World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website https://www.wjon.org

Short Communication

Volume 13, Number 6, December 2022, pages 403-408

Cerebral Infarction Caused by Trousseau’s Syndrome Associated With Lung Cancer

Figure 1. Case 1: brain diffusion-weighted MRI of initial cerebral infarctions (a) and recurrent cerebral infarctions (b). Red arrowheads point cerebral infarctions. MRI: magnetic resonance imaging.

Figure 2. Case 2: brain diffusion-weighted MRI (a, c) and CT (b) of initial cerebral infarctions (a), hemorrhagic infarction (b) and recurrent cerebral infarctions (c). Red arrowheads point cerebral infarctions, and red arrow points hemorrhagic infarction. MRI: magnetic resonance imaging; CT: computed tomography.

**Table 1.** Patient Backgrounds
Case	Age/sex	Histology	Driver mutation	C-stage^a	Previous chemotherapy	Cancer status at CI onset	Brain metastasis	Other thrombosis
^aClinical stage of Union for International Cancer Control (version eighth). ^bDuring chemotherapy. ^cAfter first-line chemotherapy. Ad: adenocarcinoma; ALK: anaplastic lymphoma kinase; CBDCA: carboplatin; CDDP: cisplatin; CI: cerebral infarction; del: deletion; DVT: deep venous thrombosis; EGFR: epidermal growth factor receptor; Ex: exon; F: female; M: male; PC: pleomorphic carcinoma; PEM: pemetrexed; SCLC: small cell lung cancer; VP-16: etoposide; WBRT: whole brain radiation therapy.
1	66/M	Ad	EGFR (Ex19del)	IVB	Osimertinib	Progressive^b	None	DVT
2	72/M	Ad	Wild	IVA	None	Before treatment	None	Renal infarcts
3	44/F	Ad	EGFR (Ex19del)	IVB	CDDP + PEM → erlotinib	Progressive^b	Post WBRT	Not detected
4	81/M	SCLC	Wild	IVB	CBDCA + VP-16	Progressive^c	Single	DVT
5	84/M	Ad	EGFR (Ex19del)	IIIB	Erlotinib	Progressive^c	None	Not detected
6	62/M	PC	Wild	IVB	CBDCA + PEM	Stable^b	None	Not detected
7	43/M	Ad	ALK	IVB	None	Before treatment	None	Not detected
8	75/F	Ad	Wild	IVB	None	Before treatment	None	Not detected
9	53/M	Ad	Wild	IVB	None	Before treatment	None	Not detected
10	64/F	Ad	EGFR (L858R)	IVB	None	Before diagnosis	Multiple	Renal infarcts

Table 1. Patient Backgrounds

Case

Age/sex

Histology

Driver mutation

C-stage^a

Previous chemotherapy

Cancer status at CI onset

Brain metastasis

Other thrombosis

^aClinical stage of Union for International Cancer Control (version eighth). ^bDuring chemotherapy. ^cAfter first-line chemotherapy. Ad: adenocarcinoma; ALK: anaplastic lymphoma kinase; CBDCA: carboplatin; CDDP: cisplatin; CI: cerebral infarction; del: deletion; DVT: deep venous thrombosis; EGFR: epidermal growth factor receptor; Ex: exon; F: female; M: male; PC: pleomorphic carcinoma; PEM: pemetrexed; SCLC: small cell lung cancer; VP-16: etoposide; WBRT: whole brain radiation therapy.

66/M

EGFR (Ex19del)

IVB

Osimertinib

Progressive^b

None

DVT

72/M

Wild

IVA

None

Before treatment

None

Renal infarcts

44/F

EGFR (Ex19del)

IVB

CDDP + PEM → erlotinib

Progressive^b

Post WBRT

Not detected

81/M

SCLC

Wild

IVB

CBDCA + VP-16

Progressive^c

Single

DVT

84/M

EGFR (Ex19del)

IIIB

Erlotinib

Progressive^c

None

Not detected

62/M

Wild

IVB

CBDCA + PEM

Stable^b

None

Not detected

43/M

ALK

IVB

None

Before treatment

None

Not detected

75/F

Wild

IVB

None

Before treatment

None

Not detected

53/M

Wild

IVB

None

Before treatment

None

Not detected

64/F

EGFR (L858R)

IVB

None

Before diagnosis

Multiple

Renal infarcts

**Table 2.** Risk Factors of Atherosclerosis
Case	Brinkman index	Dyslipidemia	Hypertension	Diabetes mellitus	Atherosclerotic changes shown by brain MRA
MRA: magnetic resonance angiography.
1	900	-	-	-	None
2	940	-	-	-	None
3	2,300	+	-	-	Vessel wall irregularities
4	900	-	+	-	None
5	470	-	-	-	None
6	2,400	-	+	+	Vessel wall irregularities
7	0	-	-	-	None
8	460	-	-	-	None
9	2,150	-	-	-	None
10	0	-	+	-	None

Table 2. Risk Factors of Atherosclerosis

Case

Brinkman index

Dyslipidemia

Hypertension

Diabetes mellitus

Atherosclerotic changes shown by brain MRA

MRA: magnetic resonance angiography.

