“Recurrent multiple cerebral infarctions related to the progression of adenomyosis: a case report”

Yasuhiro Aso, Ryo Chikazawa, Yuki Kimura, Noriyuki Kimura, Etsuro Matsubara
BMC neurology · 2018 · vol. 18(1) , pp. 119 · doi:10.1186/s12883-018-1117-1 · PMID:30129425 · PMC6102810 · W2888343932
article OA: gold CC0 ⤵ 17 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This case report describes a woman with adenomyosis who experienced recurrent cerebral infarctions, where anticoagulation was ineffective but hysterectomy ultimately prevented further events.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This case report describes a 44-year-old woman with long-standing uterine adenomyosis and heavy menstrual bleeding who developed recurrent multiple cerebral infarctions during her menstrual phase. Using brain MRI/MRA and blood testing (including D-dimer, CA125, and CA19–9), the authors observed markedly elevated hypercoagulability markers, while embolic sources were not found on transesophageal echocardiography and the patient’s hypercoagulable panel was within normal limits; recurrence continued despite anticoagulation with heparin/warfarin and a trial of the novel oral anticoagulant rivaroxaban. GnRH agonist–induced pseudomenopause improved D-dimer and prevented recurrence for 6 months, but infarctions recurred after stopping treatment, and total hysterectomy with bilateral salpingo-oophorectomy prevented further events for 2 years without anticoagulation. This paper is centrally about adenomyosis — it reports recurrent cerebral infarctions temporally linked to adenomyosis progression and menstrual cycles and evaluates anticoagulation, pseudomenopause, and hysterectomy in this context.

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Abstract

BACKGROUND: Benign gynecologic tumor, such as uterine adenomyosis, has been suggested to develop hypercoagulability. Although some cases of cerebral infarction associated with adenomyosis have been reported, the mechanism of hypercoagulation initiated by adenomyosis is still not clear, and the therapeutic strategy is uncertain. CASE PRESENTATION: A 44-year-old woman was presented to our department with headache, left hand weakness, and gait disturbance during her menstrual phase. She had a history of adenomyosis and infertility treatment for 18 years and heavy menstrual bleeding. Magnetic resonance imaging on admission showed multiple hyperintense lesions in cortical and subcortical areas in the cerebrum and cerebellum on diffusion-weighted imaging. Transesophageal echocardiography showed neither embolic sources nor existence of foramen ovale. Her laboratory data revealed anemia, a high D-dimer level, and elevated levels of a mucinous tumor marker. She had adenomyosis and no malignancy was detected. Anticoagulation therapy with intravenous heparin followed by rivaroxaban did not prevent recurrence of cerebral infarction. We discontinued rivaroxaban, and started warfarin therapy with pseudomenopause treatment, which prevented recurrence for 6 months. Five months after her last pseudomenopause treatment, multiple cerebral infarctions occurred. Total hysterectomy was performed, which prevented recurrence of the multiple cerebral infarctions for 2 years without anticoagulation therapy. CONCLUSIONS: Our findings reveal for the first time that anticoagulation therapy, including novel oral anticoagulants, had no preventive effect against cerebral infarctions associated with adenomyosis in a middle-aged woman. Although pseudomenopause treatment temporarily prevented recurrence, resection of the adenomyosis might be the most effective therapy in these cases.

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Condition tags

adenomyosisinfertility

MeSH descriptors

Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Cerebral Infarction Adult Anticoagulants Anticoagulants Cerebral Infarction Female Humans Hysterectomy Rivaroxaban Rivaroxaban

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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Cited by (17)

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