151
|
Matsunaga M, Fukahori M, Ushijima T, Miwa K. Trousseau's syndrome in a patient with gastric cancer. BMJ Case Rep 2015; 2015:bcr-2015-213284. [PMID: 26667665 DOI: 10.1136/bcr-2015-213284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Mototsugu Matsunaga
- Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Kurume, Japan
| | - Masaru Fukahori
- Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Kurume, Japan
| | - Tomoyuki Ushijima
- Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Kurume, Japan
| | - Keisuke Miwa
- Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Kurume, Japan
| |
Collapse
|
152
|
Kneihsl M, Enzinger C, Wünsch G, Khalil M, Culea V, Urbanic-Purkart T, Payer F, Niederkorn K, Fazekas F, Gattringer T. Poor short-term outcome in patients with ischaemic stroke and active cancer. J Neurol 2015; 263:150-6. [DOI: 10.1007/s00415-015-7954-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 10/20/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
|
153
|
Bond LM, Skrobo D. Multiple embolic cerebral infarcts as the first manifestation of metastatic ovarian cancer. BMJ Case Rep 2015; 2015:bcr-2015-211521. [PMID: 26443095 DOI: 10.1136/bcr-2015-211521] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 36-year-old woman presented to the emergency department with a 3-day history of an occipital headache associated with transient visual impairment and short-term memory loss. MRI of the brain showed innumerable focal embolic infarcts of differing ages, for which a cause could not be determined. The patient was discharged and readmitted 7 weeks later with acute aphasia and a right-sided hemiplegia. CT of the abdomen revealed a right-sided ovarian mass and prominent retroperitoneal nodes, which cytology confirmed to be metastatic ovarian cancer.
Collapse
Affiliation(s)
- Laura M Bond
- Department of Acute Medicine, Institution of Medicine, Dublin, Ireland
| | - Darko Skrobo
- Department of Acute Medicine, Institution of Medicine, Dublin, Ireland
| |
Collapse
|
154
|
Kuan AS, Chen SC, Yeh CM, Hung MH, Hung YP, Chen TJ, Liu CJ. Risk of Ischemic Stroke in Patients With Gastric Cancer: A Nationwide Population-Based Cohort Study. Medicine (Baltimore) 2015; 94:e1336. [PMID: 26376378 PMCID: PMC4635792 DOI: 10.1097/md.0000000000001336] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 06/18/2015] [Accepted: 07/06/2015] [Indexed: 11/26/2022] Open
Abstract
Improvements in therapeutic modalities have prolonged the survival of gastric cancer patients. Comorbidities such as thromboembolic events that emerge as a result of disease complexities and/or treatments received have not been considered. The objectives of this study are to examine the relationship between gastric cancer and ischemic stroke, and to determine predictive risk factors. A nationwide population-based cohort study was conducted using data from the Taiwan National Health Insurance database. A total of 45,060 gastric cancer patients and non-cancer counterparts without antecedent stroke were recruited. Hazard ratios (HRs) and the cumulative incidence of ischemic stroke were calculated, and risk factors for ischemic stroke were assessed. Gastric cancer patients were associated with higher risk of ischemic stroke (HR 1.11, 95% confidence interval [CI] 1.03-1.19, P = 0.007), especially in participants younger than 65 years (HR 1.61, 95% CI 1.39-1.86, P < 0.001) and in female participants (HR 1.30, 95% CI 1.14-1.49; P < 0.001) when compared with the matched cohort. Independent risk factors of ischemic stroke in gastric cancer patients included age, hypertension, atrial fibrillation, dyslipidemia, and having received major surgery for gastric cancer. Our findings suggest the importance of stroke surveillance and prevention strategies in high-risk patients. Having received major surgery for gastric cancer is a significant risk factor in these patients.
Collapse
Affiliation(s)
- Ai-Seon Kuan
- From the Neurological Institute, Taipei Veterans General Hospital (A-SK); School of Medicine, Faculty of Medicine, National Yang-Ming University (A-SK, M-HH, T-JC); Department of Medicine, Division of Hematology and Oncology, Taipei Veterans General Hospital (S-CC, M-HH, Y-PH, C-JL); and Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan (C-MY, T-JC); Institute of Public Health, National Yang-Ming University (C-JL)
| | | | | | | | | | | | | |
Collapse
|
155
|
Ischemic stroke in patients with gliomas at The University of Texas-M.D. Anderson Cancer Center. J Neurooncol 2015; 125:143-8. [PMID: 26272599 DOI: 10.1007/s11060-015-1880-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 08/08/2015] [Indexed: 01/08/2023]
Abstract
Patients with gliomas are at risk of cerebrovascular accidents (CVA) with potential consequences on survival, function, and local tumor control. Our objective was to provide information about CVA in patients with gliomas and to estimate survival in this group. We reviewed all adult glioma patients with ischemic CVA at the University of Texas-M.D. Anderson Cancer Center from 2003 through 2014. We extracted demographic, clinical, imaging, treatment and outcome data. We used descriptive summary data and estimated or compared survival rates where appropriate. 60 of 6500 patients (0.1%) with high-grade (HGG, n = 47) or low-grade glioma (LGG, n = 13) had ischemic CVA Thirty-two (53%) patients had postoperative strokes, and 20 (33%) had CVA after 2 weeks of surgery. Forty-one patients (68%) had gross total resection. For HGG and CVA, the poststroke median overall survival was 17 months versus 61 months in LGG and CVA (P = 0.03; hazard ratio (HR): 2.8; 95% CI 1.07-4.60). Survival stratified by modified Rankin Scale grade was significant (X(2) = 9.8, P = 0.007). Five patients received bevacizumab before stroke onset; none responded to antiangiogenic therapy. There was no stroke-related death. At our institution for 10 years, ischemic CVA in glioma patients was a rare complication, clearly associated in half of cases to surgery, and with a variable negative impact on performance status and neurologic function. In this group, patients with more neurological deficits lived less. The survival difference between and within subgroups was most likely due to tumor grade. More research is necessary to improve prevention of postoperative stroke in glioma patients.
