以双侧半球和前后循环脑梗死为首发症状的Trousseau综合征四例分析及文献复习
|
摘要
目的探讨以双侧半球、前后循环同时发生脑梗死为首发症状的Trousseau综合征的临床表现、辅助检查、影像学特点、治疗方法以及预后,以加深对该病的认识。方法回顾性分析2015年1月至2017年7月在首都医科大学附属北京友谊医院神经内科住院治疗的4例Trousseau综合征患者的临床资料,分析其既往病史、临床表现、治疗方法及预后。结果 4例患者均为男性,年龄分别为63岁、65岁、69岁和76岁。既往均有肿瘤病史,分别为肺癌2例,胃癌1例,胰腺癌1例。入院均为急性起病,有神经系统缺损的体征,明确诊断为急性脑梗死,梗死部位涉及前后循环、双侧半球。治疗过程中发现患者均合并深静脉血栓,其中有2例患者还出现了肺栓塞和心肌梗死。实验室检查显示高凝状态,相关肿瘤标志物CEA、CA125、CA199明显升高。4例患者早期均给予低分子肝素抗凝治疗,其中2例因并发急性肺栓塞死亡,另外2例病情稳定出院。结论 Trousseau综合征是肿瘤患者的第2位死因,以双侧半球、前后循环脑梗死为首发症状的患者,要特别注意肿瘤的筛查。提高对该病的认识,有效预防和治疗,对于延长患者生存期至关重要。
Objective To explore the clinical manifestations,auxiliary examinations,imaging features,treatment methods and prognosis of the Trousseau syndrome with acute bilateral hemispheric cerebral infarction as the first symptom,and to deepen the understanding of the disease.Methods The medical records of 4 patients of Trousseau syndrome with acute bilateral hemispheric cerebral infarction as the first symptom during2015 to 2017 were retrospectively reviewed. Their past medical history,clinical manifestations,treatment and prognosis were analyzed. Results All four patients were male with history of cancer,ages were 63,65,69 and 76 respectively. There were 2 cases of lung cancer,1 case of gastric cancer and 1 case of pancreatic cancer. The four patients were all acute onset,with signs of nervous system defect,and the diagnosis of acute cerebral infarction was clearly diagnosed. The infarction area involves the anterior and posterior circulation and bilateral hemispheres. During the treatment,all patients were found to merge deep vein thrombosis,2 of these patients also developed pulmonary embolism and myocardial infarction. Laboratory tests showed high coagulation,and tumor markers CEA,CA125,CA199 were significantly elevated. Conclusion Trousseau syndrome is the second leading cause of death in cancer patients. The bilateral hemispheres cerebral infarction is the first symptom of patients,we should pay special attention to screening of the tumor. To improve awareness of the disease and give effective prevention and treatment is essential to prolong the survival of these patients.
Objective To explore the clinical manifestations,auxiliary examinations,imaging features,treatment methods and prognosis of the Trousseau syndrome with acute bilateral hemispheric cerebral infarction as the first symptom,and to deepen the understanding of the disease.Methods The medical records of 4 patients of Trousseau syndrome with acute bilateral hemispheric cerebral infarction as the first symptom during2015 to 2017 were retrospectively reviewed. Their past medical history,clinical manifestations,treatment and prognosis were analyzed. Results All four patients were male with history of cancer,ages were 63,65,69 and 76 respectively. There were 2 cases of lung cancer,1 case of gastric cancer and 1 case of pancreatic cancer. The four patients were all acute onset,with signs of nervous system defect,and the diagnosis of acute cerebral infarction was clearly diagnosed. The infarction area involves the anterior and posterior circulation and bilateral hemispheres. During the treatment,all patients were found to merge deep vein thrombosis,2 of these patients also developed pulmonary embolism and myocardial infarction. Laboratory tests showed high coagulation,and tumor markers CEA,CA125,CA199 were significantly elevated. Conclusion Trousseau syndrome is the second leading cause of death in cancer patients. The bilateral hemispheres cerebral infarction is the first symptom of patients,we should pay special attention to screening of the tumor. To improve awareness of the disease and give effective prevention and treatment is essential to prolong the survival of these patients.
引文
[1]Elyamany G,Alzaharani AM,Bukhary E.Cancer-associated thrombosis:an overview[J].Clin Med Insights Oncol,2014,8:129-137.
[2]Khorana AA,Francis CW,Culakova E,et al.Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy[J].J Thromb Haemost,2007,5(3):632-634.
[3]Lee AY.Management of thrombosis in cancer:primary prevention and secondary prophylaxis[J].Br J Haematol,2005,128(3):291-302.
[4]Stein PD,Beemath A,Meyers FA,et al.Incidence of venous thromboembolism in patients hospitalized with cancer[J].Am J Med,2006,119(1):60-68.
[5]Donati MB,Lorenzet R.Thrombosis and cancer:40 years of research[J].Thromb Res,2012,129(3):348-352.
[6]Sanon S,Lenihan DJ,Mouhayar E.Peripheral arterial ischemic events in cancer patients[J].Vasc Med,2011,16(2):119-130.
