Suitability of Thrombolysis for Patients With Acute Ischemic Stroke Complicated With Trousseau Syndrome.

Yujie Chen,Xin Wang,Shiguang Zhu,Yan Liu,Long Han,Chundi Zhang,Rui Wang,Chenchen Ma,Ziyang Geng,Ruiguo Dong

doi:10.3389/fnins.2020.00481

Abstract

Intravenous thrombolysis (IVT) improves functional outcome after acute ischemic stroke (AIS) and is the standard first-line treatment; however, it is associated with many complications, including cerebral hemorrhage. Cancer patients are susceptible to thrombotic events – collectively referred to as Trousseau syndrome (TS) – owing to their hypercoagulable state. Here, we describe the case of a 55-year-old male with a history of hypertension for over 10 years who underwent surgery for removal of a cancer of lower esophagus, with no subsequent treatment. Three months later, he was admitted to the emergency department of our hospital with sudden dizziness and incoherent speech. Brain computed tomography revealed multiple cerebral infarctions. The patient was treated by IVT with tissue plasminogen activator (rtPA) after the onset of symptoms, which improved by the end of the treatment. However, a few months later, he experienced a recurrence of cerebral infarction and hemorrhage, which has rarely been reported. The clinical course of this case suggests that the suitability of thrombolysis with rtPA in the acute phase of cerebral infarction complicated with TS should be carefully considered.

Highlights

Ischemic cerebral infarction is a major cause of disability and mortality in adults worldwide (Shigematsu et al, 2015; Jönsson et al, 2018)
One multicenter study reported that 3.4% of patients had remote parenchymal hemorrhage after IV injection of recombinant tissue plasminogen activator (Prats-Sanchez et al, 2016)
No thrombus was found by computed tomography (CT) angiography (Figure 1F), and no obvious plaques were detected in the neck and lower extremities by color Doppler ultrasound

Summary

INTRODUCTION

Ischemic cerebral infarction is a major cause of disability and mortality in adults worldwide (Shigematsu et al, 2015; Jönsson et al, 2018). By the end of thrombolysis, the right limb weakness had improved, with an NIHSS score of 4; 24 h after thrombolysis (2019/03/06), CT showed multiple infarction in the left parietal lobe and multiple blood foci in the right occipital lobe (Figures 1B,C) At this time, the patient did not have obvious discomfort, and the dizziness and speech symptoms were slightly improved. No thrombus was found by CT angiography (Figure 1F), and no obvious plaques were detected in the neck and lower extremities by color Doppler ultrasound The patient has both cerebral infarction and cerebral hemorrhage, considering that antiplatelet drugs can aggravate the risk of bleeding, so he did not have antiplatelet treatment during the first hospitalization.

DISCUSSION

CONCLUSION

Findings

ETHICS STATEMENT