Description

A 45-year-old woman was admitted to our hospital because of impaired consciousness. She had a huge tumour measuring 10 inches in diameter on the left breast (figure 1A). Although the tumour had been increasing in size since 3 years, the patient had adamantly refused to visit a hospital. She had no history of hypertension or atrial fibrillation. Symmetrical high-intensity lesions in the thalamus were observed on MRI (diffusion-weighted images) (figure 1B, arrow). Enhanced chest CT imaging revealed a large tumour on the left breast (figure 1C, arrowheads) with metastases in the lymph nodes and lungs (figure 1C, arrows) as well as cardiac invasion. Breast mass biopsy revealed the tumour to be a mucinous carcinoma. Impaired consciousness was considered to be caused by bilateral paramedian thalamic infarction.

• Download figure
• Open in new tab
• Download powerpoint

Figure 1

(A) A huge tumour measuring 10×10 inches in diameter with pigmentary changes was observed on the left breast. (B) MRI revealed symmetrical high-intensity lesions in the thalamus on diffusion-weighted images (arrow). (C) Enhanced CT revealed a large tumour on the left breast (arrowheads) with lung metastases (arrows).

Our case did not have common risk factors for atherosclerosis such as hypertension, diabetes and smoking. The patient was diagnosed with Trousseau syndrome, a state of hypercoagulability associated with the mucinous breast carcinoma. She regained consciousness after 3 days of conservative therapy for cerebral infarction but refused chemotherapy and received end-of-life care at home.

Trousseau syndrome comprises thromboembolic disorders in arterial or venous systems associated with malignancy, especially mucin-secreting carcinomas of the pancreas and gastrointestinal tract, lung cancer and ovarian cancer.1 ,2 Thromboembolism in the lower extremities, lung, brain, heart, kidneys or spleen may lead to death among patients with this syndrome.1 ,3 The syndrome may be treated by curative tumour resection and anticoagulation therapy,1 ,3 but when patients present with advanced cancer, as that in our case, curative therapy cannot be used. Trousseau syndrome with cerebral infarction should be considered to be a cause of impaired consciousness in patients with advanced cancer, particularly mucinous carcinoma.