Clinical features of intracerebral hemorrhage in patients with colorectal cancer and its underlying pathogenesis

Abstract

BACKGROUND The diagnosis of both cancer and intracerebral hemorrhage (ICH) in the same patient is not uncommon, but the clinical features and pathogenesis of patients with colorectal cancer (CRC) and ICH are still not well known. AIM To investigate the clinical features and underlying pathogenesis of ICH in patients with CRC. METHODS A retrospective review of CRC patients complicated with ICH from three centers between January 2014 and December 2020 was performed. Clinical data such as laboratory examinations, imaging features, prognosis, and underlying pathogenesis were analyzed. RESULTS Of 16673 identified CRC patients, 20 (0.12%) suffered from ICH. There were 13 males and 7 females, with an average age (mean ± SD) of 68.45 ± 10.66 years. Fourteen patients (70%) had distant metastases and most patients (85%) showed an elevation of one or more cancer biomarkers. The hemorrhagic lesions in 13 patients (65%) were in the intracerebral lobe. Four patients were completely dependent and 4 died within 30 days after hemorrhage. Intratumoral hemorrhage (50%) and coagulopathy (50%) accounted for the majority of hemorrhages. CONCLUSION Patients with ICH and CRC often have clinical features with lobar hemorrhage, distant metastases and poor prognosis. Intratumoral hemorrhage and coagulopathy are the main causes of ICH in patients with CRC.

External validation of the diagnostic value of perihematomal edema characteristics in neoplastic and non‐neoplastic intracerebral hemorrhage

“…The dilemma associated with neoplastic ICH is that it may not always immediately disclose its underlying cause as it may be incorrectly identified as, among other conditions, hypertensive ICH, which often leads to misdiagnosis [4][5][6][7][8][9][10]. In addition, diagnosis on imaging may be mislead by strokelike symptoms in these patients, which often occur as the first clinical manifestation of the underlying brain neoplasia [4,11,12]. The ability to distinguish between neoplastic and non-neoplastic ICH is of clinical importance for the appropriate management of the patient.…”