Collapse
|
156
|
MacNeil SD, Liu K, Garg AX, Tam S, Palma D, Thind A, Winquist E, Yoo J, Nichols A, Fung K, Hall S, Shariff SZ. A Population-Based Study of 30-day Incidence of Ischemic Stroke Following Surgical Neck Dissection. Medicine (Baltimore) 2015; 94:e1106. [PMID: 26287406 PMCID: PMC4616442 DOI: 10.1097/md.0000000000001106] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The objective of this study was to determine the 30-day incidence of ischemic stroke following neck dissection compared to matched patients undergoing non-head and neck surgeries.A surgical dissection of the neck is a common procedure performed for many types of cancer. Whether such dissections increase the risk of ischemic stroke is uncertain.A retrospective cohort study using data from linked administrative and registry databases (1995-2012) in the province of Ontario, Canada was performed. Patients were matched 1-to-1 on age, sex, date of surgery, and comorbidities to patients undergoing non-head and neck surgeries. The primary outcome was ischemic stroke assessed in hospitalized patients using validated database codes.A total of 14,837 patients underwent surgical neck dissection. The 30-day incidence of ischemic stroke following the dissection was 0.7%. This incidence decreased in recent years (1.1% in 1995 to 2000; 0.8% in 2001 to 2006; 0.3% in 2007 to 2012; P for trend <0.0001). The 30-day incidence of ischemic stroke in patients undergoing neck dissection is similar to matched patients undergoing thoracic surgery (0.5%, P = 0.26) and colectomy (0.5%, P = 0.1). Factors independently associated with a higher risk of stroke in 30 days following neck dissection surgery were of age ≥75 years (odds ratio (OR) 1.63, 95% confidence interval (CI) 1.05-2.53), and a history of diabetes (OR 1.60, 95% CI 1.02-2.49), hypertension (OR 2.64, 95% CI 1.64-4.25), or prior stroke (OR 4.06, 95% CI 2.29-7.18).Less than 1% of patients undergoing surgical neck dissection will experience an ischemic stroke in the following 30 days. This incidence of stroke is similar to thoracic surgery and colectomy.
Collapse
Affiliation(s)
- S Danielle MacNeil
- Department of Otolaryngology-Head and Neck Surgery, Western University, London (SDM, ST, JY, AN, KF); Institute for Clinical and Evaluative Sciences (SDM, KL, AXG, AT, SH, SZS); Department of Epidemiology and Biostatistics, Western University (AXG, AT); Department of Family Medicine, Western University (AT); Department of Oncology, Western University, London (SDM, DP, EW, JY, AN, KF); Department of Otolaryngology-Head and Neck Surgery, Cancer Care and Epidemiology, Queens University, Kingston (SH); Department of Medicine, Division of Nephrology, Western University, London, Ontario, Canada (AXG)
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
157
|
Cocho D, Gendre J, Boltes A, Espinosa J, Ricciardi AC, Pons J, Jimenez M, Otermin P. Predictors of Occult Cancer in Acute Ischemic Stroke Patients. J Stroke Cerebrovasc Dis 2015; 24:1324-8. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.02.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 02/01/2015] [Accepted: 02/06/2015] [Indexed: 12/27/2022] Open
|
158
|
Kaur H, Sasapu A, Ramos J, Govindarajan R. An Unusual Case of Gastric Cancer with Bone Marrow Metastases and Embolic Phenomena as Initial Presentation. J Gastrointest Cancer 2015; 46:413-6. [PMID: 25859839 DOI: 10.1007/s12029-015-9714-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Harjot Kaur
- Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA.
| | - Appalanaidu Sasapu
- Department of Hematology and Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA.
| | - Jeanette Ramos
- Department of Pathology, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA.
| | - Rangaswamy Govindarajan
- Department of Hematology and Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Slot 508, 4301 West Markham, Little Rock, AR, 72205, USA.
| |
Collapse
|
159
|
The Activity of Malignancy May Determine Stroke Pattern in Cancer Patients. J Stroke Cerebrovasc Dis 2015; 24:778-83. [DOI: 10.1016/j.jstrokecerebrovasdis.2014.11.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 10/29/2014] [Accepted: 11/09/2014] [Indexed: 11/21/2022] Open
|
160
|
Abstract
Diffusion-weighted MRI (DW-MRI) provides image contrast dependent on the molecular movement of water. It has been most widely used in the diagnosis of cytotoxic edema secondary to acute cerebral ischemia, but has also proven useful in assessing tumor cellularity and grade, abscess formation, cysts and various forms of white matter disorders. Furthermore, DW-MRI is used to generate maps of subcortical white matter tracts and their relationship to structural brain lesions that may serve for preoperative planning and intraoperative guidance. We provide a comprehensive review of current practical applications of DW-MRI in the diagnosis and treatment of primary brain tumors, metastases and nonmetastatic neurologic complications of cancer. A detailed description of diffusion tensor imaging is beyond the scope of this review. We performed a comprehensive search of the PubMed database of the USA National Library of Medicine with use of various combinations of the following search terms: diffusion-weighted imaging, apparent diffusion coefficient, diffusion tensor imaging, diffusion tensor, brain, tumor, glioblastoma, lymphoma, primary CNS lymphoma, stroke, cancer, abscess, leukoencephalopathy, methotrexate, fluorouracil, capecitabine. We identified original articles and well-documented case reports of DW-MRI applications in patients with primary brain neoplasms, metastases and nonmetastatic neurologic complications that we judged to be of high impact on the field. We largely selected publications from the past 10 years, but did not exclude commonly referenced and highly regarded older publications. We also searched the reference lists of articles identified by this search strategy and selected those we judged relevant. Review articles are cited to provide readers with more details and more references than can be covered here.
Collapse
Affiliation(s)
- Joachim M Baehring
- Department of Neurology, Medicine and Neurosurgery, Yale University School of Medicine, 15 York St, LLCI 920 E, New Haven, CT 06510, USA.
| | | |
Collapse
|
161
|
Repeated Intra-Arterial Thrombectomy within 72 Hours in a Patient with a Clear Contraindication for Intravenous Thrombolysis. Case Rep Vasc Med 2015; 2015:872817. [PMID: 25692066 PMCID: PMC4322655 DOI: 10.1155/2015/872817] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 12/09/2014] [Accepted: 12/10/2014] [Indexed: 01/19/2023] Open
Abstract
Introduction. Treating patients with acute ischemic stroke, proximal arterial vessel occlusion, and absolute contraindication for administering intravenous recombinant tissue plasminogen activator (rtPA) poses a therapeutic challenge. Intra-arterial thrombectomy constitutes an alternative treatment option. Materials and Methods. We report a case of a 57-year-old patient with concomitant gastric adenocarcinoma, who received three intra-arterial thrombectomies in 72 hours due to repeated occlusion of the left medial cerebral artery (MCA). Findings. Intra-arterial recanalization of the left medial cerebral artery was performed three times with initially good success. However, two days later, the right medial cerebral artery became occluded. Owing to the overall poor prognosis at that time and knowing the wishes of the patient, we decided not to perform another intra-arterial recanalization procedure. Conclusion. To our knowledge, this is the first case illustrating the use of repeated intra-arterial recanalization in early reocclusion of intracranial vessels.
