Acute Stroke Patients Have Occult Malignancy More Often than Expected

Uemura, Junichi; Kimura, Kazumi; Sibazaki, Kensaku; Inoue, Takeshi; Iguchi, Yasuyuki; Yamashita, Shinji

doi:10.1159/000316764

Cited by 54 publications

(59 citation statements)

References 45 publications

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“…Patients with cancer with cryptogenic stroke have been found to have higher D-dimer levels compared to patients with stroke without malignancy,7 a finding consistent with our patient. Although a number of cancers have been associated with a hypercoagulable state, adenocarcinomas have been significantly associated with cancer-related stroke 8.…”

Section: Discussionsupporting

confidence: 92%

Multiple embolic cerebral infarcts as the first manifestation of metastatic ovarian cancer

Bond¹,

Skrobo²

2015

BMJ Case Reports

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SUMMARYA 36-year-old woman presented to the emergency department with a 3-day history of an occipital headache associated with transient visual impairment and short-term memory loss. MRI of the brain showed innumerable focal embolic infarcts of differing ages, for which a cause could not be determined. The patient was discharged and readmitted 7 weeks later with acute aphasia and a right-sided hemiplegia. CT of the abdomen revealed a right-sided ovarian mass and prominent retroperitoneal nodes, which cytology confirmed to be metastatic ovarian cancer. BACKGROUND

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Section: Discussionsupporting

confidence: 92%

Multiple embolic cerebral infarcts as the first manifestation of metastatic ovarian cancer

Bond¹,

Skrobo²

2015

BMJ Case Reports

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“…[4][5][6] In two studies, based on cancers detected within the first In three studies, prevalence was calculated on the basis of cancers detected solely during hospitalization and varied between 4.7 and 29.7 per 1000.…”

Section: Prevalence and Numbers Needed To Screen (Nns)mentioning

confidence: 99%

“…3 In the year before cancer is diagnosed when cancer is occult, the risk of stroke is almost twice that in the background population without occult cancer. [4][5][6][7][8] Comparative studies on prevalence of occult cancer in comparable background populations are missing. A prerequisite for implementation of cancer screening would be that prevalence of occult cancers in the stroke population is markedly higher than in the background population.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and risk of occult cancer in stroke

2019

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Objectives: Cancer is associated with higher risk of stroke. Whether this translates into higher risk of cancer in stroke of an extent calling for cancer screening in stroke is unclear. We investigated prevalence and risk of occult cancer in stroke compared to the background population without history of stroke. Materials and methods: All patients >40 years of age with incident stroke in Denmark 2003-2015 were identified through the Danish Stroke Registry (n = 85 893) and matched 1:10 on age and sex to the Danish background population without history of stroke (n = 858 740). Linking data to the Danish Cancer Registry, we determined prevalence of occult cancer in stroke defined as the event of previously unknown cancer during a 1-year follow-up in the stroke and in the background population. Cox regression models were used to study risk in comparison to the background population. Results: Prevalence (per 1000) of occult cancer in the stroke/background cohorts was 25.0/15.8 in women and 29.8/20.4 in men. Prevalence was dependent on age and sex. Highest among stroke patients aged 70-80 years (35.6 in women, 42.4 in men); lowest in patients aged 40-50 years (8.3 in women, 6.8 in men). Stroke was associated with an overall 54% higher risk of occult cancer but risk increased significantly with smoking, hazard ratio (HR) 1.47, age HR 1.27 per 10 years, male sex HR 1.25, and diabetes HR 1.25. Conclusions:Prevalence and risk of occult cancer in stroke is considerable and calls for attention when designing the stroke investigation program. K E Y W O R D Scancer, prevalence, risk, stroke

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“…Uemura et al reported that hemoglobin levels were reduced in cancer patients compared with patients with no malignancy. 12 Their explanation for the reduced hemoglobin levels in cancer patients was the general condition of these patients as a result of cancer cachexia or gastrointestinal bleeding in gastrointestinal cancer patients. The present results support those of Uemura et al; hemoglobin levels in the cancer groups were lower than the non-cancer group in the present study.…”

Section: Figurementioning

confidence: 99%