900

None

940

None

2,300

Vessel wall irregularities

900

None

470

None

2,400

Vessel wall irregularities

None

460

None

2,150

None

**Table 3.** Characteristics, Treatment and Outcomes of Cerebral Infarction
Case	Initial or Rec^a	CI imaging	Symptoms	Anticoagulant	D-dimer (µg/mL)	Min D-dimer^d (µg/mL)	PS change after CI	Chemotherapy after CI	Outcome^a
^aThe initial cerebral infarction onset date was defined as day 1. ^bMultiple CI in bilateral multiregional arteries. ^cDrugs used at the time of recurrence. ^dMinimum D-dimer after the initial cerebral infarction. AMR: amrubicin; CBDCA: carboplatin; CI: cerebral infarction; Lt: left; Min: minimum; PEM: pemetrexed; Rec: recurrence; Rt: right; s.c.: subcutaneous injection; UFH: unfractionated heparin: PS: performance status.
1	Initial	Multiple^b	Rt hemiparesis	Apixaban^c	10.76	0.72	1 → 1	CBDCA + PEM → osimertinib	Discharged (day 17)
	Rec (day 8)	Lt occipital lobe	None	UFH → heparin calcium s.c.	10.86				Alive (> 1 year)
2	Initial	Lt occipital and temporal lobe	Diplopia	Aspirin^c	12.81	16.69	1 → 4	CBDCA + PEM (1 cycle)	Discharged (day 77)
	Rec (day 20)	Multiple^b (with Lt occipital lobe hemorrhage)	Unilateral facial paralysis	None	31.6				Died (day 124)
3	Initial	Rt lacunar	Dizziness, dysarthria	Argatroban + aspirin → UFH → edoxaban^c	1.58	0.63	1 → 4	None	Died (day 131)
	Rec (day 38)	Lt multiple	Aphasia	UFH (discontinued due to cerebral hemorrhage)	2.93
4	Initial	Rt cerebrum and cerebellum	None	Aspirin^c	2.27	1.39	0 → 4	AMR (1 cycle)	Discharged (day 50)
	Rec (day 25)	Multiple^b	None	UFH → heparin calcium s.c.	8.58				Died (day 225)
5	Initial	Multiple^b	Involuntary movements of the mouth and the limbs	None	16.6	38.92	1 → 4	None	Died (day13)
	Rec (day 5)	Multiple^b	Impaired consciousness	None	38.92
6	Initial	Multiple^b	Impaired consciousness	UFH^c	28.96	10.67	0 → 3	None	Transferred (day 23)
	Rec (day 3)	Multiple^b	Impaired consciousness	UFH → heparin calcium s.c.	10.67
7	Initial	Multiple^b	Lt hemiparesis	UFH	28.8	14.78	1 → 4	None	Died (day 37)
8	Initial	Multiple^b	Impaired consciousness, Rt hemiparesis	None	6.52	4.00	3 → 4	None	Died (day 6)
9	Initial	Multiple^b	Impaired consciousness, Rt hemiparesis	UFH → heparin calcium s.c.	10.7	8.71	1 → 4	None	Died (day37)
10	Initial	Multiple^b	Lt limb weakness	UFH → heparin calcium s.c.	42.1	5.9	1 → 3	None	Discharged (day 24)

Table 3. Characteristics, Treatment and Outcomes of Cerebral Infarction

Case

Initial or Rec^a

CI imaging

Symptoms

Anticoagulant

D-dimer (µg/mL)

Min D-dimer^d (µg/mL)

PS change after CI

Chemotherapy after CI

Outcome^a

^aThe initial cerebral infarction onset date was defined as day 1. ^bMultiple CI in bilateral multiregional arteries. ^cDrugs used at the time of recurrence. ^dMinimum D-dimer after the initial cerebral infarction. AMR: amrubicin; CBDCA: carboplatin; CI: cerebral infarction; Lt: left; Min: minimum; PEM: pemetrexed; Rec: recurrence; Rt: right; s.c.: subcutaneous injection; UFH: unfractionated heparin: PS: performance status.

Initial

Multiple^b

Rt hemiparesis

Apixaban^c

10.76

0.72

1 → 1

CBDCA + PEM → osimertinib

Discharged (day 17)

Rec (day 8)

Lt occipital lobe

None

UFH → heparin calcium s.c.

10.86

Alive (> 1 year)

Initial

Lt occipital and temporal lobe

Diplopia

Aspirin^c

12.81

16.69

1 → 4

CBDCA + PEM (1 cycle)

Discharged (day 77)

Rec (day 20)

Multiple^b (with Lt occipital lobe hemorrhage)

Unilateral facial paralysis

None

31.6

Died (day 124)

Initial

Rt lacunar

Dizziness, dysarthria

Argatroban + aspirin → UFH → edoxaban^c

1.58

0.63

1 → 4

None

Died (day 131)

Rec (day 38)

Lt multiple

Aphasia

UFH (discontinued due to cerebral hemorrhage)

2.93

Initial

Rt cerebrum and cerebellum

None

Aspirin^c

2.27

1.39

0 → 4

AMR (1 cycle)

Discharged (day 50)

Rec (day 25)

Multiple^b

None

UFH → heparin calcium s.c.

8.58

Died (day 225)

Initial

Multiple^b

Involuntary movements of the mouth and the limbs

None

16.6

38.92

1 → 4

None

Died (day13)

Rec (day 5)

Multiple^b

Impaired consciousness

None

38.92

Initial

Multiple^b

Impaired consciousness

UFH^c

28.96

10.67

0 → 3

None

Transferred (day 23)

Rec (day 3)

Multiple^b

Impaired consciousness

UFH → heparin calcium s.c.

10.67

Initial

Multiple^b

Lt hemiparesis

UFH

28.8

14.78

1 → 4

None

Died (day 37)

Initial

Multiple^b

Impaired consciousness, Rt hemiparesis

None

6.52

4.00

3 → 4

None

Died (day 6)

Initial

Multiple^b

Impaired consciousness, Rt hemiparesis

UFH → heparin calcium s.c.

10.7

8.71

1 → 4

None

Died (day37)

Initial

Multiple^b

Lt limb weakness

UFH → heparin calcium s.c.

42.1

5.9

1 → 3

None

Discharged (day 24)