Collapse
|
162
|
Navi BB, Reiner AS, Kamel H, Iadecola C, Elkind MSV, Panageas KS, DeAngelis LM. Association between incident cancer and subsequent stroke. Ann Neurol 2015; 77:291-300. [PMID: 25472885 DOI: 10.1002/ana.24325] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 11/26/2014] [Accepted: 11/29/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE A study was undertaken to examine the association between incident cancer and the subsequent risk of stroke. METHODS Using the Surveillance, Epidemiology, and End Results-Medicare linked database, we identified patients with a new primary diagnosis of breast, colorectal, lung, pancreatic, or prostate cancer from 2001 through 2007. These patients were individually matched by age, sex, race, registry, and medical comorbidities to a group of Medicare enrollees without cancer, and each pair was followed through 2009. Validated diagnosis codes were used to identify a primary outcome of stroke. Cumulative incidence rates were calculated using competing risk survival statistics. RESULTS Among 327,389 pairs of cancer patients and matched controls, the 3-month cumulative incidence of stroke was generally higher in patients with cancer. Cumulative incidence rates were 5.1% (95% confidence interval [CI] = 4.9-5.2%) in patients with lung cancer compared to 1.2% (95% CI = 1.2-1.3%) in controls (p < 0.001), 3.4% (95% CI = 3.1-3.6%) in patients with pancreatic cancer compared to 1.3% (95% CI = 1.1-1.5%) in controls (p < 0.001), 3.3% (95% CI = 3.2-3.4%) in patients with colorectal cancer compared to 1.3% (95% CI = 1.2-1.4%) in controls (p < 0.001), 1.5% (95% CI = 1.4-1.6%) in patients with breast cancer compared to 1.1% (95% CI = 1.0-1.2%) in controls (p < 0.001), and 1.2% (95% CI = 1.1-1.3%) in patients with prostate cancer compared to 1.1% (95% CI = 1.0-1.2%) in controls (p = 0.085). Excess risks attenuated over time and were generally no longer present beyond 1 year. INTERPRETATION Incident cancer is associated with an increased short-term risk of stroke. This risk appears highest with lung, pancreatic, and colorectal cancers.
Collapse
Affiliation(s)
- Babak B Navi
- Department of Neurology, Weill Cornell Medical College, New York, NY; Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY; Departments of Neurology, Memorial Sloan Kettering Cancer Center, Columbia University, New York, NY
| | | | | | | | | | | | | |
Collapse
|
163
|
Wu YT, Chen CY, Lai WT, Kuo CC, Huang YB. Increasing risks of ischemic stroke in oral cancer patients treated with radiotherapy or chemotherapy: a nationwide cohort study. Int J Neurosci 2014; 125:808-16. [DOI: 10.3109/00207454.2014.967351] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
164
|
Mai H, Xia J, Wu Y, Ke J, Li J, Pan J, Chen W, Shao Y, Yang Z, Luo S, Sun Y, Zhao B, Li L. Clinical presentation and imaging characteristics of occult lung cancer associated ischemic stroke. J Clin Neurosci 2014; 22:296-302. [PMID: 25443087 DOI: 10.1016/j.jocn.2014.05.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 05/18/2014] [Indexed: 10/24/2022]
Abstract
We investigated the clinical and imaging characteristics of initial and recurrent strokes in patients with occult lung cancer associated ischemic stroke (OLCA-stroke). A retrospective review of all ischemic stroke patients with occult lung cancer in the absence of conventional stroke etiologies between 2005 and 2013 was conducted. We compared the initial and recurrent lesion patterns on diffusion-weighted MRI in patients with OLCA-stroke, with respect to vascular territory involved, number and size of lesions, clinical presentation, cancer subtypes, recurrences and fatalities, and outcome of survivors. Thirteen patients with confirmed OLCA-stroke were identified. All had elevated D-dimer levels, six had central lung cancer and seven had peripheral lung cancer. Eight (62%) had adenocarcinoma, and nine (69%) had metastasis. Ten (77%) patients had multiple lesions in multiple vascular territories. Twelve (92%) patients suffered recurrent strokes. Multiple small and large disseminated lesions in multiple vascular territories were more frequent in recurrent strokes in comparison with initial strokes. The middle cerebral artery was most frequently involved in recurrent strokes, followed by the posterior circulation territory and anterior cerebral artery, which were of similar frequency as initial strokes. Overall, 58% of patients had their first recurrent stroke within the first month, and 69% had a poor outcome, especially for those with multiple recurrent strokes and metastases. Occult cancer should be considered in the setting of multiple and recurrent embolic strokes within the short term in the absence of conventional stroke etiologies. The severity of malignancy and cancer treatments and stroke influenced the recurrences and outcome.
