FREQUENTLY RECURRENT CEREBRAL INFARCTION AND TROUSSEAU’S SYNDROME

JITING ZHU¹, JIANGLONG CHEN², QINGXI TANG¹, BIN CAI¹

¹Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China - ²Department of Neurology, Jinjiang City Hospital of Traditional Chinese Medicine, Quanzhou, Fujian, China

Introduction: Trousseau’s syndrome is a well-known malignancy-associated hypercoagulative state, leading to venous or arterial thrombosis. Stroke may be the first manifestation of the syndrome.

Materials and methods: We report a 72-year-old Chinese male developed recurrent cerebral infarction with four events in one month, despite therapy with three kinds of antithrombotics and atorvastatin. Brain magnetic resonance imagine (MRI) showed progressive multiple infarcts, involving the anterior and posterior circulation in two hemispheres of the brain. A whole body positron emission tomography-computed tomography (PET-CT) showed sigmoid carcinoma and tumor metastasis. He was finally diagnosised with sigmoid carcinoma and Trousseau syndrome. Similar medical literatures are reviewed.

Results: Ischemic stroke is a common brain lesion in patients with cancer and occasionally is its initial presentation. The widely accepted etiology is related to hypercoagulability though multiple mechanisms are believed to be involved. Elevated plas- ma levels of D-dimmer have been found in some cancer-related stroke but not all. Low-molecular-weight heparin is considered to be the first-choice agent for controlling thrombosis associated with Trousseau syndrome. Controling over the cancer may help to control the thrombosis.

Conclusion: Malignancy should be paid more attention in cryptogenic stroke, particularly in cases of frequently recurrent cerebral infarction. The case of frequent recurrence of cerebral infarction in trousseau has rarely been reported.