ArticleNeurology. Clinical practice2019
Three Territory Sign: An MRI marker of malignancy-related ischemic stroke (Trousseau syndrome).
Article in Neurology. Clinical practice, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 42 papers, 2 of them syntheses that pooled it.
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Who cites it
42 citing papers in PubMed, 2 syntheses or guidelines pooled it, 70 citations in OpenAlex.
- Stroke secondary to cancer-associated coagulopathy: a systematic review.Journal of neurology · 2026Pooled it
- Recurrent embolic stroke associated with adenomyosis: A single case report and literature review.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2023Pooled it
- Acute ischemic stroke, active malignancy and non-bacterial thrombotic endocarditis: an exploratory prospective observational study.Scientific reports · 2026Observational
- Diagnosis of Occult Cancer Using Fluorodeoxyglucose Positron Emission Tomography/CT in Cryptogenic Stroke Patients.Internal medicine (Tokyo, Japan) · 2026Article
- Three-territory sign in infective endocarditis and concomitant stroke: a retrospective analysis on characteristics and associated factors.Neurological research and practice · 2026Article
- Detection rate of FDG-PET/CT for occult cancer in patients with cryptogenic ischemic stroke.European journal of nuclear medicine and molecular imaging · 2026Observational
- Predicting cancer aetiology in patients with stroke using brain imaging alone.BMJ neurology open · 2026Article
- Trousseau's syndrome with cerebral infarction as the first manifestation.American journal of translational research · 2026Article
- Clinical features and prognosis of patients with malignant tumors complicated by cerebral infarction.American journal of cancer research · 2026Article
- Review
- Article
- Cryptogenic embolic stroke and cancer.Frontiers in neurology · 2025Review
- Outcome of patients with multivessel occlusion stroke after endovascular treatment.European stroke journal · 2024Observational
- Clinical features and prognostic factors of patients with cancer-associated stroke.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2024Article
- Trousseau's syndrome caused by hepatocellular carcinoma: a case description and literature analysis.Quantitative imaging in medicine and surgery · 2024Article
- Clinical analysis of twenty-one cases of acute ischemic stroke related to Trousseau syndrome.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2024Article
- Cancer screening in hospitalized ischemic stroke patients: a multicenter study focused on multiparametric analysis to improve management of occult cancers.The EPMA journal · 2024Article
- Malignancy-associated ischemic stroke: Implications for diagnostic and therapeutic workup.CNS neuroscience & therapeutics · 2024Review
- Clinical and radiological differentiation between Trousseau syndrome and cardiogenic embolism: a retrospective case-control study.Quantitative imaging in medicine and surgery · 2024Article
- Exploring the role of in-patient magnetic resonance imaging use among admitted ischemic stroke patients in improving patient outcomes and reducing healthcare resource utilization.Frontiers in neurology · 2024Article
Corrections and comments
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Authors and funding
3 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMultiple acute cerebral territory infarcts of undetermined origin are typically attributed to cardioembolism, most frequently atrial fibrillation. However, the importance of 3-territory involvement in association with malignancy is under-recognized. We sought to highlight the "Three Territory Sign" (TTS) (bilateral anterior and posterior circulation acute ischemic diffusion-weighted imaging [DWI] lesions), as a radiographic marker of stroke due to malignancy.
methodsWe conducted a single-center retrospective analysis of patients from January 2014 to January 2016, who suffered an acute ischemic stroke with MRI-DWI at our institution, yielding 64 patients with a known malignancy and 167 patients with atrial fibrillation, excluding patients with both to eliminate bias. All DWI images were reviewed for 3-, 2-, and 1-territory lesions. Chi-square test of proportion was used to test significance between the 2 groups.
resultsWe found an association between the groups (malignancy vs atrial fibrillation) and the number of territory infarcts (
conclusionThe TTS is a highly specific marker and 6 times more frequently observed in malignancy-related ischemic stroke than atrial fibrillation-related ischemic stroke. Evaluation for underlying malignancy in patients with the TTS is reasonable in patients with undetermined etiology.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.