以脑梗死为表现的特鲁索综合征1例临床特点及文献复习

Trousseau's syndrome with cerebral infarction:report of one case with literature review

特鲁索综合征是恶性肿瘤伴血液高凝状态引起的血栓栓塞并发症,青岛大学附属医院2020年10月收治1例以脑梗死为表现的特鲁索综合征患者。本例为胰腺恶性肿瘤患者,入院第2天出现口角歪斜、言语含糊,颅脑磁共振成像(MRI)检查显示脑实质内见多发DWI高信号,增强显示脑实质内未见异常强化,考虑为特鲁索综合征。检索中国知网、万方和PubMed数据库2011年1月至2021年6月的相关文献,共检索到以脑梗死为表现且资料比较完整的特鲁索综合征者76例,加上本例共77例。其中男性36例、女性41例,中位年龄63岁,最常见肿瘤类型为肺腺癌(24例,31.2%)。D-二聚体水平为(17.3±12.8)mg/L,颅脑CT或MRI检查提示双侧多发病变者57例(74.0%),56例行抗凝治疗。68例随访资料显示中位生存时间为90 d,log-rank法分析1年总生存率为32.6%。提示,对D-二聚体水平显著升高、多血管受累的脑梗死患者,需考虑恶性肿瘤的并发症。

Trousseau's syndrome(TS)is a complication of cancer-associated thrombosis caused by hypercoagulability.A 58-years female patient admitted to the Affiliated Hospital of Qingdao University on October 2020 and diagnosed with Trousseau's syndrome was reported.This was a patient with pancreatic malignant tumor.On the second day of admission,the mouth angle was distorted and the speech was vague.Craniocerebral MR showed multiple DWI high signals in the brain parenchyma,and brain MR enhancement showed no abnormal enhancement in the brain parenchyma.The patient was considered to be Trousseau's syndrome.Using"Trousseau's syndrome"and"cerebral infarction"as key words,the relevant literature was searched in CNKI,Wanfang and PubMed databases from January 2011 to June 2021,total of 76 cases of Trousseau's syndrome complicated with cerebral infarction were reported in the literature.Among 77 cases(including one in this study)36 were males and 41 were females,with a median age of 63 years old.The most common tumor type was lung adenocarcinoma(24 cases,31.2%).The mean D-dimer level was(17.3±12.8)mg/L,Craniocerebral CT or MRI showed that 57 cases(74.0%)had bilateral multiple lesions;and 56 cases received anticoagulant therapy.A total of 68 patients were followed up,with a median survival time of 90 days,and one year overall survival rate was 32.6%.The study indicates that for cerebral infarction with significantly elevated D-dimer level and multiple vascular involvement,malignant tumors should be considered.