J Neurocrit Care.  2019 Dec;12(2):113-116. 10.18700/jnc.190096.

Huge uterine myoma as a cause of thromboemobolic stroke

• Lee HJ
• Shin DH

• KMID: 2470474
• DOI: http://doi.org/10.18700/jnc.190096

Abstract

BACKGROUND
Embolic stroke undetermined source (ESUS), which is defined as nonlacunar infarction in the absence of cardioembolic sources, proximal artery stenosis excluded by echocardiogram, holter monitoring and vascular images, is reported to account for 9% to 25% of ischemic stroke. Because the source of embolism remains unclear, it is an important task to find the etiology for secondary prevention of stroke recurrent.
CASE REPORT
We report a case of uterine myoma found in an embolic stroke patient with incidentally found a huge uterine myoma and related deep vein thrombosis.
CONCLUSION
Uterine myoma in a middle-aged woman can be thought to be the etiological cause that can contributor to deep vein thrombosis, and it is necessary to pay attention as the etiology of ESUS.

Keyword

Embolic stroke undetermined source; Embolic stroke; Myoma

MeSH Terms

Arteries
Constriction, Pathologic
Electrocardiography, Ambulatory
Embolism
Female
Humans
Infarction
Leiomyoma*
Myoma
Secondary Prevention
Stroke*
Venous Thrombosis

Figure

• 

  Fig. 1. Brain computed tomography (CT) and CT angiography were performed immediately after arrival at the emergency room. (A) There was no remarkable finding on brain CT. (B) Cerebral blood flow and (C) cerebral blood volume map shows decreased perfusion of the left midbrain (arrows). (D) Mean transit time map shows a prolongation within the same region (arrowhead), indicative of core infarct in the left midbrain. (E) There were no stenosis or occlusion on basilar artery and the other vessels.

• 

  Fig. 2. (A) Diffusion-weighted imaging, performed after 1 day from symptom onset, showed acute ischemic lesion in the bilateral thalamus, midbrain, pons and right cerebellum (arrows). (B) Magnetic resonance angiography which was performed after 1 day from symptom onset, showed no stenosis or occlusion.

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  Fig. 3. (A) There was a 7.5 cm uterine myoma with several small myomas in pelvic cavity (arrow). (B) Femoral computed tomographic angiography reveals contrast filling defects in the right external iliac vein, left internal iliac vein (arrowheads).

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