Trousseau Syndrome Related Cerebral Infarction: Clinical Manifestations, Laboratory Findings and Radiological Features

Purpose

We summarized the clinical manifestations, laboratory data, and brain MRI of patients with Trousseau syndrome related cerebral infarction and compared them to patients with other types of cerebral infarction. Through our present research, we hope to aid the neurologists in recognizing and diagnosing this syndrome.

Methods

A total of 31 patients at our institution were identified with cerebral infarction resulting from Trousseau syndrome. We have also selected the 180 patients who have suffered from cerebral infarction as control groups and these patients were distributed to large-artery atherosclerosis group; cardio-embolism group; small-artery occlusion group, according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. The clinical data and neuroimage of these patients were collected.

Results

All our 31 cancer patients were confirmed by pathological biopsy to be adenocarcinomas and the most common cancers are gastric and lung cancers. Patients with Trousseau syndrome exhibited high serum carbohydrate antigen CEA, CA 125 and CA 199 levels. Compared to patients with other types of cerebral infarction, patients with Trousseau syndrome had an increased severity and worse prognosis. Besides, patients had the highest mean level of plasma D-dimer. We also found multiple lesions in multiple vascular territories was the most frequent type of DWI patterns in patients of Trousseau syndrome.

Conclusions

Trousseau syndrome can progress rapidly and become life-threatening. For patients who developed unexplained cerebral infarction involving multiple arterial territories, with elevated plasma D-dimer and cancer antigens, Trousseau syndrome should always be considered.

Introduction

The term “Trousseau syndrome” is defined as unexplained thrombotic events that either precede the diagnosis of an occult visceral malignancy or appear concomitantly with the tumor.¹ Traditionally, it has been generally supposed that most thrombotic events in cancer patients were within the venous circulation.² Until recently, several cohort studies have found cancer also substantially increased the risk of arterial thrombosis.3, 4, 5 Given the familiar usage of Trousseau syndrome by some authors to refer to cancer-associated hypercoagulation, we use Trousseau syndrome in that context in this study.

There are several studies on Trousseau syndrome as a cause of cryptogenic stroke. It has been reported that 14.6% of cancer patients had pathological evidence of cerebrovascular diseases events attacks and approximately half of them experienced clinical symptoms related to the disease.⁶ Identifying patients with cancer related cerebral infarction is very important, for patients with active cancer are often at increased risk of recurrent stroke, disability and mortality.7, 8, 9 When the underlying cancer is not detected, these patients receive same treatment as those who have cerebral infarctions due to other causes, which could make the treatment of cancer delayed and thus worsen their conditions. This led us to identify the specific pattern of clinical manifestations and radiological features of this type of cerebral infarction and to discuss its role in distinguishing cancer related cerebral infarction from other common causes of stroke.

Therefore, we summarized the clinical manifestations, laboratory data, and brain MRI of a group of patients with cancer related cerebral infarction from January 2015 to September 2019 in the Affiliated Hospital of Xuzhou Medical University and compared them to a group of patients with other types of cerebral infarction in the same period. Through our present research, we hope to aid the neurologists in recognizing and diagnosing this syndrome.