Collapse
Affiliation(s)
- Hui Mai
- Department of Neurology, Guangdong Medical College Affiliated Hospital, 57 South Renmin Road, Zhanjiang 524001, Guangdong, PR China
| | - Jun Xia
- Department of Radiology, Guangdong Medical College Affiliated Hospital, Zhanjiang, PR China
| | - Yongjun Wu
- Department of Radiology, Guangdong Medical College Affiliated Hospital, Zhanjiang, PR China
| | - Junlong Ke
- Department of Neurology, Guangdong Medical College Affiliated Hospital, 57 South Renmin Road, Zhanjiang 524001, Guangdong, PR China
| | - Junliang Li
- Department of Neurology, Guangdong Medical College Affiliated Hospital, 57 South Renmin Road, Zhanjiang 524001, Guangdong, PR China
| | - Jiangang Pan
- Department of Neurology, Guangdong Medical College Affiliated Hospital, 57 South Renmin Road, Zhanjiang 524001, Guangdong, PR China
| | - Wubiao Chen
- Department of Radiology, Guangdong Medical College Affiliated Hospital, Zhanjiang, PR China
| | - Yiming Shao
- Department of Critical Care Medicine, Guangdong Medical College Affiliated Hospital, Zhanjiang, PR China
| | - Zhi Yang
- Department of Neurology, Maoming People's Hospital, Maoming, PR China
| | - Saihua Luo
- Department of Neurosurgery, Lianjiang People's Hospital, Lianjiang, PR China
| | - Yonghua Sun
- Department of Radiology, Lianjiang People's Hospital, Lianjiang, PR China
| | - Bin Zhao
- Department of Neurology, Guangdong Medical College Affiliated Hospital, 57 South Renmin Road, Zhanjiang 524001, Guangdong, PR China
| | - Longxuan Li
- Department of Neurology, Guangdong Medical College Affiliated Hospital, 57 South Renmin Road, Zhanjiang 524001, Guangdong, PR China; Department of Neurology, Gongli Hospital, Pudong New Area, Shanghai, PR China.
| |
Collapse
|
165
|
Kawasaki A, Suzuki K, Takekawa H, Nakamura T, Yamamoto M, Asakawa Y, Okamura M, Hirata K. Co-occurrence of multiple cerebral infarctions due to hypercoagulability associated with malignancy and meningeal carcinomatosis as the initial manifestation of gastric cancer. BMC Neurol 2014; 14:160. [PMID: 25103421 PMCID: PMC4131164 DOI: 10.1186/s12883-014-0160-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 07/30/2014] [Indexed: 11/26/2022] Open
Abstract
Background Meningeal carcinomatosis and hypercoagulability associated with malignancy are typical late stage complications in cancer patients. The co-occurrence of meningeal carcinomatosis and cerebral infarction related to hypercoagulability associated with malignancy in an individual as the initial manifestation of malignancy has not been previously reported. Case presentation Herein, we report the case of an 80-year-old patient who presented with meningeal carcinomatosis and hypercoagulability related to malignancy as the initial manifestation of occult gastric cancer. The patient displayed consciousness disturbance, mild left facial paralysis, and bilateral positive Babinski’s sign. Using brain magnetic resonance imaging, the patient was diagnosed as having acute multiple cerebral infarctions. Cerebrospinal fluid (CSF) cytology showed adenocarcinoma and upper gastrointestinal endoscopy disclosed scirrhous gastric cancer. The patient presented with headache, fever, and meningeal irritation with a subacute course. Tuberculous or fungal meningitis was initially suspected; however, cytological evidence of adenocarcinoma in the CSF led to the diagnosis of meningeal carcinomatosis. Conclusion The comorbidity of hypercoagulability associated with malignancy and meningeal carcinomatosis should be considered in a patient presenting with multiple cerebral infarctions, progressive disturbance of consciousness, fever, and meningeal irritation.
Collapse
Affiliation(s)
| | - Keisuke Suzuki
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga 321-0293, Tochigi, Japan.
| | | | | | | | | | | | | |
Collapse
|
166
|
Navi BB, Singer S, Merkler AE, Cheng NT, Stone JB, Kamel H, Iadecola C, Elkind MSV, DeAngelis LM. Cryptogenic subtype predicts reduced survival among cancer patients with ischemic stroke. Stroke 2014; 45:2292-7. [PMID: 24994717 DOI: 10.1161/strokeaha.114.005784] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Cryptogenic stroke is common in patients with cancer. Autopsy studies suggest that many of these cases may be because of marantic endocarditis, which is closely linked to cancer activity. We, therefore, hypothesized that among patients with cancer and ischemic stroke, those with cryptogenic stroke would have shorter survival. METHODS We retrospectively analyzed all adult patients with active systemic cancer diagnosed with acute ischemic stroke at a tertiary care cancer center from 2005 through 2009. Two neurologists determined stroke mechanisms by consensus. Patients were diagnosed with cryptogenic stroke if no specific mechanism could be determined. The diagnosis of marantic endocarditis was restricted to patients with cardiac vegetations on echocardiography or autopsy and negative blood cultures. Patients were followed until July 31, 2012, for the primary outcome of death. Kaplan-Meier statistics and the log-rank test were used to compare survival between patients with cryptogenic stroke and patients with known stroke mechanisms. Multivariate Cox proportional hazard analysis evaluated the association between cryptogenic stroke and death after adjusting for potential confounders. RESULTS Among 263 patients with cancer and ischemic stroke, 133 (51%) were cryptogenic. Median survival in patients with cryptogenic stroke was 55 days (interquartile range, 21-240) versus 147 days (interquartile range, 33-735) in patients with known stroke mechanisms (P<0.01). Cryptogenic stroke was independently associated with death (hazard ratio, 1.64; 95% confidence interval, 1.25-2.14) after adjusting for age, systemic metastases, adenocarcinoma histology, and functional status. CONCLUSIONS Cryptogenic stroke is independently associated with reduced survival in patients with active cancer and ischemic stroke.
Collapse
Affiliation(s)
- Babak B Navi
- From the Department of Neurology (B.B.N., A.E.M., N.T.C., H.K., C.I., L.M.D.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K., C.I.), Weill Cornell Medical College, New York, NY; Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY (B.B.N., S.S., J.B.S., L.M.D.); and Department of Neurology, College of Physicians and Surgeons and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.).
| | - Samuel Singer
- From the Department of Neurology (B.B.N., A.E.M., N.T.C., H.K., C.I., L.M.D.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K., C.I.), Weill Cornell Medical College, New York, NY; Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY (B.B.N., S.S., J.B.S., L.M.D.); and Department of Neurology, College of Physicians and Surgeons and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.)
| | - Alexander E Merkler
- From the Department of Neurology (B.B.N., A.E.M., N.T.C., H.K., C.I., L.M.D.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K., C.I.), Weill Cornell Medical College, New York, NY; Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY (B.B.N., S.S., J.B.S., L.M.D.); and Department of Neurology, College of Physicians and Surgeons and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.)
