Multiple ischemic strokes as the initial presentation of a concealed pancreatic malignancy: Trousseau's syndrome.
- Author:
Philipp C INES
;
Evelyn A ESPOSO
;
Joseph C BOCOBO
- Publication Type:Case report
- MeSH:
X
- From:
Philippine Journal of Internal Medicine
2012;50(1):34-39
- CountryPhilippines
-
Abstract:
Background: Armand Trousseau (1801-1865) stated that an unexpected or migratory thrombophlebitis could be a forewarning of an occult visceralmalignancy.1 The classical manifestations of Troussseau's syndrome are caused by venous thrombosis, nonbacterial thrombotic endocarditis often in conjunction with arterial embolization and arterial thrombosis.Setting: St. Luke's Medical Center, Quezon City, PhilippinesCase: We report here a case of a 67-yearold male with multiple strokes as the initial presentation of a pancreatic malignancy. He had a three-month history of epigastric pain and had two strokes in a span of one month, with multiple infarcts in both hemispheres, anterior and posterior circulation. A large silent pancreatic mass was seen on abdominal CT scan measuring 4.4 x 3.7 cm. On the 30th hospital day, patient had his third stroke, withsevere disability, Modified Rankin Scale8 (MRS) grade of 5 and NIHSS of 22.Diagnostics: Cranial MRI showed multiple recent infarcts in both cerebral and cerebellar hemispheres without confirmation to a vascular territory. Thereis stenosis of both anterior and middle cerebral artery and right posterior cerebral artery. Elevated transaminases and alkaline phosphatase, conjugatedhyperbilirubinemia, hypoalbuminemia, and deranged bleeding parameters were noted. A non-contrast abdominal CT scan showed a soft density at thepancreatic tail measuring 4.4x3.7 cm, with multiple hypodensities seen in the liver and spleen.Conclusion: Stroke as the initial manifestation of a pancreatic malignancy is rare. However, in patients with repeated strokes and a steep downhill course, this should prompt further investigation such as a possible underlying malignancy.
