Dizziness, lacunar infarction, thrombocytopenia in a cancerous patient

Sir,

Dizziness in a cancerous patient receiving anticancer drug is common, however, it sometimes can be a case of hidden serious problem. Here, the author presents a case of male patient suffering from liver tumor and on anticancer therapy by ninotuzumab infusion (he had previously history of receiving surgical management, radiotherapy, chemotherapy by capecitabine but all were not done during the present illness). The complaint of this patient is a sudden developed of dizziness symptom with blurred vision within one day. This case firstly got the symptomatic treatment for the dizziness symptoms. However, the persistence of dizziness symptoms could be observed. Finally, in the next week, the case was performed Computerized Tomography (CT) scan and many minute lacuna infarctions can be seen. It is believed that the neurological aberration in this case might be due to lacuna infarction. After retrospectively review on this case, the patient had continuous of thrombotic thrombocytopenic problem (diagnosed by abnormal platelet in complete blood count and blood smear without abnormality in bone marrow, confirmed by consultant expert in hematopathologist), which can be a possible underlying etiology for infarction in this case. It can be seen that the “dizziness” can be a problem due to hidden neurological disorder in the cancerous patient and this should not be overlooked. Nevertheless, in this case, the manifestation of idiopathic thrombocytopenic purpura (ITP) is only low platelet without overt bleeding. In this case, there is also no other thromboembophilic phenomenon. Indeed, it is reported that “Cerebral infarcts in cancer patients tended to be embolic and multiple”[1] and “Patients with gastrointestinal (GI) cancer were particularly susceptible to embolic infarction.”[1] Also, it should finally suggested that early CT scan is recommended for managing the change of visual acuity in the cancerous patients.