| | - Natalie T Cheng
- From the Department of Neurology (B.B.N., A.E.M., N.T.C., H.K., C.I., L.M.D.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K., C.I.), Weill Cornell Medical College, New York, NY; Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY (B.B.N., S.S., J.B.S., L.M.D.); and Department of Neurology, College of Physicians and Surgeons and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.)
| | - Jacqueline B Stone
- From the Department of Neurology (B.B.N., A.E.M., N.T.C., H.K., C.I., L.M.D.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K., C.I.), Weill Cornell Medical College, New York, NY; Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY (B.B.N., S.S., J.B.S., L.M.D.); and Department of Neurology, College of Physicians and Surgeons and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.)
| | - Hooman Kamel
- From the Department of Neurology (B.B.N., A.E.M., N.T.C., H.K., C.I., L.M.D.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K., C.I.), Weill Cornell Medical College, New York, NY; Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY (B.B.N., S.S., J.B.S., L.M.D.); and Department of Neurology, College of Physicians and Surgeons and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.)
| | - Costantino Iadecola
- From the Department of Neurology (B.B.N., A.E.M., N.T.C., H.K., C.I., L.M.D.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K., C.I.), Weill Cornell Medical College, New York, NY; Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY (B.B.N., S.S., J.B.S., L.M.D.); and Department of Neurology, College of Physicians and Surgeons and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.)
| | - Mitchell S V Elkind
- From the Department of Neurology (B.B.N., A.E.M., N.T.C., H.K., C.I., L.M.D.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K., C.I.), Weill Cornell Medical College, New York, NY; Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY (B.B.N., S.S., J.B.S., L.M.D.); and Department of Neurology, College of Physicians and Surgeons and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.)
| | - Lisa M DeAngelis
- From the Department of Neurology (B.B.N., A.E.M., N.T.C., H.K., C.I., L.M.D.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K., C.I.), Weill Cornell Medical College, New York, NY; Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY (B.B.N., S.S., J.B.S., L.M.D.); and Department of Neurology, College of Physicians and Surgeons and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.)
| |
Collapse
|
167
|
Kim K, Lee JH. Risk factors and biomarkers of ischemic stroke in cancer patients. J Stroke 2014; 16:91-6. [PMID: 24949315 PMCID: PMC4060273 DOI: 10.5853/jos.2014.16.2.91] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 11/01/2013] [Accepted: 11/01/2013] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND PURPOSE Stroke is common among cancer patients. However, risk factors and biomarkers of stroke in cancer patients are not well established. This study aimed to investigate risk factors and biomarkers as well as etiology of ischemic stroke in cancer patients. METHODS A retrospective review was conducted in cancer patients with ischemic stroke who were admitted to a general hospital in Busan, Korea, between January 2003 and December 2012. The risk factors and biomarkers for stroke and stroke subtypes in cancer patients were compared with age- and sex-matched noncancer patients with ischemic stroke who were admitted to the same hospital during the same period. RESULTS One hundred fifty-six cancer patients with ischemic stroke were identified. Cancer patients with ischemic stroke were found to have a significantly lower proportion of hypertension, atrial fibrillation, hyperlipidemia, and ischemic heart disease than noncancer patients with ischemic stroke. However, stroke biomarkers, such as erythrocyte sedimentation rate and high-sensitivity C-reactive protein, fibrinogen, pro-brain natriuretic peptide, and D-dimer levels, were significantly increased in cancer patients with ischemic stroke than in noncancer patients. Large-artery atherosclerosis and stroke of undetermined cause were more common in cancer patients with ischemic stroke than in noncancer patients with ischemic stroke. CONCLUSIONS Cancer patients with ischemic stroke showed different risk factors, stroke biomarkers, and stroke etiology compared with noncancer patients with ischemic stroke.
Collapse
Affiliation(s)
- Kwangsoo Kim
- Department of Neurology, Kosin University College of Medicine, Busan, Korea
| | - Ji-Hun Lee
- Department of Neurology, Kosin University College of Medicine, Busan, Korea
| |
Collapse
|
168
|
Navi BB, Singer S, Merkler AE, Cheng NT, Stone JB, Kamel H, Iadecola C, Elkind MSV, DeAngelis LM. Recurrent thromboembolic events after ischemic stroke in patients with cancer. Neurology 2014; 83:26-33. [PMID: 24850486 DOI: 10.1212/wnl.0000000000000539] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To determine the cumulative rate and characteristics of recurrent thromboembolic events after acute ischemic stroke in patients with cancer. METHODS We retrospectively identified consecutive adult patients with active systemic cancer diagnosed with acute ischemic stroke at a tertiary-care cancer center from 2005 through 2009. Two neurologists independently reviewed all electronic records to ascertain the composite outcome of recurrent ischemic stroke, myocardial infarction, systemic embolism, TIA, or venous thromboembolism. Kaplan-Meier statistics were used to determine cumulative outcome rates. In exploratory analyses, Cox proportional hazard analysis was used to evaluate potential independent associations between a priori selected clinical factors and recurrent thromboembolic events. RESULTS Among 263 study patients, complete follow-up until death was available in 230 (87%). Most patients had an adenocarcinoma as their underlying cancer (60%) and had systemic metastases (69%). Despite a median survival of 84 days (interquartile range 24-419 days), 90 patients (34%; 95% confidence interval 28%-40%) had 117 recurrent thromboembolic events, consisting of 57 cases of venous thromboembolism, 36 recurrent ischemic strokes, 13 myocardial infarctions, 10 cases of systemic embolism, and one TIA. Kaplan-Meier rates of recurrent thromboembolism were 21%, 31%, and 37% at 1, 3, and 6 months, respectively; cumulative rates of recurrent ischemic stroke were 7%, 13%, and 16%. Adenocarcinoma histology (hazard ratio 1.65, 95% confidence interval 1.02-2.68) was independently associated with recurrent thromboembolism. CONCLUSIONS Patients with acute ischemic stroke in the setting of active cancer (especially adenocarcinoma) face a substantial short-term risk of recurrent ischemic stroke and other types of thromboembolism.
