Frequent Ischemic Stroke as First Manifestation of Occult Colon Cancer: A Rare Case

Tsai, Chia-Chan; Wu, Meng‐Ni

doi:10.12659/ajcr.895130

Cited by 10 publications

(2 citation statements)

References 13 publications

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“…Seven previous case series (16 patients) with DWI sequence were also analyzed in our study 3,7‐13 . The mean age of the total patients (21 patients) was 66 years (mean ± SD, 66 ± 11.74 years).…”

Section: Resultssupporting

confidence: 93%

Diffusion‐weighted imaging‐documented bilateral small embolic stroke involving multiple vascular territories may indicate occult cancer: A retrospective case series and a brief review of the literature

et al. 2020

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Aging Medicine. 2020;3:56-62. wileyonlinelibrary.com/journal/agm2 | INTRODUC TI ONDiffusion-weighted imaging (DWI) MRI is a sensitive and indispensable tool for evaluating embolic brain infarctions, especially small single or multiple infarcts in the cortex or subcortex. 1 Cardiogenic, paradoxical, and aortogenic emboli are common sources of embolic stroke. These emboli can be detected with transesophageal echocardiography (TEE).However, the embolic sources of 16% of patients with embolic stroke could not be identified. 2,3 The occurrence of embolic stroke is common in cancer patients during their clinical course. The rate of stroke in patients with cancer is twice that of the general population, as the survival rates of cancer patients have increased in recent decades. 4Hypercoagulability, tumor compression of blood, non-bacterial thrombotic endocarditis, and therapy-related effects are the main mechanisms of stroke in cancer. 5 However, stroke encountered as the first manifestation of cancer is very rare. Little research has been done on Abstract Diffusion-weighted imaging (DWI) MRI is very sensitive for detecting small embolic brain infarctions. Stroke as the first manifestation of cancer is extremely rare. We performed a retrospective study to identify the clinical and DWI features of patients with acute ischemic stroke as the first manifestation of occult cancer. A total of five patients in our hospital from January 2017 to May 2019 were analyzed. We also reviewed the literature and seven case series (16 patients) were included. Most of these patients were aged in their sixties and lung cancer was the most common type of occult cancer. Patients showed various presentations of ischemic stroke. All of the patients showed small multiple lesions on DWI that involved mostly the anterior or both anterior and posterior territories. The lesions were mostly in both the supratentorium and infratentorium, with the mechanisms of embolic and watershed infarcts.These features were useful for identifying the causes of embolic stroke. Therefore, patients with small bilateral embolic stroke, especially those involved in multiple vascular territories, should be examined for concealed malignancy. K E Y W O R D S cancer, diffusion-weighted imaging, embolic stroke, first manifestation | 57 CHI et al.the DWI presentations of cancer-related stroke. Here, we report five cancer patients with ischemic stroke as the first presentation. We also briefly review the literature on this topic. CHI et al.

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Section: Resultssupporting

confidence: 93%

Diffusion‐weighted imaging‐documented bilateral small embolic stroke involving multiple vascular territories may indicate occult cancer: A retrospective case series and a brief review of the literature

et al. 2020

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“…Therefore, in the present study, the patients who had stroke as their first manifestation would be diagnosed with KC and KCS based on elevated plasma CA125 and CEA levels, together with increased proteinuria levels. For cancer-related stroke with stroke as the first manifestation or for stroke patients with concealed cancers [ 32 – 34 ], biomarkers and their forms found in the present study may be useful for physicians in clinical practice. However, further prospective investigations with more patients are needed to confirm our findings.…”

Section: Discussionmentioning

confidence: 99%

Potential Pathogenesis and Biomarkers of Kidney Cancer-Related Stroke

et al. 2017

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BackgroundStroke risk and stroke recurrence are increased in cancer patients, but the pathogenesis and biomarkers of kidney cancer-related stroke (KCS) are generally unclear. The aim of the present research was to investigate the pathogenesis and plasma biomarkers of kidney cancer-related stroke.Material/MethodsA retrospective review was conducted on acute stroke patients with kidney cancer (KC) who were admitted to the hospital between January 2006 and December 2015. A total of 106 patients with KCS (active KC patients with acute stroke but without conventional vascular risks) were identified. In addition, 106 age- and sex-matched patients with KC alone were recruited.ResultsKCS patients had higher plasma D-dimer, cancer antigen (CA) 125, and CEA levels and greater proteinuria levels than did KC patients. Multiple logistic regression analysis showed that the risk of stroke in patients with KC increased independently by 0.8% (odds ratio [OR] 1.008; 95% confidence interval [CI] 1.002, 1.013; p=0.004) with a 1 ng/mL increase in D-dimer levels, by 1.2% (OR 1.012; 95% CI 1.007, 1.018; p=0.000) with a 1 U/mL increase in CA125, by 2.5% (OR 1.025; 95% CI 1.012, 1.038; p=0.000) with a 1 U/mL increase in CEA by 1.4% (OR 1.014; 95% CI 1.005, 1.024; p=0.004) with a 1 mg increase in urine protein in 24 hours.ConclusionsElevated plasma D-dimer, CA125 and CEA levels, and increased urine protein levels might lead to hypercoagulability and then KCS; however, they may also be biomarkers of KCS.

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Ischaemic stroke as first presentation of occult colon neoplasia in a 30-year-old young man with an associated Streptococcus gallolyticus infection causing endocarditis and infectious intracranial aneurysm

Rifino

Sangalli²,

Tagliabue³

et al. 2019

Neurol Sci

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Frequent Ischemic Stroke as First Manifestation of Occult Colon Cancer: A Rare Case

Cited by 10 publications

References 13 publications

Diffusion‐weighted imaging‐documented bilateral small embolic stroke involving multiple vascular territories may indicate occult cancer: A retrospective case series and a brief review of the literature

Diffusion‐weighted imaging‐documented bilateral small embolic stroke involving multiple vascular territories may indicate occult cancer: A retrospective case series and a brief review of the literature

Potential Pathogenesis and Biomarkers of Kidney Cancer-Related Stroke

Ischaemic stroke as first presentation of occult colon neoplasia in a 30-year-old young man with an associated Streptococcus gallolyticus infection causing endocarditis and infectious intracranial aneurysm

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