An old man suddenly couldn’t write and was mistakenly thought to have Alzheimer’s disease, but it turned out to be his “pancreas” that was to blame!

Grandma Fan was very good at handwriting and was usually proud of it. Recently, her family found that something was wrong with her. She couldn't even write her own name. They thought she had Alzheimer's disease and immediately sent her to the Hunan Provincial Second People's Hospital (Provincial Brain Hospital) for treatment.

The head MRI examination at the hospital revealed that the patient had multiple acute infarction lesions in the brain. But although Grandma Fan was old, she had a very regular life and did not have obvious common cerebrovascular disease risk factors such as hypertension, diabetes, and coronary heart disease. What caused the multiple cerebral infarctions?

Dr. Huang Xiaosong, chief physician and director of the third ward of the Department of Neurology, led the medical team to conduct a series of etiological examinations on the patient and found that Grandma Fan's coagulation function was obviously abnormal and there was a lesion in her pancreas. After further comprehensive examinations of the pancreas and other organs, it was determined that Grandma Fan's disease was caused by her pancreas. Finally, it was diagnosed as Trousseau's syndrome caused by pancreatic cancer .

Chief Physician Huang Xiaosong introduced: Trousseau's syndrome. In 1865, Trousseau first proposed that patients with gastric cancer are prone to venous thrombosis. Later, different disciplines had many different definitions of it according to the clinical manifestations they were concerned about. Later, all clinical manifestations of malignant tumor patients due to abnormal coagulation and fibrinolysis mechanisms during their disease course were collectively referred to as Trousseau's syndrome. It is common in pancreatic cancer, gastric cancer, and lung cancer .

Trousseau's syndrome is a type of tumor-related stroke. There are many mechanisms of tumor-induced stroke, and Trousseau's syndrome - central nervous system venous embolism caused by malignant tumors is only one of them. Cerebrovascular manifestations are only one of the manifestations of Trousseau's syndrome. Other system manifestations are also helpful for diagnosis, the most classic of which is migratory thrombophlebitis, and severe and very common pulmonary embolism.

Increased peripheral blood D-dimer levels are an important clinical feature of malignant tumor-related cerebral infarction and an independent risk factor for poor prognosis in patients with malignant tumors and cerebral infarction. To a certain extent, it reflects the severity of the hypercoagulable state in patients with malignant tumors.

In the treatment of Trusso's syndrome, low molecular weight heparin is still the first choice because it can directly inhibit the binding of leukocytes and platelets to mucin ligands secreted by tumors. Other treatments are mainly targeted at tumors and symptomatic supportive treatments.

Grandma Fan had multiple intracranial cerebral infarctions, but no obvious stenosis of the large blood vessels. After active and comprehensive examinations, it was found that the pancreatic malignant tumor caused multiple cerebral infarctions and Trousseau's syndrome. After active anticoagulant treatment, the patient's symptoms improved significantly. The next step is to transfer to the tumor center for further treatment of pancreatic cancer.

Chief Physician Huang Xiaosong reminds that for patients with acute stroke, if they are in a hypercoagulable state, they need to be alert to cerebral infarction and Trousseau's syndrome caused by tumor-induced hypercoagulable state, and they need to actively look for the cause of the hypercoagulable state to avoid missed diagnosis and delayed diagnosis and treatment.

Hunan Medical Chat Special Author: Li Ping, Hunan Second People's Hospital (Provincial Brain Hospital)

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(Edited by YH)