Bilateral cerebral embolism as a characteristic feature of patients with Trousseau syndrome

Trousseau syndrome is defined as a variant of intravascular thromboembolism that is induced by cancer. It may manifest itself as cerebral embolisms in some cases; however, when the cancer is not diagnosed, this identification may be difficult. Therefore, cerebral embolisms are often treated without identifying the cancer, which can worsen a patient's condition. The purpose of this study was to determine the differences in clinical features between cerebral embolisms induced by cancer (Trousseau syndrome) and those that are due to other causes, such as cardiogenic embolisms and artery-to-artery stroke. A total of 83 patients, admitted to our hospital between April 2005 and March 2013 with cerebral embolisms, were included in this study. Of these, 9 (10.8%) were diagnosed with Trousseau syndrome, 63 (75.9%) had cardiogenic embolisms and 11 (13.2%) had artery-to-artery embolisms. Patients with embolic stroke of undetermined source (ESUS) were excluded from the study. We retrospectively investigated the localization of the infarctions, cancer type, and pathology, and the levels of primary fibrin/fibrinogen degradation products (FDP). From the nine patients with Trousseau syndrome, eight had adenocarcinomas and all had elevated initial FDP. Bilateral cerebral embolisms were significantly more common in Trousseau syndrome patients than cardiogenic embolisms (P=0.00026) and artery-to-artery embolisms (P=0.0016). All of them contained microembolisms as observed by magnetic resonance imaging (MRI). This study suggests that bilateral infarctions presenting microembolisms are important features of cerebral embolism attributed to Trousseau syndrome.