title: Recurrent ischemic stroke in a patient with the Trousseau syndrome treated with dabigatran.
abstract: A 70-year-old man with multiple ischemic strokes was diagnosed with cardiac embolism and treated with dabigatran. Three months later, he suddenly developed vertigo and vomiting. Magnetic resonance imaging, showed recurrent lesions and blood tests revealed hypercoagulability, hypoproteinemia, and elevated cytokeratin 19 fragments that serve as a tumor marker of lung cancer. Chest computed tomography showed there were small nodules in bilateral lungs and swollen mediastinal lymph nodes. A conclusive diagnosis was impossible because the patient declined invasive procedures. We suspected primary lung cancer and diagnosed concomitant arterial thrombosis. We initially administered low-molecular-weight heparin, which we later changed to vitamin K antagonist. Although stroke did not recur thereafter, liver metastasis resulted in death 6 months later. The effectiveness of novel oral anticoagulants for preventing the Trousseau syndrome remains unclear. Further study is needed to prevent venous and arterial thromboses arising from the Trousseau syndrome.
authors.affiliation: Department of Neurology, Asahikawa Medical Center, National Hospital Organization, Asahikawa, Hokkaido, Japan. Electronic address: yoshidak@asahikawa.hosp.go.jp.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Department of Neurology, Asahikawa Medical Center, National Hospital Organization, Asahikawa, Hokkaido, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kimura
authors.affiliation: Department of Neurology, Asahikawa Medical Center, National Hospital Organization, Asahikawa, Hokkaido, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Aburakawa
authors.affiliation: Department of Neurology, Asahikawa Medical Center, National Hospital Organization, Asahikawa, Hokkaido, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Suzuki
authors.affiliation: Department of Neurology, Asahikawa Medical Center, National Hospital Organization, Asahikawa, Hokkaido, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Kuroda
authors.affiliation: Department of Neurology, Asahikawa Medical Center, National Hospital Organization, Asahikawa, Hokkaido, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Yahara
mesh_terms: D000368:Aged; D000991:Antithrombins / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000188:drug therapy*; D000069604:Dabigatran; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D012008:Recurrence; D020521:Stroke / Q000188:drug therapy*; D015091:beta-Alanine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000991:Antithrombins; D001562:Benzimidazoles; D006495:Heparin, Low-Molecular-Weight; D015091:beta-Alanine; D000069604:Dabigatran
keywords: Trousseau syndrome; cancer; dabigatran; warfarin