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Trousseau's Syndrome, a Previously Unrecognized Condition in Acute Ischemic Stroke Associated With Myocardial Injury.

Thalin C, Blomgren B, Mobarrez F, Lundstrom A, Laska AC, von Arbin M, von Heijne A, Rooth E, Wallen H, Aspberg S - J Investig Med High Impact Case Rep (2014)

Bottom Line: Further analyses revealed, to the best of our knowledge for the first time in stroke patients, circulating microvesicles positive for the epithelial tumor marker CK18 and citrullinated histone H3 in thrombi, markers of the recently described cancer-associated procoagulant DNA-based neutrophil extracellular traps.We also found tissue factor, the main in vivo initiator of coagulation, both in thrombi and in metastases.Troponin elevation in acute ischemic stroke is common and has repeatedly been associated with an increased risk of mortality.

View Article: PubMed Central - PubMed

Affiliation: Karolinska Institutet, Dept of Clinical Sciences, Division of Internal Medicine, Danderyd Hospital, Stockholm, Sweden.

ABSTRACT
Trousseau's syndrome is a well-known malignancy associated hypercoagulative state leading to venous or arterial thrombosis. The pathophysiology is however poorly understood, although multiple mechanisms are believed to be involved. We report a case of Trousseau's syndrome resulting in concomitant cerebral and myocardial microthrombosis, presenting with acute ischemic stroke and markedly elevated plasma troponin T levels suggesting myocardial injury. Without any previous medical history, the patient developed multiple cerebral infarctions and died within 11 days of admission. The patient was postmortem diagnosed with an advanced metastatic adenocarcinoma of the prostate with disseminated cerebral, pulmonary, and myocardial microthrombosis. Further analyses revealed, to the best of our knowledge for the first time in stroke patients, circulating microvesicles positive for the epithelial tumor marker CK18 and citrullinated histone H3 in thrombi, markers of the recently described cancer-associated procoagulant DNA-based neutrophil extracellular traps. We also found tissue factor, the main in vivo initiator of coagulation, both in thrombi and in metastases. Troponin elevation in acute ischemic stroke is common and has repeatedly been associated with an increased risk of mortality. The underlying pathophysiology is however not fully clarified, although a number of possible explanations have been proposed. We now suggest that unexplainable high levels of troponin in acute ischemic stroke deserve special attention in terms of possible occult malignancy.

No MeSH data available.


Related in: MedlinePlus

Multiple widely spread cerebral infarctions developing over the course of 9 days. Acute CT scan showed a number of small infarctions. Additional CT scans day 1, day 3, and day 9 revealed several new and larger infarctions with hemorrhagic transformations on both sides.
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fig1-2324709614539283: Multiple widely spread cerebral infarctions developing over the course of 9 days. Acute CT scan showed a number of small infarctions. Additional CT scans day 1, day 3, and day 9 revealed several new and larger infarctions with hemorrhagic transformations on both sides.

Mentions: A previously healthy 67-year-old man presented with a left arm and facial paresis, dysarthria, and left-sided neglect. He was admitted to the emergency department at Danderyd Hospital within one hour of symptom onset. Initial clinical examination was normal apart from hypertension (186/109 mm Hg on admission). A brain computed tomography (CT) scan showed a number of small diffusely marked lesions (Figure 1, row 1) suggesting cerebral infarctions of relatively recent date, but not recent enough to correspond to the present symptoms. Intravenous thrombolysis (alteplase) was administered and a marked regression of symptoms followed. Blood chemistry on admission showed elevated levels of Troponin T, 420 ng/L (530 and 362 ng/L over the following 12 hours; reference value <14 ng/L). Electrocardiogram (ECG), however, was normal and the patient had no current or history of chest pain or effort dyspnea. Cardiac telemetry during the first 24 hours showed a very short episode of possible paroxysmal atrial fibrillation as a potential cardiac source of cerebral embolism. A control CT scan the day after admission showed an additional small lesion in the right motor cortex and modest hemorrhagic transformation of the previously seen ischemic lesions (Figure 1, row 2). Ultrasound of the carotid arteries and transthoracic echocardiography (TTE) were normal.


