Abstract
Background
Trousseau’s syndrome or migrating thrombophlebitis can cause venous or arterial thrombosis; however, multiple acute ischemic strokes (MAIS) caused by Trousseau’s syndrome are rare. The aim of this study was to analyse the clinical features of Trousseau’s syndrome with MAIS and to improve the awareness and the knowledge of this disease.
Methods
Clinical data from fifteen patients who were diagnosed as Trousseau’s syndrome with MAIS in Rizhao People’s Hospital from January 2017 to April 2020 were collected and analysed. The clinical data included the following: patients’ basic information (including gender, age, underlying diseases, and tumour stage), laboratory results, imaging features, treatment regimens, and short-term prognoses were collected.
Results
The mean age was 65.5 years, with thirteen males and two females. Most patients (11/15) had a history of smoking and (or) drinking. The average score of NIHSS was 2.13. 6 of the 15 patients first presented with ischemic stroke and then found the primary tumour. Most common types of primary tumour was lung cancer (11/15), and other types of primary tumour were gastric adenocarcinoma, renal cell carcinoma, oesophageal adenosquamous carcinoma, and cholangiocarcinoma (one in each). All the 15 patients showed different levels of increase of D-dimer. The increase in CRP appears in 10 of the 15 patients. Various tumour markers were increased in the 15 patients, especially for CYFRA-211, all the patients of which were higher than normal. All of the 15 patients had multiple vascular territory lesions in DWI, and most lesions were near the cortex areas. Only 4 of the 15 patients (26.7%) occurred with peripheral venous thrombosis. Thirteen patients were given low molecular heparin for anticoagulant therapy, of which 9 patients were improved in short-term while 4 patients were not.
Conclusion
Trousseau’s syndrome with MAIS was associated with old-age male, smoking and (or) drinking history, low NIHSS score, increased D-dimer, CRP and tumour markers, and lesions near the cortex areas with multiple vascular territories in DWI. Patients with these features should be alert of malignant tumour. Most common types of primary tumour were lung cancer. Treatment with low molecular heparin may be effective in short term.
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References
Aoyama KI, Tamura M, Uchibori M, Nakanishi Y, Arai T, Aoki T, Osawa Y, Kaneko A, Ota Y (2019) Trousseau syndrome in a patient with advanced oral squamous cell carcinoma: a case report. J Med Case Rep 13:26
Chen W, He Y, Su Y (2018) Multifocal cerebral infarction as the first manifestation of occult malignancy: Case series of trousseau’s syndrome and literature review. Brain Circ 4:65–72
Finelli PF, Nouh A (2016) Three-Territory DWI Acute Infarcts: Diagnostic Value in Cancer-Associated Hypercoagulation Stroke (Trousseau Syndrome). AJNR Am J Neuroradiol 37:2033–2036
Ikushima S, Ono R, Fukuda K, Sakayori M, Awano N, Kondo K (2016) Trousseau’s syndrome: cancer-associated thrombosis. Jpn J Clin Oncol 46:204–208
Ishikawa M, Nakayama K, Ishibashi T, Sato E, Nakamura K, Katagiri H, Kyo S (2016) Case series of cerebral infarction with Trousseau’s syndrome associated with malignant gynecological tumors. Mol Clin Oncol 5:138–142
Ito S, Kikuchi K, Ueda A, Nagao R, Maeda T, Murate K, Shima S, Mizutani Y, Niimi Y, Mutoh T (2018) Changes in Serial D-Dimer Levels Predict the Prognoses of Trousseau’s Syndrome Patients. Front Neurol 9:528
Jovin TG, Boosupalli V, Zivkovic SA, Wechsler LR, Gebel JM (2005) High titers of CA-125 may be associated with recurrent ischemic strokes in patients with cancer. Neurology 11:1944–1945
Kato T, Yasuda K, Iida H, Watanabe A, Fujiuchi Y, Miwa S, Imura J, Komiya A (2016) Trousseau’s syndrome caused by bladder cancer producing granulocyte colony-stimulating factor and parathyroid hormone-related protein: A case report. Oncol Lett 12:4214–4218
Kim SG, Hong JM, Kim HY, Lee J, Chung PW, Park KY, Kim GM, Lee KH, Chung CS, Bang OY (2010) Ischemic stroke in cancer patients with and without conventional mechanisms: a multicenter study in Korea. Stroke 41:798–801
Nouh AM, Staff I, Finelli PF (2019) Three Territory Sign: An MRI marker of malignancy-related ischemic stroke (Trousseau syndrome). Neurol Clin Pract 9:124–128
Sack GH Jr, Levin J, Bell WR (1977) Trousseau’s syndrome and other manifestations of chronic disseminated coagulopathy in patients with neoplasms: clinical, pathophysiologic, and therapeutic features. Medicine 56:1–37
Shoko M (2018) Trousseau’s Syndrome Causing Refractory Deep Venous Thrombosis. Intern Med 4:623–626
Taccone FS, Jeangette SM, Blecic SA (2008) First-ever stroke as initial presentation of systemic cancer. J Stroke Cerebrovasc Dis 17:169–174
Takeshita S, Ogata T, Mera H, Tsugawa J, Aoki M, Takeshita M, Tsuboi Y (2018) Multiple Thrombi in the Heart in Trousseau Syndrome Caused by Pancreatic Carcinoma. J Stroke Cerebrovasc Dis 27:e75–e77
Tesselaar ME, Romijn FP, Van Der Linden IK, Prins FA, Bertina RM, Osanto S (2007) Microparticle-associated tissue factor activity: a link between cancer and thrombosis? J Thromb Haemostasis 5:520–527
Trousseau A (1865) Plegmasia alba dolens. Clin Med l’Hotel-Dieu Paris 3:654–712
Tsimafeyeu IV, Demidov LV, Madzhuga AV, Somonova OV, Yelizarova AL (2009) Hypercoagulability as a prognostic factor for survival in patients with metastatic renal cell carcinoma. J Exp Clin Cancer Res 28:30
Umemura T, Yamamoto J, Akiba D, Nishizawa S (2017) Bilateral cerebral embolism as a characteristic feature of patients with Trousseau syndrome. J Clin Neurosci 42:155–159
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This study was approved by the ethics committee of Rizhao People`s Hospital. A written informed consent form was obtained from each study participant.
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Ling, Y., Li, Y., Zhang, X. et al. Clinical features of Trousseau’s syndrome with multiple acute ischemic strokes. Neurol Sci 43, 2405–2411 (2022). https://doi.org/10.1007/s10072-021-05619-y
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DOI: https://doi.org/10.1007/s10072-021-05619-y