Collapse
Affiliation(s)
- Babak B Navi
- From the Department of Neurology and the Brain and Mind Research Institute (B.B.N., A.E.M., N.T.C., J.B.S., H.K., C.I., L.M.D.), Weill Cornell Medical College, New York; Department of Neurology (B.B.N., S.S., L.M.D.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (M.S.V.E.), Columbia University, New York, NY.
| | - Samuel Singer
- From the Department of Neurology and the Brain and Mind Research Institute (B.B.N., A.E.M., N.T.C., J.B.S., H.K., C.I., L.M.D.), Weill Cornell Medical College, New York; Department of Neurology (B.B.N., S.S., L.M.D.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (M.S.V.E.), Columbia University, New York, NY
| | - Alexander E Merkler
- From the Department of Neurology and the Brain and Mind Research Institute (B.B.N., A.E.M., N.T.C., J.B.S., H.K., C.I., L.M.D.), Weill Cornell Medical College, New York; Department of Neurology (B.B.N., S.S., L.M.D.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (M.S.V.E.), Columbia University, New York, NY
| | - Natalie T Cheng
- From the Department of Neurology and the Brain and Mind Research Institute (B.B.N., A.E.M., N.T.C., J.B.S., H.K., C.I., L.M.D.), Weill Cornell Medical College, New York; Department of Neurology (B.B.N., S.S., L.M.D.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (M.S.V.E.), Columbia University, New York, NY
| | - Jacqueline B Stone
- From the Department of Neurology and the Brain and Mind Research Institute (B.B.N., A.E.M., N.T.C., J.B.S., H.K., C.I., L.M.D.), Weill Cornell Medical College, New York; Department of Neurology (B.B.N., S.S., L.M.D.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (M.S.V.E.), Columbia University, New York, NY
| | - Hooman Kamel
- From the Department of Neurology and the Brain and Mind Research Institute (B.B.N., A.E.M., N.T.C., J.B.S., H.K., C.I., L.M.D.), Weill Cornell Medical College, New York; Department of Neurology (B.B.N., S.S., L.M.D.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (M.S.V.E.), Columbia University, New York, NY
| | - Costantino Iadecola
- From the Department of Neurology and the Brain and Mind Research Institute (B.B.N., A.E.M., N.T.C., J.B.S., H.K., C.I., L.M.D.), Weill Cornell Medical College, New York; Department of Neurology (B.B.N., S.S., L.M.D.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (M.S.V.E.), Columbia University, New York, NY
| | - Mitchell S V Elkind
- From the Department of Neurology and the Brain and Mind Research Institute (B.B.N., A.E.M., N.T.C., J.B.S., H.K., C.I., L.M.D.), Weill Cornell Medical College, New York; Department of Neurology (B.B.N., S.S., L.M.D.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (M.S.V.E.), Columbia University, New York, NY
| | - Lisa M DeAngelis
- From the Department of Neurology and the Brain and Mind Research Institute (B.B.N., A.E.M., N.T.C., J.B.S., H.K., C.I., L.M.D.), Weill Cornell Medical College, New York; Department of Neurology (B.B.N., S.S., L.M.D.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (M.S.V.E.), Columbia University, New York, NY
| |
Collapse
|
169
|
Prior Cancer in Patients with Ischemic Stroke: The Bergen NORSTROKE Study. J Stroke Cerebrovasc Dis 2014; 23:919-25. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.07.041] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 06/18/2013] [Accepted: 07/28/2013] [Indexed: 12/20/2022] Open
|
170
|
|
171
|
Kuan AS, Teng CJ, Wu HH, Su VYF, Chen YT, Chien SH, Yeh CM, Hu LY, Chen TJ, Tzeng CH, Liu CJ. Risk of ischemic stroke in patients with ovarian cancer: a nationwide population-based study. BMC Med 2014; 12:53. [PMID: 24661584 PMCID: PMC4022213 DOI: 10.1186/1741-7015-12-53] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 02/25/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cancer patients are at risk of thromboembolism. However, studies investigating the relationship between ovarian cancer and ischemic stroke are lacking. The objectives of this study were to assess the association between ovarian cancer and ischemic stroke, and to determine the predictive risk factors. METHODS Ovarian cancer patients aged 20 years and older without antecedent cerebrovascular events and who were followed up for more than 1 year between 1 January 2003 and 31 December 2011 were recruited from the Taiwan National Health Insurance database. Hazard ratios (HRs) of stroke risk for ovarian cancer patients compared with an age- and comorbidity-matched cohort were calculated by Cox proportional regression analysis. The difference in cumulative ischemic stroke incidence between ovarian cancer patients and the matched cohort was analyzed with the Kaplan-Meier method and tested with the log-rank test. RESULTS Each cohort (ovarian cancer and matched cohort) consisted of 8,810 individuals, with a median age of 49 years. After a median follow-up of 2.68 and 3.85 years, respectively, the ischemic stroke incidence was 1.38-fold higher in the ovarian cancer cohort than in the comparison cohort (9.4 versus 6.8 per 1,000 person-years), with an age- and comorbidity-adjusted HR of 1.49 (P <0.001). The ischemic stroke risk imposed by ovarian cancer was more prominent in patients under 50 years old (HR 2.28; P <0.001) compared with patients 50 years and older (HR 1.33; P = 0.005). Significant risk factors predicting stroke development were age 50 years and older (HR 2.21; P <0.001), hypertension (HR 1.84; P <0.001), diabetes mellitus (HR 1.71; P <0.001), and treatment with chemotherapy (HR 1.45; P = 0.017), especially platinum-based regimens. CONCLUSIONS Ovarian cancer patients were at an increased risk of developing ischemic stroke. Age, hypertension, diabetes, and chemotherapy treatment were independent risk factors.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Chia-Jen Liu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| |
Collapse
|
172
|
Lau KK, Wong YK, Teo KC, Chang RSK, Hon SFK, Chan KH, Cheung RTF, Li LSW, Tse HF, Ho SL, Siu CW. Stroke patients with a past history of cancer are at increased risk of recurrent stroke and cardiovascular mortality. PLoS One 2014; 9:e88283. [PMID: 24523883 PMCID: PMC3921146 DOI: 10.1371/journal.pone.0088283] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 01/07/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND PURPOSE Cancer patients are at increased risk of cardiovascular and cerebrovascular events. It is unclear whether cancer confers any additional risk for recurrent stroke or cardiovascular mortality after stroke. METHODS This was a single center, observational study of 1,105 consecutive Chinese ischemic stroke patients recruited from a large stroke rehabilitation unit based in Hong Kong. We sought to determine whether patients with cancer are at higher risk of recurrent stroke and cardiovascular mortality. RESULTS Amongst 1,105 patients, 58 patients (5.2%) had cancer, of whom 74% were in remission. After a mean follow-up of 76 ± 18 months, 241 patients developed a recurrent stroke: 22 in patients with cancer (38%, annual incidence 13.94%/year), substantially more than those without cancer (21%, 4.65%/year) (p<0.01). In a Cox regression model, cancer, age and atrial fibrillation were the 3 independent predictors of recurrent stroke with a hazard ratio (HR) of 2.42 (95% confidence interval (CI): 1.54-3.80), 1.01 (1.00-1.03) and 1.35 (1.01-1.82) respectively. Likewise, patients with cancer had a higher cardiovascular mortality compared with those without cancer (4.30%/year vs. 2.35%/year, p = 0.08). In Cox regression analysis, cancer (HR: 2.08, 95% CI: 1.08-4.02), age (HR: 1.04, 95% CI 1.02-1.06), heart failure (HR: 3.06, 95% CI 1.72-5.47) and significant carotid atherosclerosis (HR: 1.55, 95% CI 1.02-2.36) were independent predictors for cardiovascular mortality. CONCLUSIONS Stroke patients with a past history of cancer are at increased risk of recurrent stroke and cardiovascular mortality.
