ABSTRACT NUMBER: ESOC2026A687 UNUSUAL CAUSE OF STROKE: HIGHLIGHTING DIFFICULTY IN MANAGEMENT OF STROKE ASSOCIATED WITH ADENOMYOSIS

Abstract Background and aims Cryptogenic stroke is an imaging-confirmed stroke with unknown source despite thorough diagnostic assessment (including, at a minimum, arterial imaging, echocardiography, extended rhythm monitoring, and key laboratory studies such as a lipid profile and haemoglobin A1c. We aim to describe an unusual cause of stroke in young associated with adenomyosis who underwent thrombectomy then had inpatient investigations and rehab. We aim to shed some light on difficulties in diagnosis and management. Methods We described a stroke in a young patient including investigations and management done. Results Transthoracic and transoesophageal echo as well as a panel done for stroke in young patients were all negative. No cause could be found apart from adenomyosis. Patient had long history of adenomyosis with elevated CA-125 and D-dimer and no evidence of malignancy on CT scan. Conclusions Hypercoagulable state secondary to non-malignant cancers is an underestimated cause for cryptogenic stroke. Anticoagulation, hormonal therapy and possibly hysterectomy have been found to be of benefit. Giving the high risk of bleeding, management needs multidisciplinary approach and follow up between stroke and gynaecology as well as involving the patient’s wishes and weighing risks and benefits of every intervention available. Conflict of interest Mohamed Maged: nothing to disclose, Nic Weir: nothing to disclose, Charis Mavrokordatos: nothing to disclose