Acute Ischemic Stroke on Cancer Patients, a Distinct Etiology? A Case-Control Study

Romeiro, A; Valadas, Anabela; Marques, J. Pinto

doi:10.20344/amp.6156

Cited by 17 publications

(12 citation statements)

References 23 publications

(42 reference statements)

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“…Karlińska et al (2015) also noted that patients with stroke with an active cancer tended to present lower hematocrit levels, higher serum CRP levels, and a higher erythrocyte sedimentation rate when compared to cancer-free stroke patients (27). Several other studies have also reported elevated D-Dimers levels in cancer patients (7,19,146,147). Taking into consideration the significance D-Dimers seem to have in the diagnosis of cancer-related stroke, Guo et al (2014) used D-Dimers of ≥0.55 mg/l, and multiple territory infarctions, as criteria for the development of a clinically meaningful test for cancer-associated stroke.…”

Section: Detection Of a Cancer-associated Strokementioning

confidence: 72%

“…In several occasions, a combination of processes operate, and both hemorrhagic and ischemic stroke can simultaneously occur (20). Consequently, in patients with active malignancy, strokes are more frequently classified as 'of undetermined etiology' or as 'other determined etiology' by TOAST (https://radiopaedia.org/articles/toast-classification-in-acute-ischemic-stroke) classification, whereas in non-malignancy patients, the majority of strokes derives from small vessel occlusion (19,27,28).…”

Section: Pathophysiologymentioning

confidence: 99%

“…In patients with cancer, the most common cause of cerebrovascular thrombosis (CVT), identified in several clinical series, is a hypercoagulable state that accompanies cancer, resulting in systemic and cerebral arterial or venous thrombosis (19,52). In intravascular coagulation, tumor procoagulant activity, host inflammatory responses and extrinsic factors are involved.…”

Section: Pathophysiologymentioning

confidence: 99%

“…Summarizing, neuroimaging studies, measurement of coagulation function, and echocardiography are the most useful modalities to identify the stroke (23,31). In general, cancer-associated ischemic stroke is widely associated with lesions in multiple vascular territories (1,61,150), elevated D-dimers and fibrin degradation products (7,17,19,27,146,147,149,150), cancer markers (146) and proinflammatory components such as low hematocrit and high CRP levels (7,27,28,149). It is up to the experience of the doctor to assess the patient using the aforementioned tools, when a high level of clinical suspicion is present; consequently, vigilance is essential.…”

Section: Detection Of a Cancer-associated Strokementioning

confidence: 99%

“…The underlying causes for the development of a stroke in cancer patients differ from those of non-cancer patients, and are associated with the cancer itself, as well as with the type of treatment (1,9,13-19). In general, hypercoagulopathy or other coagulation disorders are most often related to the development of ischemic/embolic stroke (9,15,19). Cardio-embolism, large-vessel atherosclerosis and small-vessel occlusion have been reported as the major causes of ischemic stroke, while non-bacterial thrombotic endocarditis (NBTE) is rarely noted (9,17).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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Numerous types of cancer have been shown to be associated with either ischemic or hemorrhagic stroke. In this review, the epidemiology and pathophysiology of stroke in cancer patients is discussed, while providing vital information on the diagnosis and management of patients with cancer and stroke. Cancer may mediate stroke pathophysiology either directly or via coagulation disorders that establish a state of hypercoagulation, as well as via infections. Cancer treatment options, such as chemotherapy, radiotherapy and surgery have all been shown to aggravate the risk of stroke as well. The clinical manifestation varies greatly depending upon the underlying cause; however, in general, cancer-associated strokes tend to appear as multifocal in neuroimaging. Furthermore, several serum markers have been identified, such as high D-Dimer levels and fibrin degradation products. Managing cancer patients with stroke is a delicate matter. The cancer should not be considered a contraindication in applying thrombolysis and recombinant tissue plasminogen activator (rTPA) administration, since the risk of hemorrhage in cancer patients has not been reported to be higher than that in the general population. Anticoagulation, on the contrary, should be carefully examined. Clinicians should weigh the benefits and risks of anticoagulation treatment for each patient individually; the new oral anticoagulants appear promising; however, low-molecular-weight heparin remains the first choice. On the whole, stroke is a serious and not a rare complication of malignancy. Clinicians should be adequately trained to handle these patients efficiently.

