2011 Volume 33 Issue 6 Pages 583-589
A 64-year-old woman was admitted to our hospital for sudden slurred speech and right leg-predominant weakness. She experienced recurrent episodes of stroke during her 6 years of warfarinization. Magnetic resonance imaging (MRI) indicated anterior cerebral artery (A3) occlusion. Anticoagulation therapy with heparin was started because she was not suitable for t-PA treatment due to "wake-up stroke." After conversion from heparin to warfarin, ischemic stroke recurred twice in the posterior cerebral artery (P1) and the middle cerebral artery (M1) in one month. We speculated but were not able to diagnose cardioembolic stroke because there was no abnormality in her cardiac echo test, ambulatory blood pressure monitor, etc. Fibrin degradation products (FDP) and D-dimer levels were significantly elevated. Moreover, significant leukocytosis, especially monocytosis was observed. Abdominal computed tomography scan exhibited progressive pancreatic cancer which invaded into the spleen with multiple metastasis to the liver. There was a remarkable increase in CA-125 levels. After change of treatment from warfarin to low molecular weight heparin, stroke did not recur; however, she was in a serious systemic condition due to the large M1 occlusion and malignant tumor. Therefore, she received palliative care and died at 66 days after administration. We diagnosed this case as Trousseau syndrome. Monocytosis may be involved in this blood coagulation disorder.
