Ischemic Stroke in Cancer Patients With and Without Conventional Mechanisms

Abstract

Background and Methods-To assess the precise mechanisms of stroke in cancer patients, we analyzed the data for cancer patients with acute ischemic stroke registered from 6 centers in South Korea. Clinical features, risk factors, diffusion-weighted imaging lesion patterns, and laboratory findings including D-dimer levels were compared between patients with conventional stroke mechanisms (CSMs) and cryptogenic group. Results-A total of 161 patients were included in this study: 97 (60.2%) patients in the CSM group and 64 (39.8%) in the cryptogenic group. Patients in the CSM group were older and vascular risk factors were more prevalent than in the cryptogenic group. Diffusion-weighted imaging patterns of multiple lesions involving multiple arterial territories were observed more frequently in the cryptogenic group than in the CSM group. In addition, levels of the D-dimer were higher in the cryptogenic group than in the CSM group (11.5Ϯ14.6 versus 3.6Ϯ10.3 g/dL). In multivariate analysis, the diffusion-weighted imaging lesion pattern of multiple vascular territories (odds ratio, 11.2; 95% CI, 3.74 to 33.3), and D-dimer levels of Ͼ1.11 g/dL (odds ratio, 10.6; 95% CI, 3.29 to 33.8) were associated independently with the cryptogenic group. Conclusions-Stroke outside of CSM occurred in a large number in cancer patients. In stroke patients with cancer, D-dimer levels and diffusion-weighted imaging lesion patterns may be helpful in early identification of non-CSMs (especially coagulopathy associated with cancer) and possibly in guiding preventive strategies for stroke. (Stroke. 2010;41:798-801.)

Stroke and Cancer

“…Our results are in line with the results of the earlier and largest study so far by Kim et al 13 The significance of this study, however, was limited by the fact that it did not include a control group but compared patients with cancer with and without a conventional stroke etiology.…”

“…[6][7][8][9][10][11][12] The largest study including 161 patients by Kim et al in 2010 differentiated between patients with cancer+stroke with and without conventional stroke etiologies and renewed the idea of cancer-associated hypercoagulation as an important stroke etiology. 13 Significantly higher d-dimer levels as well as a significantly higher rate of multiply affected vascular territories in the group of patients without conventional stroke etiology supported the idea of cancer-associated hypercoagulation with resulting cerebral embolism. This was promoted by a higher prevalence of…”

Evaluation of Cryptogenic Stroke With Advanced Diagnostic Techniques

“…15,16 Because of the advances in cancer medicine and the steadily increasing proportion of elderly people, the number of people living with cancer is increasing. As a consequence, the proportion of patients who have cancer is expected to increase among patients with stroke, especially in those without other stroke pathogeneses.…”

“…15 Patients with cancer-related stroke often present with progressive neurological deficits for hours to days (or even weeks) rather than sudden catastrophic events with initial maximum deficits at onset. In many patients, multifocal thromboembolism culminates in widespread infarcts of various sizes, producing confusion, lethargy, or dementia.…”

Ischemic stroke in critically ill patients with malignancy

“…An autopsy-based study found that approximately 15% of all patients with cancer experienced thromboembolic events, including ischemic stroke (IS), during their clinical course [8]. Systemic cancer is related to IS via various mechanisms [9]. Specifically, cancer-related mechanisms such as coagulopathy and tumour occlusion are a common cause of IS in patients with cancer [10][11][12][13][14].…”