Abstract
BackgroundIntracerebral hemorrhage is the most feared complication of intravenous thrombolysis for acute ischemic stroke. Such hemorrhage usually occurs within or at the margin of ischemic or manifestly infarcted brain tissue. A patient with Trousseau syndrome who developed multiple extra-ischemic hemorrhages following intravenous thrombolysis is described.Case descriptionAn 80-year-old Japanese man with no other underlying disease was diagnosed with unresectable advanced lung cancer (stage IV) without brain metastasis and had not yet been treated. The patient suddenly presented with disturbance of consciousness, right hemiplegia, and total aphasia, and was admitted to our hospital. Magnetic resonance imaging revealed acute cerebral infarction extending from the basal ganglia to the corona radiata of the left cerebrum and multiple small areas of bilateral cerebral cortices. Cardiogenic cerebral embolism was considered among the differential diagnoses, but the brain natriuretic peptide level was within the normal range, and no arrhythmias such as atrial fibrillation were observed. With no other causes, the patient was diagnosed with Trousseau syndrome due to hypercoagulability associated with the advanced lung cancer. The patient received intravenous tissue plasminogen activator (t-PA) at 96 minutes after onset of symptoms. His symptoms partially improved, but they suddenly deteriorated at 84 minutes after the thrombolysis. A computed tomography (CT) scan immediately after the neurological deterioration revealed a subcortical hemorrhage in the left occipital lobe. A repeat CT scan the day after onset showed enlargement of the left occipital hemorrhage and two new subcortical hemorrhages in the right frontal and right temporal lobes. These hemorrhages were located in areas remote from the acute ischemic lesions.ConclusionTo the best of our knowledge, this is the first reported case of multiple extra-ischemic hemorrhages following intravenous thrombolysis in a patient with Trousseau syndrome. The course of this case suggests that intravenous t-PA administration for acute ischemic stroke with Trousseau syndrome may be associated with a higher risk of intracranial hemorrhage.
Highlights
Intracerebral hemorrhage is the most feared complication of intravenous thrombolysis for acute ischemic stroke
To the best of our knowledge, this is the first reported case of multiple extra-ischemic hemorrhages following intravenous thrombolysis in a patient with Trousseau syndrome. The course of this case suggests that intravenous tissue plasminogen activator (t-PA) administration for acute ischemic stroke with Trousseau syndrome may be associated with a higher risk of intracranial hemorrhage
When acute ischemic strokes occur in patients with cancer, Trousseau syndrome should be considered in the differential diagnosis
Summary
This is the first known case report of multiple extraischemic hemorrhages following intravenous t-PA in a patient with Trousseau syndrome. The course of the present case suggests that intravenous t-PA administration for acute ischemic stroke with Trousseau syndrome may be associated with a higher risk of intracerebral hemorrhage. Consent Written informed consent was obtained from the wife of the patient for publication of this case report and any accompanying images. Competing interests The authors declare that they have no competing interests. Authors’ contributions HI diagnosed and treated the patient together with NY, MN, and MS. HI conceived the study, collected data, and drafted the manuscript. RE, NY, and MN revised the manuscript. MS supervised the study and revised the manuscript. All authors read and approved the final version of the manuscript
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