Stroke with a Hidden Tumor: Retroperitoneal Paraganglioma Presenting as Catecholamine-induced Cerebrovascular Accident
Purushothaman *
Dr. Jeyasekharan Medical Trust Hospital, Nagercoil, Tamil Nadu, India.
Devaprasath Jeyasekaran
Dr. Jeyasekharan Medical Trust Hospital, Nagercoil, Tamil Nadu, India.
Rakesh Chandru
Dr. Jeyasekharan Medical Trust Hospital, Nagercoil, Tamil Nadu, India.
Joel Franklin
Dr. Jeyasekharan Medical Trust Hospital, Nagercoil, Tamil Nadu, India.
*Author to whom correspondence should be addressed.
Abstract
Background: Paragangliomas are rare neuroendocrine tumors arising from extra-adrenal chromaffin tissue of the autonomic nervous system. Functioning paragangliomas may secrete catecholamines, leading to hypertensive crises and serious cardiovascular and cerebrovascular complications.
Case Presentation: We report a 46-year-old female with no prior medical history who presented with sudden-onset headache, palpitations, and unilateral sensory disturbance. Neuroimaging revealed an acute cerebrovascular accident. Persistent accelerated hypertension prompted endocrine evaluation, which demonstrated markedly elevated catecholamine metabolites. Contrast-enhanced CT revealed a 3 cm retroperitoneal mass compressing the inferior vena cava, consistent with a functioning paraganglioma. Following adequate preoperative alpha blockade, the tumor was excised without complication. Postoperatively, the patient remained normotensive with complete resolution of symptoms.
Conclusion: Catecholamine-secreting paragangliomas represent a rare but important secondary cause of stroke in relatively young and middle-aged patients. Early recognition, biochemical evaluation, and multidisciplinary management are crucial to prevent recurrent cerebrovascular events and ensure favourable outcomes.
Keywords: Paraganglioma, catecholamines, pheochromocytoma, hypertension, stroke, retroperitoneal tumor