Stroke and Cancer: Misfortunes Never Come Singularly

Abstract

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.

Characteristics of cryptogenic stroke in cancer patients

“…Previous studies have reported that the cryptogenic stroke rate in cancer patients is relatively high; however, there has been no study of the cryptogenic stroke rate according to the presence of active cancer within the same study population. It has been suggested that paroxysmal atrial fibrillation is the latent common cause of cryptogenic stroke in the general population .…”

“…However, these stroke mechanisms are often difficult to diagnose except in an autopsy; as a result, they can be diagnosed as cryptogenic stroke in clinical practice. In fact, in patients with cancer, the incidence of cryptogenic stroke is reported to account for approximately 40–50% of stroke mechanisms and is more prevalent in patients without cancer . Previous studies have demonstrated that cancer patients with cryptogenic stroke often have high plasma D‐dimer levels and multiple vascular lesion patterns and are associated with reduced survival, suggesting that cryptogenic stroke in these patients needs specific consideration.…”

Ischemic stroke in cancer patients: A review of an underappreciated pathology

“…13, 14 In a case-control study, 32% of cancer patients with ischemic stroke had in-hospital death versus 13% of non-cancer patients with ischemic stroke. 37 Small retrospective studies have reported that high D-dimer levels may be predictive of early neurological deterioration and death in cancer-associated stroke. 15, 38 However, the prognostic utility of D-dimer and other biomarkers in cancer-associated stroke requires confirmation in prospective studies with systematic assessments.…”

“…Among ischemic stroke patients, comorbid cancer is associated with increased stroke severity, early neurological deterioration, and in‐hospital death . Median survival was 84 days in 263 patients with active solid or hematological cancer diagnosed with acute ischemic stroke at a quaternary‐care cancer center .…”

Cancer is associated with inferior outcome in patients with ischemic stroke

“…Stroke patients with Alessia Hug and SungJu Weber these authors contributed equally to this work. cancer had higher in-hospital mortality [15][16][17][18], however, the availability of longitudinal data is limited.…”