Share:
Share this content in WeChat
X
Clinical Article
Clinical and imaging features and prognostic factors of acute ischemic stroke in patients with Trousseau's syndrome
SONG Ziyang  DAI Yao  WU Zhiwei  MA Mengya  LIU Yuanqing  FENG Mengmeng  DAI Hui 

SONG Z Y, DAI Y, WU Z W, et al. Clinical and imaging features and prognostic factors of acute ischemic stroke in patients with Trousseau's syndrome[J]. Chin J Magn Reson Imaging, 2023, 14(8): 40-44, 57. DOI:10.12015/issn.1674-8034.2023.08.006.


[Abstract] Objective To analyze clinical and imaging features of acute ischemic stroke (AIS) in patients with Trousseau's syndrome, and to explore the prognostic factors.Materials and Methods A retrospective analysis was conducted on 65 patients with malignant tumor complicated with Trousseau's syndrome and their clinical and imaging features were summarized. Based on their modified Rankin Scale (mRS) score, patients were divided into good prognosis group (mRS<3, n=35) and poor prognosis group (mRS≥3, n=30) . The features of the two groups were compared using independent sample t-test, Mann-Whitney U test or χ2 test. Indices with statistical significance in univariate binary logistic regression analysis were included in multivariate binary logistic regression analysis for prognostic analysis. Besides, patients were divided into asymptomatic cerebral infarction group (n=25) and symptomatic cerebral infarction group (n=40), and multivariate binary logistic regression analysis was performed to explore the independent risk factors of symptomatic cerebral infarction.Results Patients with Trousseau's syndrome showed increased level of D-dimer, small and numerous infarcts in different vascular supply areas. Compared with the good prognosis group, the poor prognosis group showed higher proportion of three territory sign in MRI, greater number of cerebral infarctions, higher National Institutes of Health Stroke Scale (NIHSS) score at admission, higher level of D-dimer, lower level of hemoglobin (Hb) and red blood cell count (P<0.05). Multivariate analysis showed that increased D-dimer (OR=5.094, 95% CI: 1.726-15.039) was an independent prognostic factor for poor prognosis in such patients. Infarct volume was an independent risk factor for symptomatic cerebral infarction (OR=1.227, 95% CI: 1.025-1.047).Conclusions Patients with AIS complicated with Trousseau's syndrome were characterized by hypercoagulation status and small and numerous infarcts in different vascular supply areas; increased D-dimer level is an independent prognostic risk factor and infarct volume was an independent risk factor for symptomatic cerebral infarction.
[Keywords] Trousseau syndrome;magnetic resonance imaging;malignant tumor;acute ischemic stroke;prognosis;D-dimer

SONG Ziyang   DAI Yao   WU Zhiwei   MA Mengya   LIU Yuanqing   FENG Mengmeng   DAI Hui*  

Department of Radiology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China

Corresponding author: Dai H, E-mail: huizi198208@126.com

Conflicts of interest   None.

ACKNOWLEDGMENTS National Natural Science Foundation of China (No. 81971573).
Received  2023-01-03
Accepted  2023-07-27
DOI: 10.12015/issn.1674-8034.2023.08.006
SONG Z Y, DAI Y, WU Z W, et al. Clinical and imaging features and prognostic factors of acute ischemic stroke in patients with Trousseau's syndrome[J]. Chin J Magn Reson Imaging, 2023, 14(8): 40-44, 57. DOI:10.12015/issn.1674-8034.2023.08.006.

