Trousseau综合征相关性脑梗死的临床特征及误诊分析

Trousseau syndrome related cerebral infarction:clinical manifestations and misdiagnosis analysis

目的分析Trousseau综合征(TS)相关性脑梗死的临床特点、实验室检查及MRI特征,以提高TS相关性脑梗死的诊治水平。方法收集2018年11月至2023年6月48例TS相关性脑梗死患者临床资料,分析其临床特点及MRI表现,探讨实验室检查及MRI特征在诊断TS相关性脑梗死的应用价值。结果48例TS相关性脑梗死患者中男25例,女23例,年龄40~78岁,肿瘤类型前三位依次是胃癌10例(20.83%),肺癌9例(18.75%),结肠癌7例(14.58%),所有患者均有不同程度的D-二聚体(D-D)升高,48例头部MRI均属于多个血管分布区、大小不等的病灶混合,可有不同期相的混合,颅脑磁共振血管成像梗死灶与供血血管狭窄不匹配。与非误诊组比较,误诊组存在较多的传统脑血管病危险因素及DWI单个病灶数,误诊组累及血管数量、存在多时期发作的急性缺血病灶相对较少(P<0.05)。结论MRI图像显示多血管区域梗死和/或不同脑梗死病灶阶段并存及血浆D-D水平明显增高,对早期发现TS相关性脑梗死可能有一定的作用。

Objective To analyze the clinical features,laboratory examination and MRI features of Trousseau syndrome(TS)related cerebral infarction,so as to improve the diagnosis and treatment level of TS related cerebral infarction.Methods The clinical data of 48 patients with TS related cerebral infarction from November 2018 to June 2023 were collected,their clinical characteristics and MRI manifestations were analyzed,and the application value of laboratory tests and MRI features in the diagnosis of TS related cerebral infarction was explored.Results Among 48 patients with TS related cerebral infarction,there were 25 males and 23 females,aged 40-78 years old.The top three types of tumors were gastric cancer in 10 cases(20.83%),lung cancer in 9 cases(18.75%),and colon cancer in 7 cases(14.58%).All patients had varying degrees of elevated D-dimer(D-D)levels,and all 48 cases of head MRI belonged to a mixture of lesions with multiple vascular distribution areas and varying sizes,which could have different phases of mixing.The infarcted lesions on cranial magnetic resonance angiography did not match the stenosis of the blood supply vessels.Compared with non misdiagnosis group,misdiagnosis group had more traditional risk factors of cerebrovascular disease and the number of single DWI lesions,while the misdiagnosis group had relatively fewer affected blood vessels and acute ischemic lesions with multiple episodes(P<0.05).Conclusion MRI images show the coexistence of multiple vascular infarctions and/or different stages of cerebral infarction,as well as a significant increase in plasma D-D levels,which may have a certain role in early detection of TS related cerebral infarction.