300 - Beyond the Brain: Ischemic Stroke as the Initial Clue to Metastatic Leiomyosarcoma

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

JM

Josue Martes, MD

Resident Physician
Schwab Rehabilitation Hospital & Care Network
Chicago, Illinois, United States

Co-Author(s)

MK

Morgan Karloff, MD

Resident Physician
Schwab Rehabilitation Hospital
Chicago, Illinois, United States

Submitter(s)

JM

Josue Martes, MD

Schwab Rehabilitation Hospital & Care Network
Chicago, Illinois, United States

Case Diagnosis: We describe a rare case of an elderly female with an acute left precentral gyrus infarction in the setting of widely metastatic leiomyosarcoma presenting as a cryptogenic stroke.

Case Description: A 75-year-old woman with a history of type 2 diabetes and peripheral neuropathy presented with acute right hemiparesis. Initial laboratory evaluation revealed mildly prolonged PT/INR as well as elevated inflammatory markers. Head CT and CTA of head and neck were unremarkable, with exception of incidentally noted pulmunary nodules and necrotic-appearing paratracheal lymph nodes. A chest CT was then performed, which confirmed pulmonary nodules and paratracheal lymphadenopathy, and revealed hepatic lesions along with a 3.5 cm cystic mass in the pancreas. An abdominal CT was hence ordered, revealing a 6.7 x 11.9 cm retroperitoneal mass causing right-sided hydroureteronephrosis. Echocardiographic evaluation failed to identify a cardioembolic source. Subsequently, brain MRI confirmed an acute infarct of left precentral gyrus, consistent with her clinical presentation. After histopathological analysis of retroperitonial and hepatic lesions, the diagnosis of metastatic leiomyosarcoma was confirmed. PM&R was consulted, and recommended SNF placement for rehabilitation of hemiparesis symptomatology.

Discussions: While cancers are often associated with hypercoagulable states, ischemic strokes are uncommon initial manifestations of leiomyosarcoma. However, in the setting of advanced metastatic malignancy, a hypercoagulable state was considered the most likely mechanism of stroke. This was further supported by normal perfusion findings on CTA and the absence of heart abnormalities and/or cardioembolic sources.

Conclusions: Occult malignancy should be considered in patients with ischemic strokes, particularly when accompanied by systemic symptoms or abnormal lab findings. This case illustrates the diagnostic value of a comprehensive, multidisciplinary approach in uncovering non-classical stroke etiologies.