Clinical features of Trousseau’s syndrome with multiple acute ischemic strokes

Abstract

Background:Trousseau's syndrome can cause venous or arterial thrombosis, multiple acute ischemic strokes (MAIS) caused by Trousseau's syndrome is rare. The aim of this study was to analyze the clinical features of Trousseau's syndrome with MAIS, and to improve the awareness and the knowledge of this disease. Methods:Clinical data from fteen patients who were diagnosed as Trousseau's Syndrome with MAIS in Rizhao people's Hospital from January 2017 to April 2020 were collected and analyzed. The clinical data included the following: Patients' basic information, 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 rst presented with ischemic stroke, and then found the primary tumor. Most common types of primary tumor was lung cancer (11/15), other types of primary tumor were gastric adenocarcinoma, renal cell carcinoma, esophageal 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 tumor 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 territories lesions in DWI, and most lesions were near the cortex areas. Only 4 of the 15 patients (26.7%) occurred with Peripheral venous thrombosis. 13 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 Ddimer, CRP and tumor markers, lesions near the cortex areas with multiple vascular territories in DWI. Patients with these features should be alert of malignant tumor. Most common types of primary tumor were lung cancer. Treatment with Low molecular heparin may be effective in short-term. BackgroundTrousseau's syndrome was rst described in 1865 as the relationship between venous thromboembolisms and cancer [1]. Sack et al. extended this de nition to include chronic disseminated intravascular coagulopathy associated with microangiopathy, verrucous endocarpditis, and arterial embolism in patients with cancer [2]. Multiple acute ischemic strokes (MAIS) is a rare manifestation of Trousseau's syndrome, usually involvingelevation of D-dimer levels and acute simultaneous multiple embolisms in multiple vascular territories. There have been few large series studies on Clinical features of Trousseau's syndrome with MAIS. Here, we summarized and analyzed the clinical manifestations, laboratory results and brain magnetic resonance images (MRI) features of fteen patients who were diagnosed as Trousseau's Syndrome with MAIS in our hospital to improve the awareness and early diagn...

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