Trousseau's Syndrome, a Previously Unrecognized Condition in Acute Ischemic Stroke Associated With Myocardial Injury.

Thalin C, Blomgren B, Mobarrez F, Lundstrom A, Laska AC, von Arbin M, von Heijne A, Rooth E, Wallen H, Aspberg S - J Investig Med High Impact Case Rep (2014)

Multiple widely spread cerebral infarctions developing over the course of 9 days. Acute CT scan showed a number of small infarctions. Additional CT scans day 1, day 3, and day 9 revealed several new and larger infarctions with hemorrhagic transformations on both sides.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4528894&req=5

fig1-2324709614539283: Multiple widely spread cerebral infarctions developing over the course of 9 days. Acute CT scan showed a number of small infarctions. Additional CT scans day 1, day 3, and day 9 revealed several new and larger infarctions with hemorrhagic transformations on both sides.
Mentions: A previously healthy 67-year-old man presented with a left arm and facial paresis, dysarthria, and left-sided neglect. He was admitted to the emergency department at Danderyd Hospital within one hour of symptom onset. Initial clinical examination was normal apart from hypertension (186/109 mm Hg on admission). A brain computed tomography (CT) scan showed a number of small diffusely marked lesions (Figure 1, row 1) suggesting cerebral infarctions of relatively recent date, but not recent enough to correspond to the present symptoms. Intravenous thrombolysis (alteplase) was administered and a marked regression of symptoms followed. Blood chemistry on admission showed elevated levels of Troponin T, 420 ng/L (530 and 362 ng/L over the following 12 hours; reference value <14 ng/L). Electrocardiogram (ECG), however, was normal and the patient had no current or history of chest pain or effort dyspnea. Cardiac telemetry during the first 24 hours showed a very short episode of possible paroxysmal atrial fibrillation as a potential cardiac source of cerebral embolism. A control CT scan the day after admission showed an additional small lesion in the right motor cortex and modest hemorrhagic transformation of the previously seen ischemic lesions (Figure 1, row 2). Ultrasound of the carotid arteries and transthoracic echocardiography (TTE) were normal.

Bottom Line: Further analyses revealed, to the best of our knowledge for the first time in stroke patients, circulating microvesicles positive for the epithelial tumor marker CK18 and citrullinated histone H3 in thrombi, markers of the recently described cancer-associated procoagulant DNA-based neutrophil extracellular traps.We also found tissue factor, the main in vivo initiator of coagulation, both in thrombi and in metastases.Troponin elevation in acute ischemic stroke is common and has repeatedly been associated with an increased risk of mortality.

View Article: PubMed Central - PubMed

Affiliation: Karolinska Institutet, Dept of Clinical Sciences, Division of Internal Medicine, Danderyd Hospital, Stockholm, Sweden.

ABSTRACT
Trousseau's syndrome is a well-known malignancy associated hypercoagulative state leading to venous or arterial thrombosis. The pathophysiology is however poorly understood, although multiple mechanisms are believed to be involved. We report a case of Trousseau's syndrome resulting in concomitant cerebral and myocardial microthrombosis, presenting with acute ischemic stroke and markedly elevated plasma troponin T levels suggesting myocardial injury. Without any previous medical history, the patient developed multiple cerebral infarctions and died within 11 days of admission. The patient was postmortem diagnosed with an advanced metastatic adenocarcinoma of the prostate with disseminated cerebral, pulmonary, and myocardial microthrombosis. Further analyses revealed, to the best of our knowledge for the first time in stroke patients, circulating microvesicles positive for the epithelial tumor marker CK18 and citrullinated histone H3 in thrombi, markers of the recently described cancer-associated procoagulant DNA-based neutrophil extracellular traps. We also found tissue factor, the main in vivo initiator of coagulation, both in thrombi and in metastases. Troponin elevation in acute ischemic stroke is common and has repeatedly been associated with an increased risk of mortality. The underlying pathophysiology is however not fully clarified, although a number of possible explanations have been proposed. We now suggest that unexplainable high levels of troponin in acute ischemic stroke deserve special attention in terms of possible occult malignancy.

No MeSH data available.


Related in: MedlinePlus