恶性肿瘤相关缺血性脑卒中(特鲁索综合征)的临床及MRI分析

Clinical and imaging features of cancer-associated ischemic stroke(Trousseau syndrome)

目的探讨恶性肿瘤相关缺血性脑卒中(特鲁索综合征)的临床及影像学特征,以提高对该病的认识及早期影像的诊断能力。方法回顾性纳入经临床诊断为恶性肿瘤相关缺血性脑卒中病人17例,年龄52~80岁,中位年龄62岁。分析其临床资料、神经影像特征及短期预后等资料,并行文献复习。结果特鲁索综合征病人病理类型以腺癌(15例)多见,8例以神经系统症状首诊,17例均见D-二聚体明显升高及血红蛋白值减低,12例C反应蛋白升高。MRI显示17例病人梗死灶均为多发(>5个),13例最大病灶直径>15 mm,病灶易累及区域为脑叶区(16例)和小脑(14例)。DWI上显示,16例为累及多个供血区的多发病灶,其中11例病变同时分布于双侧前循环及后循环。结论当急性缺血性脑卒中病人MRI病灶分布为双侧前循环+后循环,同时具备老年人、血浆D-二聚体、C反应蛋白明显升高及血红蛋白减低等特点时,应首先考虑特鲁索综合征。

Objective To explore the clinical and imaging features of cancer-associated ischemic stroke(Trousseau syndrome)in order to improve the recognition and ability of early imaging diagnosis.Methods Seventeen cases of cancerassociated ischemic stroke,aged from 52 to 80 years,with a median age of 62 years,were retrospectively included.The clinical data,neuroimaging features and short-term prognosis were analyzed,and relevant literatures were reviewed.Results The main pathological type of Trousseau syndrome was adenocarcinoma(15 cases).Eight cases sought help due to nervous system symptoms.All the 17 patients showed significantly increased D-dimer and decreased hemoglobin.The increased CRP appeared in 12 cases.MRI showed multiple(more than 5)acute infarcts in 17 cases,and the diameter of the largest lesion was more than 15 mm in 13 cases.The vulnerable areas of the acute infarcts were the lobar area(16 cases)and the cerebellum(14 cases).DWI showed that acute cerebral infarcts involved multiple blood supply territories in 16 cases,of which 11 cases were located in bilateral anterior circulation and posterior circulation.Conclusion The diagnosis of Trousseau syndrome should be considered first in elderly acute ischemic stroke patients with increased D-dimer and CRP,decreased hemoglobin and MRI lesions in the bilateral anterior and posterior circulation.