ArticleFrontiers in oncology2026
Case Report: Trousseau syndrome presenting as multifocal cerebral infarctions in advanced gastric signet-ring cell carcinoma: tumor burden-driven hypercoagulability.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Malignancy-associated hypercoagulability is a well-recognized driver of thromboembolic events in patients with advanced cancer. Arterial complications, including ischemic stroke, can develop despite appropriate anticoagulation and are often accompanied by markedly elevated D-dimer levels, reflecting sustained coagulation activation in the setting of advanced malignancy. Case presentation: A 76-year-old man presented with gastrointestinal bleeding and was subsequently diagnosed with advanced gastric signet-ring cell carcinoma with extensive hepatic and retroperitoneal metastases. During hospitalization, he developed acute left-sided hemiplegia. Brain magnetic resonance imaging revealed multiple acute infarctions involving both cerebral hemispheres and the cerebellum across distinct vascular territories, consistent with a systemic embolic pattern. The D-dimer level increased to approximately 23.7 μg/mL at the time of neurological deterioration. After gastrointestinal bleeding had stabilized, anticoagulation with enoxaparin sodium 4,000 anti-Xa IU subcutaneously twice daily was initiated; however, D-dimer remained elevated at approximately 23.1 μg/mL on May 21. Following initiation of systemic chemotherapy with the XELOX regimen, neurological deficits improved, accompanied by a decline in D-dimer from approximately 17.5 μg/mL before chemotherapy to approximately 14.9 μg/mL on June 2. Conclusion: This case underscores the characteristic radiological features of malignancy-associated stroke and highlights the close relationship between tumor burden and systemic hypercoagulability. The observed temporal association between chemotherapy initiation and reduction in D-dimer levels supports the concept that effective tumor-directed therapy, in addition to anticoagulation, may be necessary to mitigate cancer-related thrombotic complications. Early multidisciplinary intervention is essential to optimize both neurological recovery and oncologic management.
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