A Marked Elderly Rare Case of the Advanced Ascending Colon Cancer with Lung Metastasis Who Complicated the Obstruction of The Right Internal Carotid Artery (ICA) and The Left Middle Cerebral Artery (MCA) Resulting in Trousseau Syndrome

We presented a markedly rare case who is elderly (102 years old) female suffering from advanced colon cancer with the metastasis in the lower lobe of right lung and suffering from the obstruction of right internal carotid artery (ICA) and left middle cerebral artery (MCA) emerged almost simultaneously. It is relatively rare that the obstructions of the main bilateral trunks such as ICA and the MCA may be induced almost simultaneously. Moreover, it is further rare that those cases described previously complicated an advanced colon cancer with distal metastasis (the lower lobe of the left lung). Firstly, we considered and analyzed the mechanism of relations between the advanced malignant neoplasms and the obstructions of the bilateral main trunks such as ICA and MCA. We considered that the cachexia by the malignant neoplasms may induce the hyperfunction of solidification system including the increase of D dimer and the fibrinolytic disfunction resulting in the formation of thrombosis associated with the atrial fibrillation and the various unknown other mechanism which can not be explained only by solidification cascade. Particularly, the brain has sufficient thromboplastins which causes the hyperfunction of solidification. In the contrary, thrombomodulins which shows the competitive fibrinolytic effect of thromboplastins are few in it. So, it is hypersodificative in the brain where it may be easily the target of disseminated intravascular coagulation (DIC). Moreover, the systemic condition of the every patient extremely various. However, we could not find the hyperfunction solidification and the fibrinolytic hyperfunction by the laboratory data in this patient. Therefore, it was possible that the patient suffering from cerebral infarction, the obstructions of the main trunks of bilateral cerebral hemispheres incidentally complicated malignant neoplasm, especially the ascending colon cancer with lung metastasis induced simultaneously. However, it has been widely accepted that malignant neoplasm can be the main risk factor of the deep venous thrombosis and pulmonary ones, and that almost 20% of the patients with cancers would suffer from cerebral thrombosis. So the idea that no relationships was identified between the two disorders are considered to be short-circuited. In any case of cerebral hemorrhage or infarction, it is the inevitable fact that these stroke may be induced to some extent in relation to the malignant neoplasm. Of course, the prognosis of the patients suffering from the malignant neoplasms mainly depends on the primary diseases (cancers) and this case is not also an exception. This case is 102 years old, marked elderly and we cannot ignore the factor of age and systemic condition. Furthermore, we also pay intensive caution to the disseminated intravascular coagulation (DIC) in the terminal stage. Secondly, despite of the bilateral swelling including the swelling of gyri and disappearance of sulci, this case did not manifest downward transtentorial herniation (DTH). If the younger patients with no atrophy of the cerebrums suffered from the obstructions of the main trunks of the bilateral cerebral hemispheres, they would usually manifest DTH due to swellings by the uncal herniation (UH) resulting in being fatal, even if the external decompress ion was performed. Although bilateral paresis of extremities and total aphasia were identified in this case, she was saved. The mechanism of being saved of this patient was that she was elderly and the upper tentorial pressure by the swelling of cerebrums did not influence the lower tentorial space because of the marked atrophy of cerebrums. In other words, tight posterior fossa was not performed. Compression to brain stem by uncal gyrus was not identified. The cisterns around brain stem was preserved. Neurologically, she shows an akinetic mutism. In conclusion, it is suggested that the two different disorders are induced incidentally and simultaneously.