Ischemic stroke and intracranial hemorrhage in patients with recurrent glioblastoma multiforme, treated with bevacizumab

Glioma and cerebral ischemic stroke are two major events that lead to patient death worldwide. Although these conditions have different physiological incidences,~10% of ischemic stroke patients develop cerebral cancer, especially glioma, in the postischemic stages. Additionally, the high proliferation, venous thrombosis and hypercoagulability of the glioma mass increase the significant risk of thromboembolism, including ischemic stroke. Surprisingly, these events share several common pathways, viz. hypoxia, cerebral inflammation, angiogenesis, etc., but the proper mechanism behind this co-occurrence has yet to be discovered. The hypercoagulability and presence of the D-dimer level in stroke are different in cancer patients than in the noncancerous population. Other factors such as atherosclerosis and coagulopathy involved in the pathogenesis of stroke are partially responsible for cancer, and the reverse is also partially true. Based on clinical and neurosurgical experience, the neuronal structures and functions in the brain and spine are observed to change after a progressive attack of ischemia that leads to hypoxia and atrophy. The major population of cancer cells cannot survive in an adverse ischemic environment that excludes cancer stem cells (CSCs). Cancer cells in stroke patients have already metastasized, but early-stage cancer patients also suffer stroke for multiple reasons. Therefore, stroke is an early manifestation of cancer. Stroke and cancer share many factors that result in an increased risk of stroke in cancer patients, and vice-versa. The intricate mechanisms for stroke with and without cancer are different. This review summarizes the current clinical reports, pathophysiology, probable causes of co-occurrence, prognoses, and treatment possibilities.

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“…For example, the treatment of GBM with Bevacizumab shows a stroke rate of 1.9%. [260][261][262] (Fig. 3).…”

Section: Glioma Leads To Ischemic Stroke and Brain Injuriesmentioning

confidence: 96%

The interrelationship between cerebral ischemic stroke and glioma: a comprehensive study of recent reports

Ghosh

Chakraborty

Sarkar

et al. 2019

Sig Transduct Target Ther

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“…In previous studies, the rates of ICH following craniotomy for brain tumors is cited as 1.0–4.0% with a follow-up ranging between the initial hospital stay and long-term survival after surgery [ 6 , 13 – 15 , 44 , 46 – 48 ]. However, definitions for major ICH varied between volumetric measurement of the hematoma, presence of symptoms, decrease in hemoglobin, or need for surgical evacuation of hematoma [ 14 , 15 , 21 , 23 , 24 , 49 ].…”

Section: Discussionmentioning

confidence: 99%

Venous thromboembolism and intracranial hemorrhage after craniotomy for primary malignant brain tumors: a National Surgical Quality Improvement Program analysis

et al. 2017

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Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), frequently complicates the postoperative course of primary malignant brain tumor patients. Thromboprophylactic anticoagulation is commonly used to prevent VTE at the risk of intracranial hemorrhage (ICH). We extracted all patients who underwent craniotomy for a primary malignant brain tumor from the National Surgical Quality Improvement Program (NSQIP) registry (2005–2015) to perform a time-to-event analysis and identify relevant predictors of DVT, PE, and ICH within 30 days after surgery. Among the 7376 identified patients, the complication rates were 2.6, 1.5, and 1.3% for DVT, PE, and ICH, respectively. VTE was the second-most common major complication and third-most common reason for readmission. ICH was the most common reason for reoperation. The increased risk of VTE extends beyond the period of hospitalization, especially for PE, whereas ICH occurred predominantly within the first days after surgery. Older age and higher BMI were overall predictors of VTE. Dependent functional status and longer operative times were predictive for VTE during hospitalization, but not for post-discharge events. Admission two or more days before surgery was predictive for DVT, but not for PE. Preoperative steroid usage and male gender were predictive for post-discharge DVT and PE, respectively. ICH was associated with various comorbidities and longer operative times. This multicenter study demonstrates distinct critical time periods for the development of thrombotic and hemorrhagic events after craniotomy. Furthermore, the VTE risk profile depends on the type of VTE (DVT vs. PE) and clinical setting (hospitalized vs. post-discharge patients).

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“…Tumor cells express tissue factor and cancer procoagulant and release inflammatory cytokines and vascular endothelial growth factor creating an environment prone to intravascular coagulation [43][44][45][46]. In the specific situation of adenocarcinomas, Dearborn et al (2014) described the thrombogenic effect of the production and intravascular secretion of mucin, a glycoprotein with a high molecular weight that is secreted by epithelial cells [47].…”

Section: Cerebrovascular Diseasementioning

confidence: 99%

Emergencies in Neuro-oncology

Rotta

Melo

Reis

2021

Neurocritical Care for Neurosurgeons

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Ischemic stroke and intracranial hemorrhage in patients with recurrent glioblastoma multiforme, treated with bevacizumab

Cited by 21 publications

References 45 publications

The interrelationship between cerebral ischemic stroke and glioma: a comprehensive study of recent reports

The interrelationship between cerebral ischemic stroke and glioma: a comprehensive study of recent reports

Venous thromboembolism and intracranial hemorrhage after craniotomy for primary malignant brain tumors: a National Surgical Quality Improvement Program analysis

Emergencies in Neuro-oncology

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