Trousseau syndrome-induced cerebral infarction: Two case reports

Abstract

Rationale: As a paraneoplastic syndrome, Trousseau syndrome (TS) is a collective term for various thromboembolic events caused by clotting and fibrinolytic abnormalities in patients with tumors, clinically manifesting as venous and arterial thromboembolism, as well as disseminated intravascular coagulation (DIC). The incidence rate of arterial thrombosis in patients with TS is 2% to 5%. Patient concerns: This article reports 2 patients with TS-induced cerebral infarction. One patient had been definitively diagnosed with cervical adenosquamous carcinoma (stage IVB) accompanied by metastases to the liver and scapulae on May 18, 2020, and was treated with surgery and chemoradiotherapy. The other patient had received laparoscopic radical surgery for distal gastric cancer on March 5, 2018, and had undergone postoperative chemotherapy. Diagnoses: Both current illnesses had a stroke-like onset, and cranial magnetic resonance imaging (MRI) results were in line with cerebral infarction changes. Hematological examination of both patients revealed an obviously increased D-dimer level. The results for Case 2 also indicated deep-venous thrombosis of the right lower extremity. The 2 patients were finally diagnosed with TS, which was ameliorated after anticoagulant (low-molecular-weight heparin [LMWH]) treatment. Lessons: Here, the clinical characteristics and treatment of these 2 TS patients are analyzed and the relevant literature is reviewed to improve understanding, diagnosis, and treatment of the disease. Cerebral infarction is the initial symptom in some patients with malignancies. For unexplained multiple cerebral infarctions, we should screen for occult malignancies to facilitate early diagnosis and treatment, as early and accurate identification of the cause of the disease may improve prognosis.