Recurrent ischemic stroke as an initial manifestation of an concealed pancreatic adenocarcinoma: Trousseau's syndrome

In rare instances, stroke may preceed a diagnosis of cancer and be the first clinical evidence of an underlying malignancy. Cerebral infarction mostly complicates lymphomas, carcinomas, and solid tumors. Malignancy-related thromboembolism can present as acute cerebral infarction, nonbacterial thrombotic endocarditis and migratory thrombophlebitis. It is generally attributed to a cancer-related hypercoagulable period, chronic dissemiated intravascular coagulopathy (DIC), or tumor embolism. We reported a case of malignancy-releated thromboembolism from an undiagnosed pancreatic adenocarcinoma in a 54-year-old man, who presented with recurrent ischemic stroke due to chronic DIC. He died of the underlying malignancy despite the appropriate institution of anticoagulation therapy. This case emphasizes that cerebral infarction may be the first manifestation of an undiagnosed cancer. If there is laboratory or clinical evidence associated with DIC, patients with a cerebral infarct of an unknown etiology should be investigated for a malignant process. The optimal method of anticoagulation in cancer patients with thromboembolic disease (TED) remains unclear. Chin Med J 2011;124(4):637-640