Stroke with a Hidden Tumor: Retroperitoneal Paraganglioma Presenting as Catecholamine-induced Cerebrovascular Accident

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.