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Section: Detection Of a Cancer-associated Strokementioning

confidence: 72%

Section: Pathophysiologymentioning

confidence: 99%

Section: Pathophysiologymentioning

confidence: 99%

Section: Detection Of a Cancer-associated Strokementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

et al. 2019

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Cancer is associated with inferior outcome in patients with ischemic stroke

et al. 2021

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Background Whether patients with stroke and cancer exhibit specific characteristics has remained controversial. Methods Medical records of patients with ischemic stroke in 2014 or 2015 registered in the Swiss Stroke Registry of Zurich were retrospectively analyzed and integrated with regional cancer registry data. Associations of clinical and outcome parameters with cancer diagnosed up to 5 years prior to stroke were tested. Results Of 753 patients with ischemic stroke, 59 patients with cancer were identified. History of venous thromboembolism (p < 0.001) was associated with cancer while age and cardiovascular risk factors were not. Higher levels of D-dimers (p = 0.001), erythrocyte sedimentation rate (p = 0.003), C-reactive protein (CRP) (p < 0.001), and lower levels of hemoglobin (p = 0.003) were associated with cancer. For platelets, pathologically low (p = 0.034) or high levels (p < 0.001) were linked to cancer. Modified Rankin scale (mRS) scores ≥ 4 on admission and at follow-up were more frequent in cancer patients (p = 0.038 and p = 0.001). Poor post-stroke survival was associated with cancer (HR 2.2, p < 0.001). Multivariable analysis identified venous thromboembolism (OR 5.1), pathologic platelet count (OR = 2.9), low hemoglobin (OR 2.5) and elevated CRP (OR 1.8) as independently associated with cancer. In multivariable Cox regression, risk for death was associated with cancer (HR 1.7), low hemoglobin (HR 2.6), mRS on admission ≥ 4 (HR 1.9), pathologic platelet count (HR 1.6), female sex (HR 1.7), and elevated CRP (HR 1.4). Conclusions Considering cancer as a cofactor for post-stroke outcome may impact clinical decision making.

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Predictors of unknown cancer in patients with ischemic stroke

et al. 2018

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Stroke is the second most frequent neurologic finding in postmortem studies of cancer patients. It has also been described as the first expression of an occult cancer. We have studied patients diagnosed with cancer after an ischemic stroke (IS) and we analyze differences with non-tumor patients. Single cohort longitudinal retrospective study of patients admitted to our center with IS diagnosis from 1 January 2012 to 12 December 2014. All patients were followed for 18 months. Patients with transient ischemic infarction or cerebral hemorrhage, active cancer or in the last 5 years, inability to follow-up or absence of complete complementary study (holter-EKG, echocardiogram, and dupplex/angiography-CT) were excluded. Demographic, clinical, analytical and prognostic characteristics were compared between both subgroups. From a total of 381 IS patients with no history of cancer, 29 (7.61%) were diagnosed with cancer. The mean time from stroke onset to cancer diagnosis was 6 months. The most frequent location was colon (24%). 35% were diagnosed in a metastatic stage. Older age (p = 0.003), previous cancer (p = 0.042), chronic kidney disease (CKD) (p = 0.006) and lower hemoglobin (p = 0.004) and fibrinogen (p = 0.019) values were predictors of occult neoplasm. No differences were found in other biochemical or epidemiological parameters, prognosis, etiology or clinical manifestations of the IS. In our study, older age, CKD, previous cancer and hemoglobin and fibrinogen values were related to the diagnosis of cancer after IS. More studies are needed to determine which patients could benefit from a larger study on admission that might allow an earlier diagnosis of the underlying neoplasm.

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Acute Ischemic Stroke on Cancer Patients, a Distinct Etiology? A Case-Control Study

Cited by 17 publications

References 23 publications

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

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

Cancer is associated with inferior outcome in patients with ischemic stroke

Predictors of unknown cancer in patients with ischemic stroke

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