Pathological examination of thrombi retrieved by mechanical thrombectomy and autopsy in Trousseau’s syndrome: a case report

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  • Matsuzaki Jo
    Department of Stroke Neurology, Moriguchi Ikuno Memorial Hospital
  • Ohnishi Yohei
    Department of Neurosurgery, Moriguchi Ikuno Memorial Hospital
  • Ko Saya
    Department of Neurosurgery, Moriguchi Ikuno Memorial Hospital Department of Neurosurgery, Osaka City University Graduate School of Medicine
  • Katayama Yuri
    Department of Neurology, Moriguchi Ikuno Memorial Hospital
  • Nishikawa Misao
    Department of Neurosurgery, Moriguchi Ikuno Memorial Hospital
  • Ohsawa Masahiko
    Department of Pathology, Osaka City University Graduate School of Medicine

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  • Trousseau症候群における血栓回収療法と病理解剖で回収した血栓の病理学的検討 ─1剖検例からの考察─

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<p>An 89-year-old man transferred to our hospital due to sudden-onset disturbance of consciousness, left unilateral spatial neglect, right conjugate deviation of the eyes, dysarthria, left facial paresis and left hemiparesis. Brain MRI and MRA revealed an acute ischemic lesion of the right hemisphere and occlusion of the right middle cerebral artery (MCA), respectively. We diagnosed acute ischemic stroke due to right MCA occlusion caused by cardiogenic embolization (due to atrial fibrillation) or Trousseau’s syndrome (due to advanced lung adenocarcinoma). Immediate intravenous administration of alteplase and mechanical thrombectomy were performed, which resulted in recanalization of the right MCA. Subsequently, we started post-therapy administration of oral anti-coagulants, but bilateral internal carotid artery (ICA) occlusion occurred on day 6, and the patient died due to whole-brain death on day 8. Autopsy revealed primary adenocarcinoma in the right lung, and platelet-rich white clots and fresh thrombi in the bilateral ICA. These findings suggest features of thrombi in Trousseau’s syndrome. We compared the pathological findings of thrombi from Trousseau’s syndrome with cardiogenic emboli and discussed the differential diagnosis between the thrombus from Trousseau’s syndrome and cardiogenic embolization.</p>

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