{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T05:08:21Z","timestamp":1784092101721,"version":"3.55.0"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Malignancy-associated hypercoagulability is a well-recognized driver of thromboembolic events in patients with advanced cancer. Arterial complications, including ischemic stroke, can develop despite appropriate anticoagulation and are often accompanied by markedly elevated D-dimer levels, reflecting sustained coagulation activation in the setting of advanced malignancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 76-year-old man presented with gastrointestinal bleeding and was subsequently diagnosed with advanced gastric signet-ring cell carcinoma with extensive hepatic and retroperitoneal metastases. During hospitalization, he developed acute left-sided hemiplegia. Brain magnetic resonance imaging revealed multiple acute infarctions involving both cerebral hemispheres and the cerebellum across distinct vascular territories, consistent with a systemic embolic pattern. The D-dimer level increased to approximately 23.7 \u03bcg\/mL at the time of neurological deterioration. After gastrointestinal bleeding had stabilized, anticoagulation with enoxaparin sodium 4,000 anti-Xa IU subcutaneously twice daily was initiated; however, D-dimer remained elevated at approximately 23.1 \u03bcg\/mL on May 21. Following initiation of systemic chemotherapy with the XELOX regimen, neurological deficits improved, accompanied by a decline in D-dimer from approximately 17.5 \u03bcg\/mL before chemotherapy to approximately 14.9 \u03bcg\/mL on June 2.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case underscores the characteristic radiological features of malignancy-associated stroke and highlights the close relationship between tumor burden and systemic hypercoagulability. The observed temporal association between chemotherapy initiation and reduction in D-dimer levels supports the concept that effective tumor-directed therapy, in addition to anticoagulation, may be necessary to mitigate cancer-related thrombotic complications. Early multidisciplinary intervention is essential to optimize both neurological recovery and oncologic management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1818823","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T04:46:31Z","timestamp":1784090791000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Trousseau syndrome presenting as multifocal cerebral infarctions in advanced gastric signet-ring cell carcinoma: tumor burden\u2013driven hypercoagulability"],"prefix":"10.3389","volume":"16","author":[{"given":"Haocheng","family":"Zhao","sequence":"first","affiliation":[{"name":"Department of Hematology, Yueqing People\u2019s Hospital","place":["Yueqing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shanshan","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Yueqing People\u2019s Hospital","place":["Yueqing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenye","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Hematology, Yueqing People\u2019s Hospital","place":["Yueqing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1158\/0008-5472.Can-15-3100","article-title":"Thrombosis in cancer: Research priorities identified by a National Cancer Institute\/National Heart, Lung, and Blood Institute Strategic Working Group","volume":"76","author":"Key","year":"2016","journal-title":"Cancer Res"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2019-01-894261","article-title":"If Trousseau had a 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