Recurrent Ischemic Stroke in a Patient with the Trousseau Syndrome Treated with Dabigatran

Yoshida, Kento; Kimura, T; Aburakawa, Yoko; Suzuki, Yasuhiro; Kuroda, Kenji; Yahara, Osamu

doi:10.1016/j.jstrokecerebrovasdis.2013.12.019

Cited by 15 publications

(9 citation statements)

References 5 publications

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“…[ 27 ] However, in Yoshida's case report, the patient, who was considered as with stroke caused by cardiogenic embolism, still endured recurrent stroke although using dabigatran. [ 9 ]…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, we searched in PubMed/MEDLINE using the MeSH term of “Trousseau's syndrome, cerebral infarction/ischemic stroke, and tumor/cancer/malignancy” for literature concerning about Trousseau's Syndrome presenting with cerebral infarction and summarized 19 cases including the three cases in our institution [ Table 1 ]. [ 3 4 5 6 7 8 9 10 11 12 13 14 15 16 ]…”

Section: Case Reportsmentioning

confidence: 99%

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Multifocal cerebral infarction as the first manifestation of occult malignancy: Case series of trousseau's syndrome and literature review

Chen

2018

Brain Circ

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Ischemic stroke as an initial presentation of malignancy is extremely rare and the underlying etiology is often ignored. The aim of this study is to outline the clues to occult malignancy in patients presenting with cerebral infarction initially. The clinical characteristics of total 19 patients with Trousseau's Syndrome presenting with cerebral infarction initially were analyzed. Among those patients, no conventional vascular risk factors were detected in 68% (13/19) of patients, and infarction occurring in multiple vascular distributions was found in 84% (16/19). Blood test showed thrombophilia in 79% (15/19) of patients with significantly elevated D-dimer, disseminated intravascular coagulopathy (DIC) in 59% (11/19), and elevated levels of tumor makers in 47% (9/19). The prognosis of the 19 patients was poor, with 68% (13/19) of patients undergoing a relapse of stroke in short interval, and 84% (16/19) being reportedly to die in 6 months. In patients, who developed unexplained recurrent brain infarction involving multiple arterial territory, with laboratory evidence suggesting hypercoagulability (higher level of D-dimer, or DIC), Trousseau's Syndrome should be considered, and investigation for an occult malignancy was required.

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“…[ 27 ] However, in Yoshida's case report, the patient, who was considered as with stroke caused by cardiogenic embolism, still endured recurrent stroke although using dabigatran. [ 9 ]…”

Section: Discussionmentioning

confidence: 99%

Section: Case Reportsmentioning

confidence: 99%

Multifocal cerebral infarction as the first manifestation of occult malignancy: Case series of trousseau's syndrome and literature review

Chen

2018

Brain Circ

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“…There have been reports that deep venous thrombosis occurred after change of heparin to oral warfarin during treatment for this disease 16) and that the recurrence of cerebral infarction could not be prevented with dabigatran, a direct thrombin inhibitor. 17) In our patient, also, the recurrence of cerebral infarction could not be prevented by dual-antiplatelet therapy, resulting in major artery occlusion. We suspected Trousseau syndrome and planned to perform transesophageal echocardiography to detect NBTE after treatment and, due to anxiety over hemorrhagic complications in the established infarcted region, to begin administering heparin after demonstration of NBTE by transesophageal echocardiography, but early recurrence was observed after 2 days.…”

Section: Discussionmentioning

confidence: 51%

A Case of Mechanical Thrombectomy for Middle Cerebral Artery Occlusion with Trousseau Syndrome

Shinohara

Tsumura

Hasegawa

et al. 2017

JNET

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Objective and Case Presentation:The patient was an 86-year-old woman with histories of surgery for stomach, colon, and pancreatic cancers. In addition to left hemiparesis as a sequela of two past episodes of cerebral infarction, she newly developed right hemiplegia and acute cerebral infarction due to left middle cerebral artery (MCA) occlusion.Since the condition was not an indication for intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA), mechanical thrombectomy was immediately performed, and almost complete recanalization could be achieved about 5 hours after the onset. The retrieved thrombus was a white and elastic hard fibrin thrombus that contained no blood cells. Although temporary symptomatic relief was obtained, bilateral MCA occlusion occurred in succession, and the patient died on the 35th day of illness. Conclusion:Accumulation of cases and pathological evaluation of retrieved thrombi are necessary for the elucidation of the optimal mechanical thrombectomy or antithrombotic therapy for acute cerebral infarction due to Trousseau syndrome.

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“…Few studies have investigated the effectiveness of direct oral anticoagulants in patients with Trousseau’s syndrome. Dabigatran has been reported to be ineffective for prevention of recurrent ischemic stroke [ 12 ]. In the present patient, stroke recurred under apixaban administration preoperatively.…”

Section: Discussionmentioning

confidence: 99%

Mitral valve nonbacterial thrombotic endocarditis: a rare multi-surgery-tolerant survivor of Trousseau’s syndrome

et al. 2018

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BackgroundFew previous reports have documented cases of nonbacterial thrombotic endocarditis associated with Trousseau’s syndrome for which surgery proved possible for both the primary tumor and the cardiac lesion. The effectiveness of direct oral anticoagulants in patients with Trousseau’s syndrome has also received scant attention.Case presentationA 69-year-old man with repeated episodes of cerebral infarction was diagnosed as having nonbacterial thrombotic endocarditis after mitral valve replacement surgery. Stroke recurred preoperatively under apixaban administration. A stomach biopsy also identified gastric adenocarcinoma, and gastric surgery was performed on the 40th postoperative day. The patient was discharged from the hospital and has been free of thromboembolism under a regime of subcutaneous heparin self-injection thereafter.ConclusionsWe have reported a rare multi-surgery-tolerant survivor of Trousseau’s syndrome in whom subcutaneous heparin injection was useful for preventing thromboembolic events over a long period.

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Recurrent Ischemic Stroke in a Patient with the Trousseau Syndrome Treated with Dabigatran

Cited by 15 publications

References 5 publications

Multifocal cerebral infarction as the first manifestation of occult malignancy: Case series of trousseau's syndrome and literature review

Multifocal cerebral infarction as the first manifestation of occult malignancy: Case series of trousseau's syndrome and literature review

A Case of Mechanical Thrombectomy for Middle Cerebral Artery Occlusion with Trousseau Syndrome

Mitral valve nonbacterial thrombotic endocarditis: a rare multi-surgery-tolerant survivor of Trousseau’s syndrome

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