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CLINICAL IMAGES
Year : 2016  |  Volume : 144  |  Issue : 6  |  Page : 945

Massive cerebral infarct due to Trousseau's syndrome in gastric cancer


Department of General Medicine, MES Medical College, Perinthalmanna 679 338, Kerala, India

Date of Submission10-Mar-2015
Date of Web Publication28-Apr-2017

Correspondence Address:
C A Mansoor
Department of General Medicine, MES Medical College, Perinthalmanna 679 338, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_377_15

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How to cite this article:
Mansoor C A, Jemshad A. Massive cerebral infarct due to Trousseau's syndrome in gastric cancer. Indian J Med Res 2016;144:945

How to cite this URL:
Mansoor C A, Jemshad A. Massive cerebral infarct due to Trousseau's syndrome in gastric cancer. Indian J Med Res [serial online] 2016 [cited 2020 Jun 4];144:945. Available from: http://www.ijmr.org.in/text.asp?2016/144/6/945/205401

A 27 yr old woman presented to the department of Medicine, MES Medical College, Perinthalmanna, Kerala, India, in January 2015 with sudden onset left-sided hemiplegia in the morning. She had advanced signet ring cell carcinoma of the stomach diagnosed 20 days earlier and received one cycle of chemotherapy. Her routine blood investigations were normal. Magnetic resonance imaging of brain revealed large infarct in right middle cerebral artery territory ([Figure 1] & [Figure 2]). Tests for antinuclear antibody and antiphospholipid antibodies were negative. Hereditary hypercoagulable states including protein C, protein S, antithrombin III deficiencies and activated protein C resistance were negative. Echocardiogram and carotid vertebral Doppler were normal. A diagnosis of cerebral infarct due to Trousseau's syndrome was made since other causes were ruled out. She was started on anticoagulants. Her hemiplegia persisted when followed up after two months. Trousseau's syndrome involves unexplained thrombotic events preceding the diagnosis of an occult visceral malignancy or with the tumour. Gastric malignancy leading to Trousseau's syndrome is rare.
Figure 1: Contrast magnetic resonance imaging of brain: Large area of T2W and fluid-attenuated inversion recovery hyperintensity (arrow in A and B ) in the right fronto-temporo-parietal region with diffusion restriction (arrow in C ) appearing hypointense in apparent diffusion coefficient (arrow in D ) without contrast enhancement (arrows in E and F ). Magnetic resonance angiogram showed absent signal in the right middle cerebral artery (arrows in G and H .

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Figure 2: Contrast magnetic resonance imaging of brain: Axial computed tomography scan image ( A ) and coronal T1 fluid-attenuated inversion recovery image ( B ) showing thrombus in M1 segment of the right middle cerebral artery (arrows). Susceptibility weighted image ( C ) did not show areas of blooming and magnetic resonance venogram ( D ) was also normal.

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    Figures

  [Figure 1], [Figure 2]



 

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