Patterns of Acute Cerebral Infarcts in Patients with Active Malignancy Using Diffusion-Weighted Imaging

Abstract

Background and Purpose: It is still controversial whether the nature of cerebral infarcts differs between cancer patients and the general population. The aim of this study is to delineate the characteristics of acute cerebral infarction in patients with active malignancy using diffusion-weighted imaging (DWI). Materials and Methods: Seventy consecutive patients with both active malignancy and acute cerebral infarction (confirmed by DWI) were retrospectively included. These 70 were divided into 3 groups on the basis of infarct pattern: embolic infarction, large artery disease, and lacunar infarction. Medical records were reviewed in detail for demographic data, cancer information, vascular risk factors, and prognosis. Results: Two thirds of cancer patients had multiple infarcts, and 30% of infarcts were located infratentorially. Embolic infarction, large artery disease, and lacunar infarction occurred in 60, 31, and 9% of cancer patients, respectively. Gastrointestinal (GI) cancer was significantly related to embolic infarction (odds ratio 4.64, p = 0.04). The 3-month mortality rates were higher in patients with rather than without cancer metastasis (68 vs. 8%; p < 0.001). Conclusions: Cerebral infarcts in cancer patients tended to be embolic and multiple. Patients with GI cancer were particularly susceptible to embolic infarction.

Clues to Occult Cancer in Patients with Ischemic Stroke

“…It has been well known that multiple acute stroke lesions on DWI are presumably caused by multiple emboli [13], [14]. Our previous study using microembolic signals detected by transcranial Doppler also suggested the embolic nature of CA-stroke [3].…”

The Activity of Malignancy May Determine Stroke Pattern in Cancer Patients

“…Some authors used the criterion of 6-month delay between the diagnosis of cancer and index stroke, 4,6,7,15,16 whereas others considered cancer active if stroke occurred during oncological therapy. 17 Neurologic deficit was assessed with the National Institutes of Health Stroke Scale (NIHSS). The etiology of ischemic stroke was determined according to the criteria developed for the Trial of Org 10172 in Acute Stroke Treatment.…”

Stroke and Cancer

“…4,5 A small number of earlier studies on this topic generated conflicting results. [6][7][8][9][10][11][12] The largest study including 161 patients by Kim et al in 2010 differentiated between patients with cancer+stroke with and without conventional stroke etiologies and renewed the idea of cancer-associated hypercoagulation as an important stroke etiology. 13 Significantly higher d-dimer levels as well as a significantly higher rate of multiply affected vascular territories in the group of patients without conventional stroke etiology supported the idea of cancer-associated hypercoagulation with resulting cerebral embolism.…”