Cerebral infarction from non-bacterial thrombotic endocarditis

Rogers, Lisa; Cho, Eun-sook; Kempin, Sanford; Posner, Jerome B.

doi:10.1016/0002-9343(87)90908-9

Cited by 174 publications

(58 citation statements)

References 43 publications

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“…10 A similar approach might also be considered when a stroke occurs secondary to NBTE. 11 Thus, the approach to the patient with cancer who develops a stroke would be different than that for the nononcological patient if it is deemed secondary to chronic DIC/hypercoagulability.…”

Section: Discussionmentioning

confidence: 99%

Should cerebral ischemic events in cancer patients be considered a manifestation of hypercoagulability?

Chaturvedi

Ansell

Recht

1994

Stroke

120

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Background and Purpose Previous studies, mainly autopsybased, suggest that the spectrum of stroke in cancer patients differs from that of the general population. These studies also suggest that cerebrovascular events frequently are a manifestation of hypercoagulability. However, no studies that address this question in the adult oncological population from a clinical perspective are available. We therefore assessed the clinical impact of cerebral ischemic events in cancer patients and attempted to determine whether their occurrence represents a manifestation of Trousseau's syndrome.Methods A computerized database that records all neurological admissions and consultations at a tertiary medical center was used to retrospectively identify all patients with cerebral ischemic events and cancer.Results Thirty-three patients representing 3.5% of all stroke consultations and admissions seen at the University of Massachusetts Medical Center were identified during the period 1988 through 1992. Large-vessel atherosclerosis was the

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Section: Discussionmentioning

confidence: 99%

Should cerebral ischemic events in cancer patients be considered a manifestation of hypercoagulability?

Chaturvedi

Ansell

Recht

1994

Stroke

120

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“…Marantic endocarditis is characterized by sterile platelet-fibrin vegetations on normal cardiac valves. 8, 9 These lesions are generally small and friable and, as such, are very difficult to diagnose definitively in vivo , including with transesophageal echocardiography. 10 However, a large autopsy study reported that marantic endocarditis is the most common cause of symptomatic ischemic stroke in patients with cancer.…”

Section: Introductionmentioning

confidence: 99%

Cryptogenic Subtype Predicts Reduced Survival Among Cancer Patients With Ischemic Stroke

Navi

Singer

Merkler

et al. 2014

Stroke

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Background and Purpose Cryptogenic stroke is common in patients with cancer. Autopsy studies suggest that many of these cases may be due to marantic endocarditis, which is closely linked to cancer activity. We, therefore, hypothesized that among patients with cancer and ischemic stroke, those with cryptogenic stroke would have shorter survival. Methods We retrospectively analyzed all adult patients with active systemic cancer diagnosed with acute ischemic stroke at a tertiary-care cancer center from 2005 through 2009. Two neurologists determined stroke mechanisms by consensus. Patients were diagnosed with cryptogenic stroke if no specific mechanism could be determined. The diagnosis of marantic endocarditis was restricted to patients with cardiac vegetations on echocardiography or autopsy and negative blood cultures. Patients were followed until July 31, 2012 for the primary outcome of death. Kaplan-Meier statistics and the log-rank test were used to compare survival between patients with cryptogenic stroke and patients with known stroke mechanisms. Multivariate Cox proportional hazard analysis evaluated the association between cryptogenic stroke and death after adjusting for potential confounders. Results Among 263 patients with cancer and ischemic stroke, 133 (51%) were cryptogenic. Median survival in patients with cryptogenic stroke was 55 days (interquartile range [IQR] 21-240) versus 147 days (IQR 33-735) in patients with known stroke mechanisms (p<0.01). Cryptogenic stroke was independently associated with death (hazard ratio 1.64, 95% confidence interval 1.25-2.14) after adjusting for age, systemic metastases, adenocarcinoma histology, and functional status. Conclusions Cryptogenic stroke is independently associated with reduced survival in patients with active cancer and ischemic stroke.

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“…kidneys, lungs, and skin). No arterial branch occlusions were seen on this patient's arteriogram as compared to the majority of cases of NBTE [6]. A complete search for other causes of cerebral vasculopathy (bacterial meningitis, syphilis, tuberculosis, rheumatoid/lupus vasculopathy and Wegeners granulomatosis) was negative.…”

mentioning

confidence: 61%

“…CSF cytology demonstrated This patient developed cerebral infarction and vasculopathy in association with meningeal carcinomatosis as the initial manifestation of breast cancer. Cerebral infarction in the setting of metastatic cancer is most commonly due to nonbacterial thrombotic endocarditis (NBTE) in which a hypercoagulable state predisposes to thrombosis, embolization, and cerebral vessel occlusion, often in the setting of disseminated intravascular coagulation (DIC) [5,6]. Although this occurs not infrequently in lung cancer, it is associated with breast cancer in only 1% of cases [7].…”

mentioning

confidence: 99%