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CASE SERIES
Year : 2018  |  Volume : 4  |  Issue : 2  |  Page : 65-72

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


1 Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
2 Department of Neurology, Xuanwu Hospital, Capital Medical University; Department of Neurology, The Beijing Moslem People Hospital, Beijing, China

Correspondence Address:
Dr. Weibi Chen
Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bc.bc_1_18

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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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