Multiple Cerebral Infarctions Complicating Deep Vein Thrombosis Associated With Uterine Adenomyosis: A Case Report and Literature Review

Abstract

We describe a 46-year-old woman who developed multiple cerebral infarctions in the left middle cerebral artery territory and deep vein thrombosis, presumably related to uterine adenomyosis. Uterine adenomyosis can cause coagulation abnormalities, as observed in Trousseau's syndrome. Along with previous reports, our case experienced a stroke during menstruation and presented with increased cancer antigen 125 (CA125) levels. A hysterectomy was performed to prevent the recurrence of cerebral infarction. Our case also had complicated deep vein thrombosis, which is also known as a complication of uterine adenomyosis. We consider cerebral infarction and deep vein thrombosis with uterine adenomyosis might be caused by a common mechanism, hypercoagulation. Hysterectomy requires careful discussion before undergoing it because of fertility problems, but it might be the most effective approach for preventing the recurrence of brain infarction derived from adenomyosis and may be effective for both cerebral infarction and deep vein thrombosis.

Isolated distal deep vein thrombosis associated with adenomyosis: Case report and literature review

“…Among these cases, multiple cerebral infarctions were the most frequently observed, accounting for 18 out of 33 cases (54.5%). Notably, seven of these cases (38.9%) exhibited systemic embolism, 4 , 5 , 10 , 14 , 16 , 18 resembling Trousseau's syndrome commonly seen in cancer patients. These observations suggest that hypercoagulability may play a significant role in the pathogenesis of thrombotic complications related to adenomyosis.…”

“… 26 Limited data are available regarding other types of thrombotic events. To further investigate this association, we conducted a literature search on PubMed using the terms “adenomyosis AND thrombo OR infarction.” This search strategy yielded a total of 22 eligible case or series reports (Table 1 ), including 25 cases (75.7%) of ischemic stroke, 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 6 cases (18.2%) of PE, 22 , 23 and 2 cases (6.1%) of DVT. 24 , 25 The median age of these documented patients was 45 years (range 34–59), with a tendency to experience thrombotic events during menstrual cycles.…”

“…The association between CA125 levels and the severity of adenomyosis remains uncertain. Nonetheless, a pooled analysis of 23 documented stroke cases 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 with CA125 measurements revealed a significant increase in CA125 levels among nine individuals (cases 1, 2, 5, 10, 17–19, 21, 24) experiencing systemic embolism (defined as stroke complicating extremity or organ embolism) and/or recurrent embolism, in contrast to the 14 cases (cases 4, 6–9, 11–16, 20, 23, 25) with isolated and nonrecurrent embolism (see Figure 3 ). This preliminary investigation emphasizes the need for further research to establish the potential value of CA125 in the treatment and monitoring of thrombotic complications associated with adenomyosis.…”

“… 2 In 1991, Kupryjańczyk described a case of intravascular endometriosis with thrombosis in a patient diagnosed with adenomyosis. 3 Subsequently, several isolated case reports and case series have documented the occurrence of ischemic stroke 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 and pulmonary embolism (PE) 22 , 23 in patients with adenomyosis, suggesting a possible association with hypercoagulability induced by this disorder. However, there are few reports of cases complicated by isolated deep vein thrombosis (DVT).…”