosis-associated recurrent acute cerebral infarction mimicking Trousseau’s syndrome: A case study and review of literature. 29-Apr-2022;13:179
How to cite this URL: Nobuhiko Arai, Kazunari Yachi, Ryutaro Ishihara, Takao Fukushima. Adenomyosis-associated recurrent acute cerebral infarction mimicking Trousseau’s syndrome: A case study and review of literature. 29-Apr-2022;13:179. Available from: https://surgicalneurologyint.com/surgicalint-articles/11565/
Background: Adenomyosis is a common and benign uterine disease. Acute cerebral infarction (CI) associated with adenomyosis is rarely reported and difficult to treat. We experienced successful treatment for this disease.
Case Description: A 50-year-old woman presented with a 2-day history of visual disturbance. Magnetic resonance imaging showed multiple tiny diffusion-weighted high-density spots on several lobes. No common risk factors for stroke were detected. Cancer antigen 125 level was 999 U/mL, along with massively expanded uterus and adnexa. Based on the diagnosis of benign adenomyosis, Xa inhibitor and GnRH agonists were administered for CI and adenomyosis, respectively. Acute CI recurred 7 days after admission. We suspected a relationship between infarction and adenomyosis and concluded hysterectomy as a proper treatment strategy based on the literature. Eighteen months after hysterectomy, no recurrence of CI without anti-thrombus medications has been detected.
Conclusion: Hysterectomy is a radical therapy that is effective in preventing acute CI due to adenomyosis associated with ischemic symptoms.
Keywords: Acute cerebral infarction, Adenomyosis, CA125, Hysterectomy, Trousseau’s syndrome
Adenomyosis is a common and benign uterine disease. The formation of uterine glands and stroma in the endometrial membrane is the pathological trait of this disease. This disease presents with abnormal uterine bleeding, pelvic pain, and uterine growth in volume with a prevalence of 20–35% in women.[
A 50-year-old woman presented with a 2-day history of visual disturbance that was later identified as left-sided hemianopsia. Magnetic resonance imaging (MRI) revealed multiple acute CIs in almost all lobes [
In this case, we experienced acute CI associated with adenomyosis which recurs as early as 7 days after the initial attack under the Xa inhibitor. From this case, we found that Xa inhibitor is not potent enough to prevent recurrence of CI and hysterectomy which assumed to be radical treatment for CI and adenomyosis should be performed within 7 days after the first symptom.
Adenomyosis is relatively common female disease, from which around 20–30% of all woman have suffered in the world.[
The radical treatment for adenomyosis associated with acute CIs must be hysterectomy. The present case showed recurrent CI under the anti-coagulant agents which is Xa inhibitor which would be ideal theoretically. In the past two cases presented recurrent CI under the anti-thrombus medication with GnRH agonists for adenomyosis.[
Adenomyosis can lead to the recurrent acute CIs. Hysterectomy could be a radical and appropriate treatment for those condition.
The authors certify that they have obtained all appropriate patient consent.
There are no conflicts of interest.
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