[1]
VARKI A. Trousseau's syndrome: multiple definitions and multiple mechanisms[J]. Blood, 2007, 110(6): 1723-1729. DOI: 10.1182/blood-2006-10-053736.
[2]
NOUH A M, STAFF I, FINELLI P F. Three Territory Sign: An MRI marker of malignancy-related ischemic stroke (Trousseau syndrome)[J]. Neurol Clin Pract, 2019, 9(2): 124-128. DOI: 10.1212/CPJ.0000000000000603.
[3]
ZHEN C, WANG Y, WANG H, et al. Multiple cerebral infarction linked to underlying cancer: a review of Trousseau syndrome-related cerebral infarction[J]. Br J Hosp Med (Lond), 2021, 82(5): 1-7. DOI: 10.12968/hmed.2020.0696.
[4]
OKADA S, MIYAGAWA-HAYASHINO A, FUJINAMI J, et al. Trousseau's syndrome associated with pulmonary pleomorphic carcinoma exhibiting aggressive features: A case report[J]. Mol Clin Oncol, 2020, 12(1): 36-40. DOI: 10.3892/mco.2019.1947.
[5]
LIU Y, LI X, SONG F, et al. Clinical Features and Prognostic Factors of Acute Ischemic Stroke Related to Malignant Gastrointestinal Tumor[J/OL]. Front Neurol, 2021, 12: 777483 [2022-10-24]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8655855. DOI: 10.3389/fneur.2021.777483.
[6]
TANAKA T, SUZUKI H, MIWA K, et al. Hyperlipidemia as a risk factor for Trousseau syndrome-related cerebral infarction in patients with advanced gastrointestinal cancer[J]. Oncol Lett, 2022, 24(3): 318. DOI: 10.3892/ol.2022.13437.
[7]
BAO L, ZHANG S, GONG X, et al. Trousseau Syndrome Related Cerebral Infarction: Clinical Manifestations, Laboratory Findings and Radiological Features[J/OL]. J Stroke Cerebrovasc Dis, 2020, 29(9): 104891 [2022-10-24]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8655855. DOI: 10.1016/j.jstrokecerebrovasdis.2020.104891.
[8]
TODA Y, KANO Y. Three-territory sign in Trousseau's syndrome[J/OL]. BMJ Case Rep, 2022, 15(11): e253520 [2022-10-24]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9660682. DOI: 10.1136/bcr-2022-253520.
[9]
Chinese Society of Neutrology, Chinese Stroke Society. Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018[J]. Chin J Neurol, 2018, 51(9): 666-682. DOI: 10.3760/cma.j.issn.1006-7876.2018.09.004.
[10]
MALEK E G, ELBEJJANI M, ABBAS R, et al. TOAST classification and risk factors of ischemic stroke in Lebanon[J]. Acta Neurol Scand, 2020, 141(4): 294-300. DOI: 10.1111/ane.13201.
[11]
LIU F, TSANG R C, ZHOU J, et al. Relationship of Barthel Index and its Short Form with the Modified Rankin Scale in acute stroke patients[J/OL]. J Stroke Cerebrovasc Dis, 2020, 29(9): 105033 [2022-10-24]. https://pubmed.ncbi.nlm.nih.gov/32807445. DOI: 10.1016/j.jstrokecerebrovasdis.2020.105033.
[12]
KNEIHSL M, ENZINGER C, WÜNSCH G, et al. Poor short-term outcome in patients, with ischaemic stroke and active cancer[J]. J Neurol, 2016, 263(1): 150-156. DOI: 10.1007/s00415-015-7954-6.
[13]
NAVI B B, IADECOLA C. Ischemic stroke in cancer patients: A review of an underappreciated pathology[J]. Ann Neurol, 2018, 83(5): 873-883. DOI: 10.1002/ana.25227.
[14]
ADESS M, EISNER R, NAND S, et al. Thromboembolism in cancer patients: pathogenesis and treatment[J]. Clin Appl Thromb Hemost, 2006, 12(3): 254-266. DOI: 10.1177/1076029606291432.
[15]
YUAN T F, WANG J P. Clinical and Imaging Features of Acute Cerebral Infarction in Non-small Cell Lung Cancer Patients with Trousseau Syndrome[J]. Chin J Lung Cancer, 2021, 24(1): 13-18. DOI: 10.3779/j.issn.1009-3419.2021.102.01.
[16]
TYBJERG A J, BABORE A D, OLSEN T S, et al. Types of occult cancer in stroke and the relation to smoking[J]. Acta Neurologica Scandinavica, 2020, 142(5): 486-492. DOI: 10.1111/ane.13299.
[17]
NAVI B B, REINER A S, KAMEL H, et al. Risk of Arterial Thromboembolism in Patients With Cancer[J]. J Am Coll Cardiol, 2017, 70(8): 926-938. DOI: 10.1016/j.jacc.2017.06.047.
[18]
SCHWARZBACH C J, SCHAEFER A, EBERT A, et al. Stroke and cancer: the importance of cancer-associated hypercoagulation as a possible stroke etiology[J]. Stroke, 2012, 43(11: 3029-3034. DOI: 10.1161/STROKEAHA.112.658625.
[19]
