Objective To investigate the clinical and magnetic resonance imaging (MRI) features of Trousseau’s syndrome (TS) with acute cerebral infarction, so as to improve the accuracy of diagnosis of this disease. Methods Fifty-three cases of TS with clinically confirmed acute multiple brain infarction (AMBI) and 52 cases of TS without AMBI were enrolled, and the head MRI, primary tumor imaging and clinical data of the patients were retrospectively analyzed. The clinical and MRI features and thrombus types of the 2 groups were compared. Results There were significant differences in the types of thrombus between the 2 groups (P＝0.001), while there were no significant differences in gender, age, whether they had hypertension, diabetes mellitus, hyperlipidemia, basic cardiovascular diseases or not, preventive medication use, abnormal coagulation function, or D-dimer level (all P＞0.05). The primary tumor type of 105 TS patients was mainly adenocarcinoma. MRI of the head of 53 TS with AMBI patients showed that the distribution area of acute and subacute infarct foci was bilateral anterior circulation in 16 cases, bilateral anterior circulation＋bilateral posterior circulation in 17 cases, bilateral anterior circulation＋unilateral posterior circulation in 4 cases, and unilateral anterior circulation in 16 cases. Enhancement scans were performed in 23 cases, of which 11 cases showed some infarct foci appeared enhanced and 12 cases did not show significant enhancement. Twenty-eight cases did not show meaningful stenosis of the cerebral arteries, 4 cases showed stenosis occlusion of the cerebral arteries, and all lesions did not conform to cerebrovascular distribution. Twenty-four cases of arterial thrombosis (10 cases of carotid artery thrombosis, 3 cases of lower-extremity arterial thrombosis, 5 cases of cerebral arterial ring thrombosis, 1 cases of pulmonary artery thrombosis, 1 case of renal artery thrombosis, and 4 cases of subclavian artery thrombosis) and 3 cases of venous thrombosis (deep vein thrombosis of the lower extremities) were found among the patients with visualized thrombosis. The D-dimer level was increased in different degrees. Conclusion Multiple speckled and patchy acute anterior and posterior cerebral infarcts involving bilateral cerebral and cerebellar cortex, subcortical areas and hemi-oval centers with lesions not conforming to cerebrovascular distribution are the characteristic manifestations of MRI of the head in the combination of malignant tumors with TS. Adenocarcinoma is the main malignant tumor, and the combination of D-dimer index can improve the accuracy of diagnosis.