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A case of stroke correlated with Three Territory Sign in a patient with Trousseau Syndrome

RESUMO

CASE REPORT
A 78-year-old male patient, hypertensive and former smoker, was admitted to a tertiary
hospital with suspected ischemic stroke, presented with left upper limb plegia and left lower
limb paresis for three days before the admission, with mild dyslalia and responsive to verbal
commands. Cranial Computed Tomography (CT) revealed gliosis and myelin rarefactions,
and Cranial Magnetic Resonance Imaging (MRI) showed randomly distributed foci of
ischemic insult in three brain regions. Four days after admission, the patient reported
worsening epigastric pain with irradiation to the spine. A CT scan of the abdomen/pelvis
indicated a primary solid-cystic lesion, involving the body of the pancreas and bilateral renal
cysts. USG indicated secondary neoplastic liver implants. The presence of cerebrovascular
lesions in three regions suggested a diagnosis of Trousseau Syndrome (TS) associated with
a neoplastic condition. The patient remained clinically stable and it was decided to maintain
the clinical treatment of the stroke, and he was assigned for a follow-up at the oncology
department.

DISCUSSION
TS is characterized as a spectrum of pathophysiological disorders associated with neoplastic
conditions that can cause microthrombi by mucin, P-selectin, and L-selectin and thrombi
induced by the action of tissue factors. Thrombotic events may precede the diagnosis of
visceral malignancy or arise concomitantly with the tumor, indicating a hypercoagulable state
with a tendency to multiple thromboembolisms. Ischemic stroke is characterized by the
occlusion of blood vessels that carry out the vascularization of the Nervous System (NS),
with active cancer being a risk factor for this clinical condition. In TS, the excess of embolic
signals in patients with active neoplasia explains the lesion in three territories associated
with stroke. In the report, the 78-year-old patient was diagnosed with solid-cystic lesions in
the pancreas with an MRI indicating multiple foci of ischemic insult and pattern in three
territories of cerebrovascular compromise.

FINAL CONSIDERATIONS
Due to the association of TS with a clinical condition of hypercoagulability that favors
thromboembolic occurrences, it is necessary for health professionals to identify the etiology
of ischemic stroke episodes of neoplastic origin more quickly and accurately. Familiarization
with such vascular injuries may allow conduct that leads to a better prognosis for patients.