Cerebral ischaemia secondary to non-bacterial thrombotic endocarditis as the presenting symptom of an ovarian tumour

Introduction. In cancer patients, cerebrovascular accidents (CVA) are the most common complication occurring in the central nervous system after metastasis. One of its causations is non-bacterial thrombotic endocarditis (NBTE), which appears on rare occasions as the first symptom of the tumour The clinical manifestations of NBTE are the result of multiple systemic embolism. Emboli consist of platelets and strands of fibrin that are deposited in the valves of the heart, within a context of a state of hypercoagulability secondary to the tumour. The tumours that are most frequently associated to NBTE are mucin-secreting adenocarcinomas. Cases of ovarian cancer with NBTE are rare in the different series reported in the literature. Case report. We describe the case of a 58-year-old female, previously asymptomatic, who suddenly showed a lowered level of consciousness, hemiplegia on the right-hand side and motor aphasia. A computerised axial tomography scan taken at 48 hours showed two acute ischaemic lesions in the left hemisphere. Magnetic resonance imaging of the brain with diffusion sequences revealed multiple ischaemic lesions in different arterial territories. Transthoracic echocardiography at 24 hours showed a vegetation on the posterior leaflet of the mitral valve. The patient was treated with intravenous sodium heparin and no new CVA appeared. The valve injuries disappeared after treatment. In a study conducted to search for occult neoplasia, a tumour was found in the right ovary. Conclusions. NBTE must be taken into account in cases of cerebral embolism due to unknown causes. The results of the analyses of most patients reveal chronic disseminated intravascular coagulation. The most valuable diagnostic tests are the transesophageal echocardiogram and magnetic resonance imaging of the brain with diffusion sequences. Preferred treatment is with heparin.