Collapse
Affiliation(s)
- Kui-Kai Lau
- Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
- Research Center of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Yuen-Kwun Wong
- Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Kay-Cheong Teo
- Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Richard Shek-Kwan Chang
- Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Sonny Fong-Kwong Hon
- Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Koon-Ho Chan
- Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
- Research Center of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Raymond Tak-Fai Cheung
- Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
- Research Center of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Leonard Sheung-Wai Li
- Division of Rehabilitation Medicine, Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Hung-Fat Tse
- Research Center of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Shu-Leong Ho
- Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
- Research Center of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- * E-mail: (CWS); (SLH)
| | - Chung-Wah Siu
- Research Center of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
- * E-mail: (CWS); (SLH)
| |
Collapse
|
173
|
Depuydt S, Sarov M, Vandendries C, Guedj T, Cauquil C, Assayag P, Lambotte O, Ducreux D, Denier C. Significance of acute multiple infarcts in multiple cerebral circulations on initial diffusion weighted imaging in stroke patients. J Neurol Sci 2014; 337:151-5. [DOI: 10.1016/j.jns.2013.11.039] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 11/20/2013] [Accepted: 11/25/2013] [Indexed: 11/26/2022]
|
174
|
Cruz-Flores S. Neurologic complications of valvular heart disease. HANDBOOK OF CLINICAL NEUROLOGY 2014; 119:61-73. [PMID: 24365289 DOI: 10.1016/b978-0-7020-4086-3.00006-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Valvular heart disease (VHD) is frequently associated with neurologic complications; cerebral embolism is the most common of these since thrombus formation results from the abnormalities in the valvular surfaces or from the anatomic and physiologic changes associated with valve dysfunction, such as atrial or ventricular enlargement, intracardiac thrombi, and cardiac dysrhythmias. Prosthetic heart valves, particularly mechanical valves, are very thrombogenic, which explains the high risk of thromboembolism and the need for anticoagulation for the prevention of embolism. Infective endocarditis is a disease process with protean manifestations that include not only cerebral embolism but also intracranial hemorrhage, mycotic aneurysms, and systemic manifestations such as fever and encephalopathy. Other neurologic complications include nonbacterial thrombotic endocarditis, a process associated with systemic diseases such as cancer and systemic lupus erythematosus. For many of these conditions, anticoagulation is the mainstay of treatment to prevent cerebral embolism, therefore it is the potential complications of anticoagulation that can explain other neurologic complications in patients with VHD. The prevention and management of these complications requires an understanding of their natural history in order to balance the risks posed by valvular disease itself against the risks and benefits associated with treatment.
Collapse
Affiliation(s)
- Salvador Cruz-Flores
- Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA.
| |
Collapse
|
175
|
Predictive value of plasma (D)-dimer levels for cancer-related stroke: a 3-year retrospective study. J Stroke Cerebrovasc Dis 2013; 23:e249-54. [PMID: 24295603 DOI: 10.1016/j.jstrokecerebrovasdis.2013.10.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 10/23/2013] [Accepted: 10/24/2013] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Cerebrovascular disease is the second leading cause of central nervous system pathology in cancer patients. Cancer-associated hypercoagulation plays an important role in cancer-related stroke. The present study aims to test whether plasma d-dimer levels could predict comorbid malignancy in patients with ischemic stroke. METHODS Five hundred sixteen stroke patients with measured d-dimer levels and who were consecutively admitted to our stroke center from 2009 to 2012 were included. Cancer status was determined by medical chart, and 59 patients were identified to have active cancer. An additional 48 cancer patients with stroke were identified from the hospital database. Several d-dimer cutoff levels were used to predict cancer-related stroke. RESULTS Stroke patients with active cancer had significantly higher d-dimer levels than those without cancer (P < .001). The average d-dimer level in stroke patients without cancer was .66 ± 1.83 mg/L, whereas the levels for active cancer patients from the stroke center and hospital database were 5.70 ± 9.63 mg/L and 10.47 ± 12.31 mg/L, respectively. When using d-dimer of .55 mg/L or more and multiple territory infarctions as criteria, the specificity and positive predictive value (PPV) for cancer-related stroke were 99.7% and 92.9%, respectively. When using d-dimer of 5.5 mg/L or more as the cutoff value, the test had a high specificity and PPV regardless the brain magnetic resonance imaging (MRI) findings. Six stroke patients fitting our criteria were confirmed to have occult malignancy after comprehensive cancer survey. CONCLUSIONS Extraordinary high d-dimer levels or combining d-dimer and MRI findings may be used as a screening tool to detect malignancy in stroke patients.
