Key result
Metastatic pancreatic cancer presents with a rare triad of ischemic stroke, PE, and hemorrhagic brain metastasis.
Why the study?
The simultaneous occurrence of arterial stroke, venous thromboembolism, and hemorrhagic brain metastasis in pancreatic ductal adenocarcinoma is exceedingly rare, creating a management dilemma.
Case Report (n=1)
This case report highlights the rare and complex presentation of concurrent ischemic stroke, pulmonary embolism, and hemorrhagic brain metastasis in a patient with pancreatic cancer, underscoring the challenges of balancing thrombosis and hemorrhage risks.
Answers are grounded in this paper and cite their sources.
Complicates anticoagulation decisions in PDAC with mixed thrombotic-hemorrhagic events; leaves open evidence-based strategies for Trousseau syndrome.
Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive malignancy frequently complicated by paraneoplastic hypercoagulability, known as Trousseau syndrome. While isolated thromboembolic events such as ischemic stroke or pulmonary embolism (PE) are well-documented in PDAC, the simultaneous occurrence of arterial stroke, venous thromboembolism, and hemorrhagic brain metastasis is exceedingly rare. We present the case of a middle-aged woman with metastatic PDAC who developed an acute ischemic stroke in the context of PE and hemorrhagic metastasis. There was a management dilemma regarding the best options of treatment and possible complications. This report underscores the protean neurologic and thromboembolic manifestations of Trousseau syndrome and highlights the rare but devastating triad of stroke, PE, and hemorrhagic brain metastasis in PDAC. It also emphasizes the importance of individualized, multidisciplinary management strategies when faced with conflicting risks of thrombosis and hemorrhage in patients with advanced malignancy.
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Dahshan et al. (2026) conducted a case report in Pancreatic ductal adenocarcinoma with Trousseau syndrome (n=1). A middle-aged woman with metastatic pancreatic ductal adenocarcinoma presented with the rare and devastating triad of acute ischemic stroke, pulmonary embolism, and hemorrhagic brain metastasis.
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