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Right hemiplegia and dyspnea: What is the link between?

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ABSTRACT
Introduction. Lung cancer is one of the most common and aggressive cancers. The most important risk factor is smoking.
Case report. A 63-year-old male, with a history of smoking for 30 years, presented for dyspnea at mild effort, right upper quadrant pain and right hemiplegia installed progressively 2 weeks before admission. Clinical examination revealed: cachectic patient; decreased breath sounds, without crackles, normal blood pressure and heart rate, pain in the right hypochondrium, hepatomegaly ] with nodular irregularities, right quasi-complete hemiplegia. Lab tests: leukocytosis with neutrophilia, thrombocytosis, mild hepatic cytolysis, increased inflammatory markers. Tumor markers: normal alpha-fetoprotein, increased CA 125 and CA 15-3, negative Ac HCV and Ag HBs. CT scan revealed multiple brain tumors, with discrete perilesional edema, some with necrosis, with thick, irregular, nodular appearance; two tumors in the left lung. Secondary pulmonary, hepatic and cerebral determinations. Right portal vein thrombosis. Polyserositis. Neurosurgical exam concluded that the patient had no surgical indication. At bronchoscopy, no lesions have been detected, therefore no biopsy could be performed. The patient was referred to the oncologist for palliative treatment. The final diagnosis was: left pulmonary tumor with hepatic and cerebral pulmonary determinations, total right portal vein thrombosis, right quasi-complete hemiplegia.
Conclusions. Sometimes, the clinical onset of cancer is related to the symptoms of metastasis. A late diagnosis limits the therapeutical options only to palliative therapy. The particularity of the case consists of clinical onset with neurological signs secondary to cerebral metastasis.
Keywords: lung cancer, portal vein thrombosis, cerebral metastases, hemiplegia.

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Diana Belciu, Ruxandra-Nicoleta Horodinschi, Claudia Ionescu, Ovidiu Gabriel Bratu and Camelia C. Diaconu

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