[7]Srensen HT,Mellemkjaer L,Olsen JH,et al.Prognosis of cancers associated with venous thromboembolism[J].N Engl J Med,2000,343(25):1846-1850.
[8]Khorana AA.Targeted prophylaxis in cancer:the evidence accumulates[J].Intern Emerg Med,2013,8(3):187-189.
[9]Wun T,White RH.Epidemiology of cancer-related venous thromboembolism[J].Best Pract Res Clin Haematol,2009,22(1):9-23.
[10]Bick RL.Cancer-associated thrombosis[J].N Engl J Med,2003,349(2):109-111.
[11]Mackman N.Role of tissue factor in hemostasis,thrombosis,and vascular development[J].Arterioscler Tromb Vasc Biol,2004,24(6):1015-1022.
[12]Donati MB,Lorenzet R.Thrombosis and cancer:40 years of research[J].Thromb Res,2012,129(3):348-352.
[13]Jovin TG,Boosupalli V,Zivkovic SA,et al.High titers of CA-125may be associated with recurrent ischemic strokes in patients with cancer[J].Neurology,2005,64(11):1944-1945.
[14]Khorana AA,Kuderer NM,Culakova E,et al.Development and validation of a predictive model for chemotherapy-associated thrombosis[J].Blood,2008,111(10):4902-4907.
[15]Prandoni P,Lensing AW,Piccioli A,et al.Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis[J].Blood,2002,100(10):3484-3488.
[16]Douketis JD,Crowther MA,Foster GA,et al.Does the location of thrombosis determine the risk of disease recurrence in patients with proximal deep vein thrombosis[J]?Am J Med,2001,110(7):515-519.
[17]Lyman GH,Bohlke K,Khorana AA,et al.Venous thromboembolism prophylaxis and treatment in patients with cancer:american society of clinical oncology clinical practice guideline update 2014[J].J Clin Oncol,2015,33(6):654-656.
[18]Lee AY,Rickles FR,Julian JA,et al.Randomized comparison of low molecular weight heparin and coumarin derivatives on the survival of patients with cancer and venous thromboembolism[J].J Clin Oncol,2005,23(10):2123-2129.
[2]Khorana AA,Francis CW,Culakova E,et al.Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy[J].J Thromb Haemost,2007,5(3):632-634.
[3]Lee AY.Management of thrombosis in cancer:primary prevention and secondary prophylaxis[J].Br J Haematol,2005,128(3):291-302.
[4]Stein PD,Beemath A,Meyers FA,et al.Incidence of venous thromboembolism in patients hospitalized with cancer[J].Am J Med,2006,119(1):60-68.
[5]Donati MB,Lorenzet R.Thrombosis and cancer:40 years of research[J].Thromb Res,2012,129(3):348-352.
[6]Sanon S,Lenihan DJ,Mouhayar E.Peripheral arterial ischemic events in cancer patients[J].Vasc Med,2011,16(2):119-130.
[7]Srensen HT,Mellemkjaer L,Olsen JH,et al.Prognosis of cancers associated with venous thromboembolism[J].N Engl J Med,2000,343(25):1846-1850.
[8]Khorana AA.Targeted prophylaxis in cancer:the evidence accumulates[J].Intern Emerg Med,2013,8(3):187-189.
[9]Wun T,White RH.Epidemiology of cancer-related venous thromboembolism[J].Best Pract Res Clin Haematol,2009,22(1):9-23.
[10]Bick RL.Cancer-associated thrombosis[J].N Engl J Med,2003,349(2):109-111.
[11]Mackman N.Role of tissue factor in hemostasis,thrombosis,and vascular development[J].Arterioscler Tromb Vasc Biol,2004,24(6):1015-1022.
[12]Donati MB,Lorenzet R.Thrombosis and cancer:40 years of research[J].Thromb Res,2012,129(3):348-352.
[13]Jovin TG,Boosupalli V,Zivkovic SA,et al.High titers of CA-125may be associated with recurrent ischemic strokes in patients with cancer[J].Neurology,2005,64(11):1944-1945.
[14]Khorana AA,Kuderer NM,Culakova E,et al.Development and validation of a predictive model for chemotherapy-associated thrombosis[J].Blood,2008,111(10):4902-4907.
[15]Prandoni P,Lensing AW,Piccioli A,et al.Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis[J].Blood,2002,100(10):3484-3488.
[16]Douketis JD,Crowther MA,Foster GA,et al.Does the location of thrombosis determine the risk of disease recurrence in patients with proximal deep vein thrombosis[J]?Am J Med,2001,110(7):515-519.
[17]Lyman GH,Bohlke K,Khorana AA,et al.Venous thromboembolism prophylaxis and treatment in patients with cancer:american society of clinical oncology clinical practice guideline update 2014[J].J Clin Oncol,2015,33(6):654-656.
[18]Lee AY,Rickles FR,Julian JA,et al.Randomized comparison of low molecular weight heparin and coumarin derivatives on the survival of patients with cancer and venous thromboembolism[J].J Clin Oncol,2005,23(10):2123-2129.