Anti cancers
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Carotid arterial thrombus and stroke: case report A 63-year-old woman developed carotid arterial thrombus and stroke following treatment with folinic acid, fluorouracil, irinotecan and cetuximab for sigmoid adenocarcinoma [duration of treatment to reaction onset not stated]. The woman, who had a history of stage 4 sigmoid adenocarcinoma, presented to hospital in Taiwan with consciousness change and right hemiparesis. She had been receiving chemotherapy with folinic acid, fluorouracil and irinotecan (FOLFIRI regimen) along with cetuximab targeted therapy [route and dosage not stated] after lower anterior resection. She had taken her last chemotherapy (fifth 5th cycle) 4 days prior. On presentation, her vital signs were normal, and she was alert. Neurological examination showed speech problems with right-sided limb weakness. Her symptoms were incorrect naming, non-fluent speech output, fair comprehension, word substitution with intact repetition and obedience on secondary commands. Her National Institute of Health Stroke Scale score was 6 out of 42. A brain CT scan was non-significant for intracranial haemorrhage, and she was administered unspecified tissue plasminogen activator. Echocardiography was insignificant for intracardiac thrombus. However, brain MRI revealed acute infarction in the parietal lobe and left insula, and MRI angiography showed an occlusion of the Sylvian and cortical M3 segment of the left middle cerebral artery and vague plaque image in the left internal carotid artery of the neck. Coagulation study revealed normal prothrombin time, partial thrombin time, antithrombin III and fibrinogen with elevated D-dimer. Other lab reports were normal, including the tumour markers CA-199 and CEA. Based on the findings, chemotherapy induced carotid arterial thrombus and stroke was considered. The woman’s weakness improved slightly on day 2; however, her motor aphasia persisted. On day 5, neurosonography showed thick atherosclerotic plaque in the left carotid bulb, and she was initiated on dabigatran on day 7. Follow-up neurosonography on day 10 showed the presence of the plaque image, which disappeared on day 24. She was discharged with mild motor dysphasia and no motor weakness. She received dabigatran for 3 months and later received aspirin to prevent thrombus formation. Along with this, she received chemotherapy with tegafur. No recurrence was noted after the 18-month follow-up. Wu B-C, et al. The resolution of carotid arterial thrombus by oral anticoagulation after IV thrombolysis for chemotherapy-induced stroke: A case report. Medicine 99: e21922, 803504065 No. 35, 28 Aug 2020. Available from: URL: http://doi.org/10.1097/MD.0000000000021922
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Reactions 3 Oct 2020 No. 1824
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