Open AccessTrousseau Syndrome in a patient on Direct Oral Anticoagulant use: A Case Report
Author(s) -
Marina Trombin Marques,
Leonardo de Sousa Bernardes,
Rafael Zini Moreira da Silva,
Matheus Gonçalves Maia,
Edson Júnior Gonçalves Bechara,
Eduardo dos Santos Sousa,
Juliana Rodrigues Dias Primo,
Vivian Dias Baptista Gagliardi,
Rubens José Gagliardi
Publication year - 2021
Language(s) - English
Resource type - Conference proceedings
DOI - 10.5327/1516-3180.508
Subject(s) - medicine , etiology , stroke (engine) , magnetic resonance imaging , thrombosis , deep vein , stenosis , diabetes mellitus , hemiparesis , radiology , rivaroxaban , warfarin , surgery , atrial fibrillation , angiography , mechanical engineering , engineering , endocrinology
Background: The Three Territory Sign (TTS) is a radiologic marker of ischemic stroke associated with malignant neoplastic diseases (Trousseau Syndrome) and corresponds to a rare stroke etiology. Case Report: Female, 62-year-old patient, with comorbidities of smoking, hypertension and diabetes, presented with a sudden faciobrachial-predominant left hemiparesis settled in the day before the admission. Diagnosed with a metastatic rectal adenocarcinoma seven months before, she underwent a rectosigmoidectomy three months ago and developed deep vein thrombosis, starting anticoagulant therapy with rivaroxaban 20mg daily. A Magnetic Resonance Imaging (MRI) revealed several lesions with restricted diffusion in multiple vascular territories, bilaterally, corresponding to ischemic stroke. Etiologic investigation did not detect signs of cardioembolism, nor significant vessel stenosis or unstable atherosclerotic plaques. In admission, she had a D-dimer level of 11,43μg (0- 0,5μg/mL). Conclusion: The evidence of TTS is about six times more frequent in stroke related to malignancies compared to cardioembolic etiology. The D-dimer is a marker of malignancies in cryptogenic stroke, elevated in 75% of cases. The most common associated neoplasms are pulmonary (40%) and gastrointestinal (33,3%). In the MRI, the lesions can be isolated or gathered, generally small and peripheral. There is no evidence regarding the ideal preventive therapy. It is necessary to reinforce the importance of investigating malignancies in patients presenting with cryptogenic stroke and TTS, a syndrome that is still poorly recognized.