Multiple embolic cerebral infarcts as the first manifestation of metastatic ovarian cancer

Bond, Laura M.; Skrobo, Darko

doi:10.1136/bcr-2015-211521

Cited by 6 publications

(6 citation statements)

References 20 publications

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“…21 Cerebral ischemia might occur due to embolus metastatic glioma cells, as reported recently. 22 Another unusual case of acute ischemic infarction of the middle cerebral artery was caused by a proliferating glioma mass. 23 In certain cases, it is notably difficult to distinguish the early symptoms of stroke and glioma, which might lead to improper therapy.…”

Section: Interplay Between Cerebral Ischemia and Glioma: What Do Clinmentioning

confidence: 99%

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

Ghosh

Chakraborty

Sarkar

et al. 2019

Sig Transduct Target Ther

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Glioma and cerebral ischemic stroke are two major events that lead to patient death worldwide. Although these conditions have different physiological incidences,~10% of ischemic stroke patients develop cerebral cancer, especially glioma, in the postischemic stages. Additionally, the high proliferation, venous thrombosis and hypercoagulability of the glioma mass increase the significant risk of thromboembolism, including ischemic stroke. Surprisingly, these events share several common pathways, viz. hypoxia, cerebral inflammation, angiogenesis, etc., but the proper mechanism behind this co-occurrence has yet to be discovered. The hypercoagulability and presence of the D-dimer level in stroke are different in cancer patients than in the noncancerous population. Other factors such as atherosclerosis and coagulopathy involved in the pathogenesis of stroke are partially responsible for cancer, and the reverse is also partially true. Based on clinical and neurosurgical experience, the neuronal structures and functions in the brain and spine are observed to change after a progressive attack of ischemia that leads to hypoxia and atrophy. The major population of cancer cells cannot survive in an adverse ischemic environment that excludes cancer stem cells (CSCs). Cancer cells in stroke patients have already metastasized, but early-stage cancer patients also suffer stroke for multiple reasons. Therefore, stroke is an early manifestation of cancer. Stroke and cancer share many factors that result in an increased risk of stroke in cancer patients, and vice-versa. The intricate mechanisms for stroke with and without cancer are different. This review summarizes the current clinical reports, pathophysiology, probable causes of co-occurrence, prognoses, and treatment possibilities.

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Section: Interplay Between Cerebral Ischemia and Glioma: What Do Clinmentioning

confidence: 99%

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

Ghosh

Chakraborty

Sarkar

et al. 2019

Sig Transduct Target Ther

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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: Resultsmentioning

confidence: 99%

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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“…A previous population‐based study reported an increased risk of ischemic stroke in OC patients 19 . In addition, some case reports reported stroke and multiple embolic cerebral infarcts as the first manifestations of ovarian cancer 20, 21 …”

Section: Discussionmentioning

confidence: 99%

“…19 In addition, some case reports reported stroke and multiple embolic cerebral infarcts as the first manifestations of ovarian cancer. 20,21 Regarding death due to other (non-ovary) cancers, risk of death decreases with time after OC diagnosis. These findings agree with a previous Canadian study on patients with epithelial OC, 22 where other cancers were the second highest death cause in long-term OC survivors, after OC.…”

Section: Discussionmentioning

confidence: 99%

Non‐cancer death causes after ovarian cancer diagnosis: A population‐based cohort

Elmehrath

Afifi

Abdel-Malek

2021

J of Obstet and Gynaecol

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Background Research on non‐cancer death causes in ovarian cancer (OC) patients remains limited. We aim to focus on and evaluate the non‐cancer death causes after OC diagnosis. Methods We studied 82 590 OC patients diagnosed between 2000 and 2016, using the Surveillance, Epidemiology, and End Results (SEER) Program. Risks of death causes were calculated as standardized mortality ratios. Results Of included patients, 48 125 (58.3%) died during the follow‐up period. The highest number of deaths, 21 722 (45.1%), occurred within 1–5 years after OC diagnosis. On the other hand, 19 992 (41.5%) of deaths occurred within a year from ovary cancer diagnosis, 5255 (10.9%) occurred within 5–10 years, and 1156 (2.4%) deaths occurred after more than 10 years following OC diagnosis. Non‐cancer death causes comprise a significant percentage of deaths in OC patients, increasing with time after diagnosis. Conclusions Cardiac diseases, cerebrovascular diseases, and COPD were among the most common non‐cancer death causes after OC diagnosis. Other critical non‐cancer death causes include septicemia and benign neoplasms. Mortality risk differences based on race and age were also highlighted. These findings provide critical insights into how OC survivors should be followed‐up and counseled for relevant future health risks.

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Multiple embolic cerebral infarcts as the first manifestation of metastatic ovarian cancer

Cited by 6 publications

References 20 publications

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

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

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

Non‐cancer death causes after ovarian cancer diagnosis: A population‐based cohort

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