Trousseau's syndrome with cerebral infarction as the first manifestation

This study aims to highlight the clinical significance of Trousseau's syndrome in cancer patients, particularly focusing on arterial thromboembolism (ATE), which remains understudied compared to venous thromboembolism (VTE). This report emphasizes the need for clinical vigilance in diagnosing Trousseau's syndrome when cancer patients present with atypical thromboembolic events.

The analysis proposes diagnostic criteria for suspected Trousseau's syndrome in cancer patients presenting with acute multiple cerebral infarctions. Key indicators include: a) Absence of severe cerebrovascular disease risk factors; b) Imaging evidence of lesions spanning multiple arterial territories or exhibiting the "Three Territory Sign" (TTS); c) Elevated D-dimer levels; d) Abnormal tumor markers or confirmed tumor lesions.

Clinical observations reveal that cancer patients with acute multifocal cerebral infarction, particularly those demonstrating multi-arterial territory involvement or TTS in neuroimaging, coupled with significantly elevated D-dimer (>5 µg/mL) and tumor markers (e.g., CEA, CA125), show high correlation with Trousseau's syndrome. These findings differentiate it from conventional atherosclerotic thromboembolism.

Trousseau's syndrome should be prioritized in differential diagnoses for cancer patients presenting with unexplained arterial thromboembolic events. Early anticoagulation therapy (e.g., low molecular weight heparin) rather than antiplatelet therapy is recommended as the primary intervention. This approach addresses the unique hypercoagulable state driven by tumor-associated fibrinolysis abnormalities, potentially reducing recurrent thromboembolic complications.