Chen Yongzhen, Wan Qiuxia, Li Shanshan, Liu Bo
Department of Neurology, Shenzhen Longhua District Central Hospital, Shenzhen, Guangdong, P. R. China.
Department of Hematology, Shenzhen Longhua District Central Hospital, Shenzhen, Guangdong, P. R. China.
Medicine (Baltimore). 2024 Dec 13;103(50):e40937. doi: 10.1097/MD.0000000000040937.
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%.
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.
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.
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.
作为一种副肿瘤综合征,特鲁索综合征(TS)是肿瘤患者因凝血和纤溶异常引起的各种血栓栓塞事件的统称,临床表现为静脉和动脉血栓栓塞以及弥散性血管内凝血(DIC)。TS患者动脉血栓形成的发生率为2%至5%。
本文报道2例TS所致脑梗死患者。1例患者于2020年5月18日确诊为宫颈腺鳞癌(IVB期)伴肝和肩胛骨转移,接受了手术及放化疗。另1例患者于2018年3月5日接受了远端胃癌腹腔镜根治术,并接受了术后化疗。
两例现患疾病均呈卒中样起病,头颅磁共振成像(MRI)结果符合脑梗死改变。两名患者的血液学检查均显示D - 二聚体水平明显升高。病例2的检查结果还显示右下肢深静脉血栓形成。这2例患者最终被诊断为TS,经抗凝(低分子肝素[LMWH])治疗后病情改善。
在此,对这2例TS患者的临床特征及治疗进行分析,并复习相关文献,以提高对该病的认识、诊断及治疗水平。脑梗死是部分恶性肿瘤患者的首发症状。对于不明原因的多发性脑梗死,应筛查隐匿性恶性肿瘤以便早期诊断和治疗,因为尽早准确识别病因可能改善预后。