Moffitt AM report PEARLS 9/2: Multiple brain infarcts and stroke w/u, malignant pleural effusions

UPDATE 9/3: Thank you to HH for this great recent article in the Annals of Neurology on the association between cancer and subsequent stroke (related to cancer-mediated hypercoagulability)!Cancer and stroke

  • Take-home pearl: For patients with multiple brain infarcts in no particular anatomical distribution, worry about a more proximal source of emboli – ddx includes endocarditis (in a patient with malignancy, think marantic endocarditis), other endovascular infections, vasculitis, hypercoagulability.
  • Standard stroke w/u: CTA or MRA of the head and neck, TTE +/- TEE with bubble, EKG and telemetry (x48h) (r/o afib), and risk stratification with lipids and A1c
    • Want to r/o afib, cardioembolic phenomena, aortic arch atherosclerosis, carotid atherosclerosis, and intracranial vessel disease
  • Other pearls from the morning:
    • Overall, malignant pleural effusions portend a poor prognosis (median survival <4 mos). PleurX for malignant pleural effusions can help with sx relief esp in pts with rapidly accumulating effusions. Check out the attached JGIM review by some of our own UCSFers, Kana McKee and Jeff Kohlwes!
    • Meig’s syndrome is the triad of ascites, hydrothorax, and benign ovarian tumor – resolves with resection of tumor! Pseudo-Meig’s is characterized by hydrothorax, ascites, and malignant ovarian tumors or other pelvic tumors.
  • Bonus pearls:
    • PICA stroke = posterior inferior cerebellar artery = largest branch of the vertebral artery, supplying the cerebellum!
    • Xeloda = capecitabine = prodrug of fluorouracil

Evernote: https://www.evernote.com/shard/s34/sh/26b9445b-4514-4a01-8396-1dbccaeebbbb/1de69834e06df2c797abb4578df5d505

Pleurex for malignant pleural effusions VanMeter

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