Hemorrhagic and Ischemic Stroke in Children With Cancer

Abstract

BACKGROUND Adult survivors of childhood cancer have an increased risk of cerebrovascular disease; little is known about early stroke risk in childhood cancer. Our objectives were to assess stroke prevalence in children with cancer; to establish cancer and stroke type; and to determine if modifiable risk factors for stroke were present. METHODS Children with stroke and cancer were compared to all children seen for cancer at a single institution from 2000–2009. An international classification of disease-9th version code search and search of existing pediatric oncology and stroke databases identified children <18 years with ischemic stroke, intracerebral hemorrhage and cerebral sinovenous thrombosis. RESULTS Of 1,411 children with cancer, 15 had stroke (1.1%, 95% CI: 0.6–1.7%). Strokes were 7 intracerebral hemorrhages, 5 ischemic strokes (1 of them followed by intracerebral hemorrhage), and 3 sinovenous thromboses. Stroke occurred at a median of 5 months post-cancer diagnosis. Ten children with strokes had hematologic malignancies and 5 had brain tumors. Thirteen patients died post-stroke, 8 via withdrawal of care. White blood cell count ≥48,000/mm3 was found in 4 children, all with intracerebral hemorrhage. Five of 7 children with intracerebral hemorrhage had platelets <50,000/mm3 CONCLUSIONS Stroke has a prevalence of approximately 1% in children with cancer. Hemorrhagic stroke and ischemic stroke occur with approximately equal frequency; children with leukemia and brain tumors are at greatest risk.

Acute Central Nervous System Complications in Pediatric Acute Lymphoblastic Leukemia

“…It ranged from 0.47% to 4.2% in various studies. [18][19][20] Unlike the other studies, five cases of intracranial aspergillosis (n ¼ 5/23; 19.2%) occurred during induction and reinduction phases. Children were receiving intensive chemotherapy with corticosteroids and had severe neutropenia.…”

“…L-asparaginase treatment causes imbalance of pro-and anticoagulating systems. [15][16][17][18] The prevalence of intracranial thrombosis and hemorrhage in this cohort was 1.4% (n ¼ 5/343). It ranged from 0.47% to 4.2% in various studies.…”

Cancer-associated stroke: Pathophysiology, detection and management (Review)

“…Lymphoproliferative malignancies can also be associated with secondary immune thrombocytopenia (54). In a study by Correale et al (1990) on 989 patients with lymphoma, 2% had ICH, in clear association with platelet alterations (66) and in a 2013 study on pediatric cancer patients, all those suffering with ICH had platelet counts of <100,000/mm 3 (67).…”

Cerebral sinus venous thromboses in children with acute lymphoblastic leukaemia – a multicentre study from the Nordic Society of Paediatric Haematology and Oncology

“…In comparison, a metaanalysis of 17 prospective studies comprising 1752 children with ALL estimated the rate of CNS thrombosis including cerebral infarction and stroke to be 2Á9% (Caruso et al, 2006) and a large British study with 1824 children with ALL reported an incidence of 1Á1% (Qureshi et al, 2010). A recent large American study on children with cancer and stroke reported two CSVTs in 190 children with ALL (1Á1%) (Noje et al, 2013) Thirteen (65%) of the children with CSVT were boys. One patient with CSVT had bilineage ALL, two patients had T-cell ALL while the others had precursor-B ALL.…”