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26.09.2021 | Original Article

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

verfasst von: Yitong Ling, Yinye Li, Xiaoyu Zhang, Lihua Dong, Jintao Wang

Erschienen in: Neurological Sciences | Ausgabe 4/2022

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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.
Literatur
1.
Zurück zum Zitat 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 13:26CrossRef 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 13:26CrossRef
2.
Zurück zum Zitat 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 4:65–72CrossRef 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 4:65–72CrossRef
3.
Zurück zum Zitat Finelli PF, Nouh A (2016) Three-Territory DWI Acute Infarcts: Diagnostic Value in Cancer-Associated Hypercoagulation Stroke (Trousseau Syndrome). AJNR Am J Neuroradiol 37:2033–2036CrossRef Finelli PF, Nouh A (2016) Three-Territory DWI Acute Infarcts: Diagnostic Value in Cancer-Associated Hypercoagulation Stroke (Trousseau Syndrome). AJNR Am J Neuroradiol 37:2033–2036CrossRef
4.
Zurück zum Zitat Ikushima S, Ono R, Fukuda K, Sakayori M, Awano N, Kondo K (2016) Trousseau’s syndrome: cancer-associated thrombosis. Jpn J Clin Oncol 46:204–208CrossRef Ikushima S, Ono R, Fukuda K, Sakayori M, Awano N, Kondo K (2016) Trousseau’s syndrome: cancer-associated thrombosis. Jpn J Clin Oncol 46:204–208CrossRef
5.
Zurück zum Zitat 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 5:138–142CrossRef 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 5:138–142CrossRef
6.
Zurück zum Zitat 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 9:528CrossRef 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 9:528CrossRef
7.
Zurück zum Zitat 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 11:1944–1945CrossRef 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 11:1944–1945CrossRef
8.
Zurück zum Zitat 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 12:4214–4218CrossRef 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 12:4214–4218CrossRef
9.
Zurück zum Zitat 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 41:798–801CrossRef 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 41:798–801CrossRef
10.
Zurück zum Zitat Nouh AM, Staff I, Finelli PF (2019) Three Territory Sign: An MRI marker of malignancy-related ischemic stroke (Trousseau syndrome). Neurol Clin Pract 9:124–128CrossRef Nouh AM, Staff I, Finelli PF (2019) Three Territory Sign: An MRI marker of malignancy-related ischemic stroke (Trousseau syndrome). Neurol Clin Pract 9:124–128CrossRef
11.
Zurück zum Zitat 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 56:1–37CrossRef 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 56:1–37CrossRef
12.
Zurück zum Zitat Shoko M (2018) Trousseau’s Syndrome Causing Refractory Deep Venous Thrombosis. Intern Med 4:623–626 Shoko M (2018) Trousseau’s Syndrome Causing Refractory Deep Venous Thrombosis. Intern Med 4:623–626
13.
Zurück zum Zitat Taccone FS, Jeangette SM, Blecic SA (2008) First-ever stroke as initial presentation of systemic cancer. J Stroke Cerebrovasc Dis 17:169–174CrossRef Taccone FS, Jeangette SM, Blecic SA (2008) First-ever stroke as initial presentation of systemic cancer. J Stroke Cerebrovasc Dis 17:169–174CrossRef
14.
Zurück zum Zitat 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–e77CrossRef 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–e77CrossRef
15.
Zurück zum Zitat 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 5:520–527CrossRef 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 5:520–527CrossRef
16.
Zurück zum Zitat Trousseau A (1865) Plegmasia alba dolens. Clin Med l’Hotel-Dieu Paris 3:654–712 Trousseau A (1865) Plegmasia alba dolens. Clin Med l’Hotel-Dieu Paris 3:654–712
17.
Zurück zum Zitat 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 28:30CrossRef 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 28:30CrossRef
18.
Zurück zum Zitat Umemura T, Yamamoto J, Akiba D, Nishizawa S (2017) Bilateral cerebral embolism as a characteristic feature of patients with Trousseau syndrome. J Clin Neurosci 42:155–159CrossRef Umemura T, Yamamoto J, Akiba D, Nishizawa S (2017) Bilateral cerebral embolism as a characteristic feature of patients with Trousseau syndrome. J Clin Neurosci 42:155–159CrossRef
Metadaten
Titel
Clinical features of Trousseau’s syndrome with multiple acute ischemic strokes
verfasst von
Yitong Ling
Yinye Li
Xiaoyu Zhang
Lihua Dong
Jintao Wang
Publikationsdatum
26.09.2021
Verlag
Springer International Publishing
Erschienen in
Neurological Sciences / Ausgabe 4/2022
Print ISSN: 1590-1874
Elektronische ISSN: 1590-3478
DOI
https://doi.org/10.1007/s10072-021-05619-y

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