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Total palliative care for a patient with multiple cerebral infarctions that occurred repeatedly in association with gastric cancer (Trousseau's syndrome)

Published online by Cambridge University Press:  30 July 2012

Katsuyuki Ukai ,
Akiko Okajima ,
Aya Yamauchi ,
Eiji Sasaki ,
Yohsuke Yamaguchi ,
Hiroyuki Kimura ,
Branko Aleksic  and
Norio Ozaki
Katsuyuki Ukai*
Affiliation:
Palliative Care Team, Kamiiida Daiichi General Hospital, Kita-ku, Nagoya, Japan Department of Psychogeriatrics, Kamiiida Daiichi General Hospital, Kita-ku, Nagoya, Japan Department of Psychiatry, Nagoya University Graduate School of Medicine, NagoyaJapan
Akiko Okajima
Affiliation:
Palliative Care Team, Kamiiida Daiichi General Hospital, Kita-ku, Nagoya, Japan Department of Surgery, Kamiiida Daiichi General Hospital, Kita-ku, Nagoya, Japan
Aya Yamauchi
Affiliation:
Palliative Care Team, Kamiiida Daiichi General Hospital, Kita-ku, Nagoya, Japan Department of Psychogeriatrics, Kamiiida Daiichi General Hospital, Kita-ku, Nagoya, Japan Department of Psychiatry, Nagoya University Graduate School of Medicine, NagoyaJapan
Eiji Sasaki
Affiliation:
Department of Surgery, Kamiiida Daiichi General Hospital, Kita-ku, Nagoya, Japan
Yohsuke Yamaguchi
Affiliation:
Department of Surgery, Kamiiida Daiichi General Hospital, Kita-ku, Nagoya, Japan
Hiroyuki Kimura
Affiliation:
Department of Psychiatry, Nagoya University Graduate School of Medicine, NagoyaJapan
Branko Aleksic
Affiliation:
Department of Psychiatry, Nagoya University Graduate School of Medicine, NagoyaJapan
Norio Ozaki
Affiliation:
Department of Psychiatry, Nagoya University Graduate School of Medicine, NagoyaJapan
*
Address correspondence and reprint requests to: Katsuyuki Ukai, Palliative Care Team (Psychogeriatrics), Kamiiida Daiichi General Hospital, 2-70 Kamiiida-kitamachi, Kita-ku, Nagoya 462-0802, Japan. E-mail: [email protected]
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Abstract

Objective:

Malignancy-related thromboembolism, also referred to as Trousseau's syndrome, can present as acute cerebral infarction, nonbacterial thrombotic endocarditis (NBTE), and migratory thrombophlebitis. Therefore, many physical, neurological, and psychological symptoms associated with Trousseau's syndrome may occur in the clinical course.

Method:

To illustrate this, we report a case of a male patient in his 50s with carcinomatous peritonitis caused by gastric cancer, with multiple cerebral infractions that developed during disease progression. The patient was admitted to our hospital for the treatment of side effects of chemotherapy, although he strongly hoped to go home as soon as possible. In addition to making social supports plans, we were required to perform intensive total palliative care, because of his physical pain, general fatigue, anorexia, abdominal and neck pain, and psychological issues (insomnia, delirium, depression, suicidal thoughts, self-mutilation, panic attacks, agoraphobia, fear of death, and feelings of hopelessness).

Results:

To the best of our knowledge, based on the literature search, this is the first reported case of Trousseau's syndrome described in the context of total palliative care, especially psychological care.

Significance of results:

We propose that neurological symptoms of Trousseau's syndrome cause these extensive mental disorders. Furthermore, because of the prognosis of Trousseau's syndrome, we should utilize our expertise fulfill the patient's wishes.

Keywords

Trousseau's syndromeCerebral infarctionTotal palliative carePalliative care team (PCT)Mental disorders
Type
Case Report
Information
Palliative & Supportive Care , Volume 11 , Issue 2 , April 2013 , pp. 169 - 172
Copyright
Copyright © Cambridge University Press 2012

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