SHIMOHAMA S, OKI K, NARITA H, et al. Trousseau's Syndrome Presenting as Multiple Cerebral Infarctions Caused by Mucin-producing Bladder Micropapillary Urothelial Cancer[J]. Intern Med, 2022, 61(1: 97-101. DOI: 10.2169/internalmedicine.7477-21.
[20]
VENEPALLY N R, ARSANJANI R, AGASTHI P, et al. A New Insight Into Nonbacterial Thrombotic Endocarditis: A Systematic Review of Cases[J]. Anatol J Cardiol, 2022, 26(10: 743-749. DOI: 10.5152/AnatolJCardiol.2022.1282.
[21]
YOO J, CHOI J K, KIM Y D, et al. Outcome of Stroke Patients with Cancer and Nonbacterial Thrombotic Endocarditis[J]. J Stroke, 2020, 22(2: 245-253. DOI: 10.5853/jos.2020.00619.
[22]
LING Y, LI Y, ZHANG X, et al. Clinical features of Trousseau's syndrome with multiple acute ischemic strokes[J]. Neurol Sci, 2022, 43(4: 2405-2411. DOI: 10.1007/s10072-021-05619-y.
[23]
GUO L, WANG L, LIU W. Ability of the number of territories involved on DWI-MRI to predict occult systemic malignancy in cryptogenic stroke patients[J/OL]. J Stroke Cerebrovasc Dis, 2020, 29(7: 104823 [2022-10-24]. https://pubmed.ncbi.nlm.nih.gov/32362555.
[24]
CHI X, ZHAO R, PEI H, et al. Diffusion-weighted imaging-documented bilateral small embolic stroke involving multiple vascular territories may indicate occult cancer: A retrospective case series and a brief review of the literature[J]. Aging Med (Milton), 2020, 3(1: 53-59. DOI: 10.1002/agm2.12105.
[25]
FINELLI P F. MR Three-Territory Sign in Cancer-Associated Hypercoagulation Stroke (Trousseau Syndrome): An Overlooked Diagnostic Feature: MR Three-Territory Sign[J]. Neurologist, 2021, 27(2: 37-40. DOI: 10.1097/NRL.0000000000000356.
[26]
TSUSHIMA M, METOKI N, HAGII J, et al. D-dimer and C-reactive Protein as Potential Biomarkers for Diagnosis of Trousseau's Syndrome in Patients with Cerebral Embolism[J/OL]. J Stroke Cerebrovasc Dis, 2020, 29(2: 104534 [2022-10-24]. https://pubmed.ncbi.nlm.nih.gov/31810721.
[27]
NAM K W, KIM C K, KIM T J, et al. D-dimer as a predictor of early neurologic deterioration in cryptogenic stroke with active cancer[J]. Eur J Neurol, 2017, 24(1: 205-211. DOI: 10.1111/ene.13184.
[28]
DIRIX L Y, SALGADO R, WEYTJENS R, et al. Plasma fibrin D-dimer levels correlate with tumour volume, progression rate and survival in patients with metastatic breast cancer[J]. Br J Cancer, 2002, 86(3: 389-395. DOI: 10.1038/sj.bjc.6600069.
[29]
WANG Z, MIAO J, WANG L, et al. EGFR-mutant NSCLC presenting with stroke and massive systemic embolization as the first manifestation: case report[J/OL]. BMC Neurol, 2021, 21(1: 221 [2022-10-24]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8188717. DOI: 10.1186/s12883-021-02236-2.
[30]
BABY P, SRIJITHESH P R, REDDY A V, et al. Transcultural Adaptation and Validation of Kannada version of the National Institute of Health Stroke Scale (NIHSS)[J]. Ann Indian Acad Neurol, 2022, 25(2: 224-228. DOI: 10.4103/aian.aian_707_21.
[31]
PARK Y H, KIM B J, KIM J S, et al. Impact of both ends of the hemoglobin range on clinical outcomes in acute ischemic stroke[J]. Stroke, 2013, 44(11: 3220-3222. DOI: 10.1161/STROKEAHA.113.002672.
[32]
GUO L J, LIU W H. Clinical and prognosis features of acute ischemic stroke patient with cancer patient[J]. J Apoplexy and Nervous Diseases, 2019, 36(1: 37-42. DOI: 10.19845/j.cnki.zfysjjbzz.2019.01.008.
[33]
LI S D, PENG B. The U-shaped relationship between hemoglobin concentration and stroke[J]. Chin J Neurol, 2019, 52(12: 1068-1072. DOI: 10.3760/cma.j.issn.1006-7876.2019.12.012.
[34]
ZHANG R, XU Q, WANG A, et al. Hemoglobin Concentration and Clinical Outcomes After Acute Ischemic Stroke or Transient Ischemic Attack[J/OL]. J Am Heart Assoc, 2021, 10(23: e022547 [2022-10-24]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9075388. DOI: 10.1161/JAHA.121.022547.

PREV Multi-sequence MRI-based convolutional neural network predicts the methylation status of MGMT promoter in glioma
NEXT Cerebral imaging characteristics of pruritus caused by eczema based on fALFF and FC analyses
  



Tel & Fax: +8610-67113815    E-mail: editor@cjmri.cn