Recurrent ischemic stroke as an initial manifestation of an concealed pancreatic adenocarcinoma: Trousseau's syndrome

• Published in: Chinese medical journal Vol. 124; no. 4; pp. 637 - 640
• Main Authors: Giray, Semih, Sarica, Feyzi Birol, Arlier, Zulfikar, Bal, Nebil
• Format: Journal Article
• Language: English
• Published: China Department of Neurology,Baskent University Faculty of Medicine, Adana 01250, Turkey%Department of Neurosurgery,Baskent University Faculty of Medicine, Adana 01250, Turkey%Department of Pathology,Baskent University Faculty of Medicine, Adana 01250, Turkey 20-02-2011
• Subjects: Adenocarcinoma - complications; Adenocarcinoma - diagnosis; Adenocarcinoma - physiopathology; Humans; Male; Middle Aged; Pancreatic Neoplasms - complications; Pancreatic Neoplasms - diagnosis; Pancreatic Neoplasms - physiopathology; Stroke - diagnosis; Stroke - etiology; Thrombosis - diagnosis; Thrombosis - etiology; pancreas adenocarcinoma; Trousseau's syndrome; disseminated intravascular coagulation; ischemic stroke
• ISSN: 0366-6999
• DOI: 10.3760/cma.j.issn.0366-6999.2011.04.030

In rare instances, stroke may precede a diagnosis of cancer and be the first clinical evidence of an underlying malignancy.Cerebral infarction mostly complicates lymphomas, carcinomas, and solid tumors. Malignancy-related thromboembolism can present as acute cerebral infarction, nonbacterial thrombotic endocarditis and migratory thrombophlebitis. It is generally attributed to a cancer-related hypercoagulable period, chronic disseminated intravascular coagulopathy (DIC), or tumor embolism. We reported a case of malignancy-related thromboembolism from an undiagnosed pancreatic adenocarcinoma in a 54-year-old man, who presented with recurrent ischemic stroke due to chronic DIC. He died of the underlying malignancy despite the appropriate institution of anticoagulation therapy.This case emphasizes that cerebral infarction may be the first manifestation of an undiagnosed cancer. If there is laboratory or clinical evidence associated with DIC, patients with a cerebral infarct of an unknown etiology should be investigated for a malignant process. The optimal method of anticoagulation in cancer patients with thromboembolic disease (TED) remains unclear.