A Case of Oropharyngeal Squamous Cell Carcinoma Complicated by Multiple Cerebral Infarctions due to Trousseau Syndrome

Abstract

Trousseau syndrome refers to a hypercoagulable state associated with malignancies. It is characterized by venous, and more rarely, arterial thrombosis. The most common pathology encountered in cases with arterial thrombosis is cerebral infarction, which is often multiple and diffusely distributed. Trousseau syndrome is commonly reported in cases of adenocarcinoma and is relatively rare in cases of squamous cell carcinoma. We report a rare case of multiple cerebral infarcts due to Trousseau syndrome in a patient with oropharyngeal squamous cell carcinoma.

A 61-year-old patient who had been treated for Stage IVB oropharyngeal carcinoma presented to our emergency department with double vision, nausea and difficulty in walking. Clinical examination revealed upbeat nystagmus and, raised D-dimer levels, and MRI showed multiple bilateral cerebral infarcts. Anticoagulant treatment was commenced, but the patient died one month after detection of the cerebral infarctions due to disease progression.

When encountering patients with multiple infarctions or recurrent thrombotic episodes, it is important to suspect Trousseau syndrome, and to carry out investigation to detect the responsible occult carcinomas and promptly commence treatment.