Middle cerebral artery infarction in a cancer patient: a fatal case of Trousseau's syndrome.
Trousseau's syndrome is defined as any unexplained thrombotic event that precedes the diagnosis of an occult visceral malignancy or appears concomitantly with a tumour. This report describes a young, previously healthy man diagnosed to have an acute middle cerebral arterial ischaemic stroke and lower-limb deep vein thrombosis, who subsequently succumbed to pulmonary arterial embolism. During the course of his illness, he was diagnosed to have a malignant pleural effusion secondary to an occult adenocarcinoma. This report highlights the need for a high degree of suspicion for occult malignancy and non-bacterial thrombotic endocarditis in young (<60 years old) ischaemic stroke patients with no identifiable conventional cardiovascular risks. In selected patients, transoesophageal echocardiography is the diagnostic investigation of choice, since transthoracic imaging is not sensitive. Screening tests for serum tumour markers and prompt heparinisation of these patients are suggested whenever ischaemic stroke secondary to malignancy-induced systemic hypercoagulability is suspected.
Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
Peter Y M
PY
Woo
Danny T M
DT
Chan
Tom C Y
TC
Cheung
X L
XL
Zhu
W S
WS
Poon
D000230:Adenocarcinoma / Q000150:complications*; D000328:Adult; D017809:Fatal Outcome; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000209:etiology*; D008297:Male; D009382:Neoplasms, Unknown Primary / Q000150:complications*; D010997:Pleural Neoplasms / Q000150:complications; D013577:Syndrome; D020246:Venous Thrombosis / Q000209:etiology*
Cerebral infarction; Embolism; Thrombosis