D-dimer and C-reactive Protein as Potential Biomarkers for Diagnosis of Trousseau's Syndrome in Patients with Cerebral Embolism

• Published in: Journal of stroke and cerebrovascular diseases Vol. 29; no. 2; p. 104534
• Main Authors: Tsushima, Michiko, Metoki, Norifumi, Hagii, Joji, Saito, Shin, Shiroto, Hiroshi, Yasujima, Minoru, Kato, Tomo, Kudo, Natsumi, Toyama, Yuichi, Yokono, Yoshikazu, Nozaka, Masashi, Kawamura, Yosuke, Nakata, Masamichi, Tomita, Hirofumi
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-02-2020
• Subjects: Aged; Aged, 80 and over; Biomarkers - blood; C-reactive protein; C-Reactive Protein - analysis; cerebral embolism; Diffusion Magnetic Resonance Imaging; Female; Fibrin Fibrinogen Degradation Products - analysis; Humans; Intracranial Embolism - blood; Intracranial Embolism - diagnosis; Intracranial Embolism - etiology; Male; Neoplasms - blood; Neoplasms - complications; Neoplasms - diagnosis; Patient Admission; Plasma D-dimer; Predictive Value of Tests; Retrospective Studies; Risk Assessment; Risk Factors; Sex Factors; Stroke - blood; Stroke - diagnosis; Stroke - etiology; Syndrome; trousseau's syndrome; Up-Regulation; Plasma D-dimer; C-reactive protein; cerebral embolism; trousseau's syndrome
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2019.104534

Differentiating stroke due to Trousseau's syndrome from other types of cerebral embolism is challenging, especially in patients with occult cancer. The current study aimed to determine predicting factors and biomarkers of stroke due to Trousseau's syndrome.
This retrospective study comprised 496 consecutive patients with acute cerebral embolism, including 19, 85, 310, and, 82 patients with stroke due to Trousseau's syndrome, artery-to-artery embolism, cardioembolic stroke, and embolic stroke with undetermined source, respectively. All patients were evaluated within 72 hours of onset. The clinical characteristics, laboratory findings, and patterns on diffusion-weighted magnetic resonance imaging (DWI) were compared among the groups.
Plasma D-dimer and C-reactive protein (CRP) levels were significantly higher in the Trousseau's syndrome than in the other causes of cerebral embolism. Multivariate analyses demonstrated that female sex, multiple lesions on DWI, high D-dimer and CRP levels, and low platelet and low brain natriuretic peptide levels were independent predictors that could distinguish Trousseau's syndrome from the other causes of cerebral embolism. The cutoff values of D-dimer and CRP to identify stroke due to Trousseau's syndrome was 2.68 µg/mL fibrinogen equivalent units and .29 mg/dL, respectively.
The elevated D-dimer and CRP levels on admission in addition to specific clinical features may be useful for diagnosis of Trousseau's syndrome in patients with cerebral embolism.