Pathophysiology, Mechanism, and Outcome of Ischemic Stroke in Cancer Patients

Abdelsalam, Mohamed; Abu-Hegazy, Mohammad; El-Hadaad, Hend Ahmed; Wahba, Hanan Ahmed; Egila, Hossam; Esmael, Ahmed

doi:10.1016/j.jstrokecerebrovasdis.2020.105299

Cited by 10 publications

(5 citation statements)

References 53 publications

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“…In the study of M. Abdelsalam, C-reactive protein, fibrinogen and D-dimer were highly elevated in 78 ischemic stroke patients with cancer than in 78 patients with only ischemic stroke (Abdelsalam et al, 2020). In the present study, there were no significant differences of homocysteine, hs-CRP and fibrinogen between the short and long interval groups.…”

Section: Discussioncontrasting

confidence: 55%

In Patients with Acute Ischemic Stroke and Cancer: The Shorter Interval, the Higher D-Dimer

Wang

Zhou

2022

Asian Pac J Cancer Prev

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Objectives: Acute ischemic stroke in cancer patients is uncommon. The study was aimed to identify the relationship of patients' characteristics and the interval time between the diagnosis of stroke and cancer. Methods: The clinical features of acute ischemic stroke patients with cancer were retrospectively analyzed from May, 2016 to April, 2021. Categorical data was compared between groups using chi-square test. Hematological biomarkers were compared using Mann-Whitney U test. Results: A total of 70 acute ischemic stroke patients with cancer were identified. The median interval time between the diagnosis of acute ischemic stroke and cancer was 53.0 months. Patients with interval < 53.0 months and > 53.0 months were regarded the short interval group and the long interval group, respectively. Between the short and long interval groups, there was no significant differences in respect to sex, age, chemotherapy, hypertension, diabetes, smoking, atrial fibrillation and dyslipidemia. The medians of homocysteine, high-sensitivity C-reactive protein and fibrinogen were also not significantly different between the two different interval groups. D-dimer in the short interval group was higher than that in the long interval group (216 vs. 142 ng/mL, p = 0.037). The long interval group had more surgery for cancer than the short interval group (94.3% vs. 57.1%, p = 0.000). Conclusion: In conclusion, in patients with ischemic stroke and cancer, patients with short interval time between the diagnosis of ischemic stroke and cancer had higher D-dimer than patients with long interval time.

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Section: Discussioncontrasting

confidence: 55%

In Patients with Acute Ischemic Stroke and Cancer: The Shorter Interval, the Higher D-Dimer

Wang

Zhou

2022

Asian Pac J Cancer Prev

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“…Many other haematological, inflammatory, and tumour markers are also increased in cancer-related stroke, including P-selectin, thrombin–antithrombin, thrombomodulin, soluble intercellular adhesion molecule, vascular cellular adhesion molecule, CA19-9, CA125, and C-reactive peptide. 106 , 121 , 122 However, the relative difference for these markers between cancer and non-cancer patients is not as large as for D- dimer, and many are costly and not routinely available in practice. 106 It is emphasized that plasma D- dimer and TCD HITS are not specific to cancer as an ESUS aetiology but rather serve as quantitative surrogate markers for central embolic processes, which may contribute to ESUS, including atrial cardiomyopathy and atrial arrhythmias.…”

Section: Cancermentioning

confidence: 99%

Embolic strokes of undetermined source: a clinical consensus statement of the ESC Council on Stroke, the European Association of Cardiovascular Imaging and the European Heart Rhythm Association of the ESC

Ntaios,

Baumgartner,

Doehner

et al. 2024

European Heart Journal

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One in six ischaemic stroke patients has an embolic stroke of undetermined source (ESUS), defined as a stroke with unclear aetiology despite recommended diagnostic evaluation. The overall cardiovascular risk of ESUS is high and it is important to optimize strategies to prevent recurrent stroke and other cardiovascular events. The aim of clinicians when confronted with a patient not only with ESUS but also with any other medical condition of unclear aetiology is to identify the actual cause amongst a list of potential differential diagnoses, in order to optimize secondary prevention. However, specifically in ESUS, this may be challenging as multiple potential thromboembolic sources frequently coexist. Also, it can be delusively reassuring because despite the implementation of specific treatments for the individual pathology presumed to be the actual thromboembolic source, patients can still be vulnerable to stroke and other cardiovascular events caused by other pathologies already identified during the index diagnostic evaluation but whose thromboembolic potential was underestimated. Therefore, rather than trying to presume which particular mechanism is the actual embolic source in an ESUS patient, it is important to assess the overall thromboembolic risk of the patient through synthesis of the individual risks linked to all pathologies present, regardless if presumed causally associated or not. In this paper, a multi-disciplinary panel of clinicians/researchers from various backgrounds of expertise and specialties (cardiology, internal medicine, neurology, radiology and vascular surgery) proposes a comprehensive multi-dimensional assessment of the overall thromboembolic risk in ESUS patients through the composition of individual risks associated with all prevalent pathologies.

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“…Higher levels of inflammatory markers, such as erythrocyte sedimentation rate (ESR) and C‐reactive protein (CRP); hypercoagulability markers, such as fibrinogen and D‐dimer; and tumor biomarkers, such as CA125/199 and lower levels of hemoglobin, are often seen in MAS. 18 , 43 , 44 Increased fibrinogen (≥600 mg/dL) or CRP (≥20 mg/L) suggest increased risk of MAS (specificity of 96% and 91%, respectively). 45 D‐dimers are particularly valuable as biomarkers for occult malignancy in stroke patients.…”

Section: Diagnostic Clues Of Mas Patientsmentioning

confidence: 99%

Malignancy‐associated ischemic stroke: Implications for diagnostic and therapeutic workup

Xie,

Hsu,

Lin

et al. 2024

CNS Neurosci Ther

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BackgroundPatients with malignancies have an increased risk of suffering ischemic stroke via several mechanisms such as coagulation dysfunction and other malignancy‐related effects as well as iatrogenic causes. Moreover, stroke can be the first sign of an occult malignancy, termed as malignancy‐associated ischemic stroke (MAS). Therefore, timely diagnostic assessment and targeted management of this complex clinical situation are critical.FindingsPatients with both stroke and malignancy have atypical ages, risk factors, and often exhibit malignancy‐related symptoms and multiple lesions on neuroimaging. New biomarkers such as eicosapentaenoic acid and blood mRNA profiles may help in distinguishing MAS from other strokes. In terms of treatment, malignancy should not be considered a contraindication, given comparable rates of recanalization and complications between stroke patients with or without malignancies.ConclusionIn this review, we summarize the latest developments in diagnosing and managing MAS, especially stroke with occult malignancies, and provide new recommendations from recently emerged clinical evidence for diagnostic and therapeutic workup strategies.

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Pathophysiology, Mechanism, and Outcome of Ischemic Stroke in Cancer Patients

Cited by 10 publications

References 53 publications

In Patients with Acute Ischemic Stroke and Cancer: The Shorter Interval, the Higher D-Dimer

In Patients with Acute Ischemic Stroke and Cancer: The Shorter Interval, the Higher D-Dimer

Embolic strokes of undetermined source: a clinical consensus statement of the ESC Council on Stroke, the European Association of Cardiovascular Imaging and the European Heart Rhythm Association of the ESC

Malignancy‐associated ischemic stroke: Implications for diagnostic and therapeutic workup

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