Cerebral ischemia as presenting manifestation of neoplastic changes of lowmalignant potential. Report of 2 cases and review of the literature

Thrombembolic events as paraneoplastic complications in malignant disease a ccount for severe morbidity and mortality in these patients. In some cases disturbance in hemostasis is the first manifestation of a neoplastic proces s. We report the cases of two patients with cerebral and extracerebral vess el occlusions, in whom epithelial tumors of low malignant potential (border line-tumors) of ovar and peritoneum were diagnosed later on. In one case th e removal of the tumor stopped the coagulation problems. The second patient died a few days after the first symptoms with devastating multiple vessel occlusion. In stroke of unknown aetiology a paraneoplastic process should b e kept in mind. The diagnosis is more probable with recurrent thrombembolis m in different body regions and when warfarin therapie was ineffective. Tho ughtful coagulation studies and a tumor search program is recommended in th ese cases.