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Neurologic manifestations of intravascular coagulation in patients with cancer

A clinicopathologic analysis of 12 cases

Neuropsychiatric and Hematology Services, Department of Medicine, and Department of Pathology, Memorial Sloan-Kettering Cancer Center, and Departments of Neurology and Pathology, Cornell University Medical College, New York.

Among 1,459 autopsied patients with cancer, 12 had multifocal infarcts of the brain that appeared to be caused by intravascular coagulation. Most of these patients were women with leukemia or lymphoma, and all had a clinical course in which neurologic signs and symptoms were prominent. All had evidence of generalized brain disease (delirium and stupor or coma), and several also had focal brain disease (focal seizures, hemiparesis). All patients had laboratory evidence of coagulation abnormalities, although these were often not severe when neurologic symptoms began. Pathologically, there were multifocal hemorrhagic or ischemic infarcts in the distribution of several cerebral vessels, without a systemic source for cerebral emboli. Fibrin thrombi were identified in cerebral vessels and in vessels of several other organs. The clinical findings fit the pathologic picture, and in most instances the correct diagnosis might have been made earlier had it been considered.

This study was supported in part by National Cancer Institute Clinical Cancer Research Center grant 2160-192 to the Memorial Hospital for Cancer and Allied Diseases and National Cancer Institute grant CA-08748 to Sloan-Kettering Institute for Cancer Research.

Received for publication March 28, 1975.

Reprint requests should be addressed to Dr. Jerome B. Posner, 444 East 68th Street, New York, NY 10021.

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