Cerebral Thrombo-Embolism in Malignancy

The fascinating and constantly lengthening list of the neurological complications of malignant tumors must now include those that result from cerebral emboli originating from the vegetations of a nonbacterial thrombotic endocarditis (NBTE). Although the possibility that there is a high frequency of thrombosis in patients with carcinoma and other neoplasms has been long discussed, its importance as a cause of brain lesions is not well known. The purpose of this report is to describe the clinical and pathological features of five patients with carcinoma who had nonbacterial thrombotic endocarditis with embolism to the brain and other organs.

Among 5,000 autopsies performed in the Department of Pathology of the University of Toronto from 1954 to 1963, there were 90 cases of aseptic cerebral embolism. As shown in Table 1, most of the emboli were secondary to myocardial infarction or rheumatic heart disease. Only seven were associated with nonbacterial thrombotic endocarditis.