Clinical data of 12 cases of Trousseau syndrome with cerebral infarction as initial presentation admitted in the neurology department of the Fourth Affiliated Hospital of Hebei Medical University from December 2011 to December 2017 were retrospectively analyzed.Of the 12 patients,4 cases had risk factors for cerebral infarction and 8 ones had no risk factors.There were 2 patients with 1 lesion and 10 patients with two or more lesions in brain imaging.The infarction lesions of 9 patients were located in 2 or more arterial blood supply areas.Ten patients showed an elevated plasma D-dimer level,5 had elevated fibrinogen level,7 showed increased blood platelet count and 8 had increased homocysteine level.Ten cases were confirmed by pathology,2 cases by clinic and imaging diagnosis.The study suggests that multiple lesions with several cerebral arteries involved,high plasma D-dimer and fibrinogen levels may be the clinical characteristics of Trousseau syndrome with initial presentation as acute ischemic stroke and lacking of risk factors.The hypercoagulation state may be the important pathogenesis of this disorder.