No abstract

Introduction: Hypercoagulable state may be an important first presentation in malignancies especially pancreatic cancer. The trousseau syndrome is caused by venous thrombosis, non-bacterial thrombotic endocarditis and arterial thrombosis. We describe a patient who had the cerebral infarction as the initial manifestation of pancreatic cancer and we discuss that full work up for every patient with atypical stroke should be done. Case Presentation: We report a 67-year-old man who developed multiple cerebral infarctions as the initial manifestation of pancreatic cancer. Cancer antigen 19-9 (CA 19-9) was 52,065 U/mL (Normal value: 0 -33 U/mL), computerized tomography (CT) scan of the abdomen showed multiple hypodensities in both lobes of the liver and Heterogeneous hypodensity was seen in the pancreas that was highly suggestive of pancreas adenocarcinoma and was confirmed with the biopsy. Conclusions: In the case of multiple brain infarctions in both anterior and posterior circulation, without evidence of common cause, trousseau syndrome and hypercoagulability state should be considered.

Pantothenate Kinase-associated Neurodegeneration (PKAN) is an autosomal recessive disorder that is caused by variation in pantothenate kinase-2 gene (PANK2) gene on chromosome 20. The common presentation of this disease includes progressive dystonia, Parkinsonism, retinopathy, cognitive impairment, and spasticity. The typical magnetic resonance imaging finding is eye of the tiger sign in globus pallidus and not pathogenic and not found in all patients. In the present study, we describe two siblings who have a novel variation of the PANK2 gene. These patients with the same genotype, have different ages at the onset of disease and also the various severity of the disease. The description of these cases helps to understand this disease, its symptoms, pathogenesis, and its treatment.

Neuromyelitis Optica (NMO) is a rare disease of the central nervous system that causes optic nerve and spinal cord involvement. The our patient first developed acute paraplegia that was treated with intravenous methylprednisolone with diagnosis of acute thoracic myelitis according to magnetic resonance imaging (MRI) finding , concurrently with tapering of oral prednisolone, again affected by quadriplegia and respiratory failure. She was seropositivity for NMO-IgG that was negative in first admission and MRI of spine shows hyperintense lesion in whole cervical and upper thoracic MRI. With considering the findings, NMO was diagnosed and the plasmapheresis starts for her. We report a case of this syndrome because it can increase the physician's awareness of the unusual manifestations of this syndrome.