Concurrent ischemic stroke, pulmonary embolism, and hemorrhagic brain metastasis in pancreatic ductal adenocarcinoma: A case report.

Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive malignancy frequently complicated by paraneoplastic hypercoagulability, known as Trousseau syndrome. While isolated thromboembolic events such as ischemic stroke or pulmonary embolism (PE) are well-documented in PDAC, the simultaneous occurrence of arterial stroke, venous thromboembolism, and hemorrhagic brain metastasis is exceedingly rare. We present the case of a middle-aged woman with metastatic PDAC who developed an acute ischemic stroke in the context of PE and hemorrhagic metastasis. There was a management dilemma regarding the best options of treatment and possible complications. This report underscores the protean neurologic and thromboembolic manifestations of Trousseau syndrome and highlights the rare but devastating triad of stroke, PE, and hemorrhagic brain metastasis in PDAC. It also emphasizes the importance of individualized, multidisciplinary management strategies when faced with conflicting risks of thrombosis and hemorrhage in patients with advanced malignancy.