Metastatic Ovarian Cancer Discovered After Recurrent Embolic Strokes

What happened, in summary

A 36-year-old woman first came to the hospital after a brief episode of headache, visual disturbance, memory difficulty, and other symptoms that had already resolved. Brain MRI showed many small embolic infarcts, but an extensive cardiac, vascular, and neurological evaluation did not identify a cause. She was discharged on aspirin.

Seven weeks later, she returned with aphasia and right-sided paralysis from another major stroke. She received clot-dissolving treatment and underwent successful cerebral artery thrombectomy, with good motor recovery but persistent expressive aphasia. During that admission, new abdominal symptoms led to CT imaging that showed a 6.4 x 3.9 cm right ovarian mass, enlarged retroperitoneal nodes, and pelvic fluid. A left axillary lymph-node sample showed metastatic adenocarcinoma. She was diagnosed with metastatic ovarian cancer, documented as Stage IV. No ovarian tissue specimen was obtained, so the subtype remained uncertain, although papillary serous ovarian cancer was considered most likely.

Because of her complex medical condition, she was not considered suitable for cancer surgery. Her plan included palliative-team support and 3 cycles of paclitaxel and carboplatin. She received 1 cycle on day 33 of the admission and died on day 54. Her case links recurrent unexplained thrombotic strokes with the later discovery of advanced ovarian malignancy.