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Cancer patients exhibit an elevated stroke risk (1)(2)(3)(4)(5). In a case-control study examining the epidemiology of cancer in stroke patients and their clinical course, we identified 72 active cancer and 72 control patients from the 1493 stroke admissions to Princess Margaret Hospital, Hong Kong in 2009. The prevalence of cancer among stroke patients was 4·8% (Table 1), and stroke was the first symptom of their cancer in nine patients. The proportions of ischemic stroke (IS) (79·2%) and haemorrhagic stroke (HS) (20·8%) in cancer group were comparable with noncancer group, and vascular risk factors (hypertension, diabetes mellitus, and hyperlipidemia) were less prevalent. The cancers we identified followed the local cancer epidemiology, with lung and colorectal cancer being the two most common types. In HS, both groups had similar proportions of deep parenchymal and lobar haemorrhages, but multiple haemorrhages were only seen in the three cancer patients. Except for the two acute promyelocytic leukaemia patients who bled, the distributions of other cancers among HS patients were similar to those with IS. Among IS, the proportions of patients in the four Oxfordshire-classified syndromes were comparable in the two groups. The etiology of IS was undetermined in half of the cancer patients compared with only 28·3% of the noncancer patients. There was no difference in the severity of neurological impairment [National Institutes of Health Stroke Scale (NIHSS) 10·7 (cancer) and 11·8 (noncancer)], but cancer patients had a higher hospital-acquired pneumonia (11·1% vs. 4·2%) and hospital mortality (31·9% vs. 12·5%) rates. At three-months poststroke, cancer remained the most important independent predictor of mortality [odds ratio 12·4 (3·0-51·4)], and more cancer patients were disabled. We concluded that stroke and cancer, when coinciding, carried a high morbidity and mortality rate. Often, the occurrence of stroke in cancer patients could not be sufficiently explained by conventional etiology, implicating the role of cancer-related factors in their stroke pathophysiology.

ObjectiveLate-onset Pompe disease (LOPD) is a lysosomal storage disease resulted from deficiency of the enzyme acid α-glucosidase. Patients usually develop a limb-girdle pattern of myopathy and respiratory impairment, and enzyme replacement therapy (ERT) is the only specific treatment available. Recently, LOPD has been associated with low bone mineral density (BMD), but the effect of ERT on BMD is inconclusive. In this report we described our early observations on the change of BMD after ERT in Chinese LOPD patients.ResultsWe studied four Chinese LOPD patients with different severities of myopathy. All were underweight, and three had osteoporosis at baseline. We found significant weight gain in three patients after ERT and all four patients showed improvement in BMD. The biggest improvement, 84.4% increase in BMD, was seen in a lady with the most prominent weight recovery. Our results suggest that ERT improves BMD in Chinese LOPD and weight gain could be a major contributor to this effect.

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