Stroke as the first manifestation of concealed cancer

J Neurol Sci. 2007 Jul 15;258(1-2):80-3. doi: 10.1016/j.jns.2007.02.035. Epub 2007 Apr 3.


Background and purpose: Trousseau's syndrome (TS) is defined as a malignancy-related thromboembolism occurring in patients with an underlying or undiagnosed malignancy. Stroke seldom occurs as the first manifestation of a cancer. We investigated the clinical and radiological features of patients with TS.

Methods: We reviewed the clinical, pathologic, and radiological records of consecutive stroke patients, whose cancers were diagnosed at stroke presentation. Cancer-related stroke was defined if no definite cause was confirmed and malignancy was detected within 6 months of first stroke onset without cancer-related treatment. All patients underwent brain diffusion-weighted MRI (DWI), MR angiography, and echocardiography. The sizes, numbers, and locations of all hyperintense lesions in the DWI were noted.

Results: Ten patients were finally analyzed. Histologically, cancers were often proven to adenocarcinomas (50%, 5/10) of advanced stage. Six of 10 patients tested (60%) had elevated D-dimer. Seven of the 10 patients (70%) showed bihemispheric anterior and posterior involvement. DWI features showed numerous small and medium or large lesions in multiple territories in 9 patients (90%).

Conclusions: The authors emphasize that when presented with multiple bihemispheric infarctions on DWI and an unknown etiology, the neurologist must consider the existence of a concealed cancer.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cerebral Infarction / pathology
  • Diffusion Magnetic Resonance Imaging / methods
  • Echocardiography / methods
  • Female
  • Humans
  • Magnetic Resonance Angiography / methods
  • Male
  • Middle Aged
  • Neoplasms / complications*
  • Retrospective Studies
  • Stroke / diagnosis*
  • Stroke / etiology*