Clinical manifestation of cancer related stroke: retrospective case–control study

Abstract

Cancer related stroke may have different phenotypes from non-cancer stroke, especially in terms of stroke progression and recurrence. We performed a case-control study to identify their incidences and risk factors in cancer related stroke. Between January 2001 and December 2009, we conducted a retrospective review of acute ischemic stroke patients with cancer who were admitted to Seoul National University Hospital, Seoul, Korea. The stroke patients without cancer served as control. We collected demographic variables, vascular risk factors, stroke phenotype, clinical course, and cancer information including diagnosis, stage, and treatment status. Among cancer stroke patients, the potential risk factor of stroke recurrence was evaluated. The mean age of the 102 cancer patients was 66.4 ± 10.8 years, and 64.7 % were men. The mean time interval from cancer diagnosis to stroke onset was 39.7 ± 60.9 months. The principal lesion pattern of cancer stroke was multiple dots extending single vascular territory (39.2 %), and they were associated with low hemoglobin and high fibrinogen levels. Stroke progression and recurrence were noted in 9.8 and 27.5 % of cancer stroke patients, and in 9.3 and 12.7 % of control patients, respectively. The stroke subtype was independently associated with recurrence of cancer stroke after multiple logistic regression (odds ratio = 3.165, 95 % confidence interval = 1.080-9.277, p = 0.036). Cancer related stroke has a distinct phenotype in terms of infarction pattern and laboratory findings. Stroke recurrence is frequently observed among cancer stroke patients, and its risk is related with stroke subtype.

Recurrent Thromboembolic Events after Ischemic Stroke in Patients with Primary Brain Tumors

“…(5, 26, 27) Patients with primary brain tumors experienced a short-term recurrent stroke rate that was approximately double the recurrent stroke rate observed in the general population. (6) We did not find any significant independent predictors of recurrent thromboembolism.…”

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

“…Case series from Asia, 6,8,9 reported gastric cancer as the most common malignancy, which is also one of the most frequent in the general Korean population. In the published Norway population study, 16 colorectal was the most common cancer.…”

“…8,9 Furthermore, one of the stroke etiology cancer-related mechanisms proposed is explained by the expression of mucin-secreting tumour procoagulants, 19 for which adenocarcinoma histology is frequently linked. 10 In one of the few studies with histological analysis 8 patients with active cancers had more frequently adenocarcinoma, a difference we did not find in our case series.…”

“…[2][3][4] Reflecting deeper knowledge of pathophysiology, in addition to a broad spectrum of diagnostic methods, recent data analysis has moved from traditional risk factor analysis to the study of mechanisms though unique to malignancy. [5][6][7][8][9] Despite the fact that 'cryptogenic' stroke is more common in cancer patients, 10 recent publications suggest that ischemic stroke in those patients is distinctive by its association with hypercoagulability, a distinctive multiple lesion pattern on brain imaging and embolism. [5][6][7][8][9]11 Such investigation approaches appear to indicate that multiple mechanisms are involved in ischemic stroke etiology in cancer patients, linking both pathologies.…”

“…[5][6][7][8][9] Despite the fact that 'cryptogenic' stroke is more common in cancer patients, 10 recent publications suggest that ischemic stroke in those patients is distinctive by its association with hypercoagulability, a distinctive multiple lesion pattern on brain imaging and embolism. [5][6][7][8][9]11 Such investigation approaches appear to indicate that multiple mechanisms are involved in ischemic stroke etiology in cancer patients, linking both pathologies. Nevertheless, it is still unclear whether the characteristics of ischemic stroke in cancer patients differ from non-cancer patients, turning out impossible to define in which cancer patient subgroup malignancy causes stroke more directly.…”