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

Abstract

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.

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

“…Hemorrhagic stroke can cause direct adverse effects on the tumor within the cranial vault. 250,251 The intravascular coagulopathy that causes embolism is the main mechanism of cancer-related stroke. 252,253 Direct effects either from tumor compression or from tumor embolism are another causal mechanism of stroke.…”

Cancer‐associated ischemic stroke

“…3,4 In a Swedish nationwide follow-up study, patients with cancer developed ischemic stroke 2.2 times more often than their age-and sex-matched non-cancer control population during a six months follow-up. 7 Other reported common cancer types include breast, urogenital and prostate cancers. 5 A Danish registry-based case-control study with over 264 000 cancer patients also showed an approximately 2-fold risk for ischemic stroke in occult cancers.…”

“…Although the risk of stroke decreased rapidly, it remained elevated even over 10 years. 7 Cancer and ischemic stroke share multiple common risk factors such as age, obesity, and smoking. 6 No solid data exist on exact prevalence of different cancer types in ischemic stroke patients.…”

“…However, lung, pancreatic, and colorectal cancers seem to have a higher association with ischemic stroke, perhaps due to their aggressiveness. 7 Other reported common cancer types include breast, urogenital and prostate cancers. 7 Cancer and ischemic stroke share multiple common risk factors such as age, obesity, and smoking.…”

“…7 Other reported common cancer types include breast, urogenital and prostate cancers. 7 Cancer and ischemic stroke share multiple common risk factors such as age, obesity, and smoking. Thus, cancer patients are not immune to common causes of ischemic stroke such as atrial fibrillation, large-artery atherosclerosis, and small-vessel occlusions.…”