Supplementary Material for: Prostate Adenocarcinoma Diagnosed after Surveying for Unusual Embolic Events: A Case Report

Introduction
Current versatile treatments for acute vessel occlusion—whether arterial or venous—have significantly improved the success of recanalization. However, patients who present with unexplained thromboembolic events, including arterial and venous, especially in the absence of traditional risk factors, should undergo thorough evaluation for potential underlying causes, including malignancies.
Case Presentation
A 66-year-old man experienced deep vein thrombosis of the left femoral vein and underwent catheter-directed thrombolysis followed by rivaroxaban therapy. Two weeks later, he presented with acute drowsiness, right-sided hemiparesis, and left hemineglect. Brain magnetic resonance imaging revealed acute multiple infarcts.
During hospitalization, laboratory findings indicated disseminated intravascular coagulation. Further evaluation showed a markedly elevated prostate-specific antigen level, prompting prostate magnetic resonance imaging, which revealed advanced prostate cancer with staging of cT4N1M1a. The diagnosis was confirmed by biopsy. Hormone therapy with degarelix was initiated. Atrial fibrillation also developed during the hospital stay, and apixaban was prescribed. The patient demonstrated continuous clinical improvement and achieved a modified Rankin Scale score of 2 at nine months post-stroke.
Conclusion
This case highlights the importance of thorough investigation in patients with unusual thromboembolic events, both arterial and venous. Timely diagnosis and treatment of underlying malignancy are crucial in preventing recurrence of cancer-related stroke.