Collapse
|
176
|
Murthy SB, Karanth S, Shah S, Shastri A, Rao CPV, Bershad EM, Suarez JI. Thrombolysis for Acute Ischemic Stroke in Patients With Cancer. Stroke 2013; 44:3573-6. [DOI: 10.1161/strokeaha.113.003058] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Santosh B. Murthy
- From the Department of Neurology, Baylor College of Medicine, Houston, TX (S.B.M., S.S., C.P.V.R., E.M.B., J.I.S.); Division of Management, Policy and Community Health, University of Texas School of Public Health, Houston, TX (S.K.); and Department of Hematology and Oncology, Montefiore Medical Center, Bronx, NY (A.S.)
| | - Siddharth Karanth
- From the Department of Neurology, Baylor College of Medicine, Houston, TX (S.B.M., S.S., C.P.V.R., E.M.B., J.I.S.); Division of Management, Policy and Community Health, University of Texas School of Public Health, Houston, TX (S.K.); and Department of Hematology and Oncology, Montefiore Medical Center, Bronx, NY (A.S.)
| | - Shreyansh Shah
- From the Department of Neurology, Baylor College of Medicine, Houston, TX (S.B.M., S.S., C.P.V.R., E.M.B., J.I.S.); Division of Management, Policy and Community Health, University of Texas School of Public Health, Houston, TX (S.K.); and Department of Hematology and Oncology, Montefiore Medical Center, Bronx, NY (A.S.)
| | - Aditi Shastri
- From the Department of Neurology, Baylor College of Medicine, Houston, TX (S.B.M., S.S., C.P.V.R., E.M.B., J.I.S.); Division of Management, Policy and Community Health, University of Texas School of Public Health, Houston, TX (S.K.); and Department of Hematology and Oncology, Montefiore Medical Center, Bronx, NY (A.S.)
| | - Chethan P. Venkatasubba Rao
- From the Department of Neurology, Baylor College of Medicine, Houston, TX (S.B.M., S.S., C.P.V.R., E.M.B., J.I.S.); Division of Management, Policy and Community Health, University of Texas School of Public Health, Houston, TX (S.K.); and Department of Hematology and Oncology, Montefiore Medical Center, Bronx, NY (A.S.)
| | - Eric M. Bershad
- From the Department of Neurology, Baylor College of Medicine, Houston, TX (S.B.M., S.S., C.P.V.R., E.M.B., J.I.S.); Division of Management, Policy and Community Health, University of Texas School of Public Health, Houston, TX (S.K.); and Department of Hematology and Oncology, Montefiore Medical Center, Bronx, NY (A.S.)
| | - Jose I. Suarez
- From the Department of Neurology, Baylor College of Medicine, Houston, TX (S.B.M., S.S., C.P.V.R., E.M.B., J.I.S.); Division of Management, Policy and Community Health, University of Texas School of Public Health, Houston, TX (S.K.); and Department of Hematology and Oncology, Montefiore Medical Center, Bronx, NY (A.S.)
| |
Collapse
|
177
|
Lee EJ, Nah HW, Kwon JY, Kang DW, Kwon SU, Kim JS. Ischemic stroke in patients with cancer: is it different from usual strokes? Int J Stroke 2013; 9:406-12. [PMID: 23981525 DOI: 10.1111/ijs.12124] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 02/13/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND It remains unclear whether the characteristics of ischemic stroke in patients with cancer (ISC) differ from usual ischemic strokes (non-ISC). Although a small number of studies have been conducted to characterize ISC, the status of cancer has rarely been considered seriously. AIMS We aimed to investigate the features of ISC according to the status of cancer, and compare their characteristics with those of non-ISC. METHODS We assessed and classified 204 ISC patients into two groups: 104 with active (ISC-active) and 100 with inactive (ISC-inactive) cancer. For each ISC patient, two age- and gender-matched ischemic stroke patients without history of cancer were selected as non-ISC control subjects. We compared the clinical/laboratory data, stroke mechanisms, and diffusion weighted imaging (DWI) lesion patterns between ISC-active and non-ISC patients, and between ISC-inactive and non-ISC patients. RESULTS ISC-active patients demonstrated higher C-reactive protein (CRP) and D-dimer, more frequent cryptogenic stroke and patterns of multiple DWI lesions (in bilateral anterior or in anterior and posterior circulations), and less prevalent conventional risk factors than non-ISC patients, while ISC-inactive patients revealed no such marked differences. Among ISC-active patients, both elevated CRP and D-dimer levels were associated with cryptogenic mechanism and multiple lesion patterns. Furthermore, ISC-active patients with cryptogenic strokes tended to have multiple lesion patterns and metastasis. CONCLUSIONS ISC-active, but not ISC-inactive, is distinct in terms of risk factors, stroke mechanisms, and lesion patterns. Chronic inflammation and an activated coagulation system may contribute to the pathogenic mechanism of strokes, the extent of each depending on the activity and severity of cancer.
Collapse
Affiliation(s)
- Eun-Jae Lee
- Stroke Center and Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea
| | | | | | | | | | | |
Collapse
|
178
|
Chu CN, Chen PC, Bai LY, Muo CH, Sung FC, Chen SW. Young nasopharyngeal cancer patients with radiotherapy and chemotherapy are most prone to ischaemic risk of stroke: a national database, controlled cohort study. Clin Otolaryngol 2013. [PMID: 23194286 DOI: 10.1111/coa.12064] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- C.-N. Chu
- Department of Radiation Oncology; China Medical University Hospital; Taichung; Taiwan
| | | | | | - C.-H. Muo
- Management Office for Health Data; China Medical University Hospital; Taichung; Taiwan
| | | | | |
Collapse
|
179
|
Clinical manifestation of cancer related stroke: retrospective case-control study. J Neurooncol 2013; 111:295-301. [PMID: 23299460 DOI: 10.1007/s11060-012-1011-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 11/20/2012] [Indexed: 12/16/2022]
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.
Collapse
|
180
|
Taniyama D, Yamamoto R, Kawasaki M, Kamata H, Miyamoto K, Mashimo S, Sakamaki F. Nonbacterial thrombotic endocarditis leading to acute heart failure due to aortic stenosis in a patient with lung cancer. Intern Med 2013; 52:1617-20. [PMID: 23857096 DOI: 10.2169/internalmedicine.52.0123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report an autopsied case of a patient with adenocarcinoma of the lungs who developed nonbacterial thrombotic endocarditis (NBTE) that caused acute heart failure (AHF) due to acute aortic stenosis (AS). A 37-year-old man was admitted to our hospital due to chest pain and fever. He was diagnosed as having Stage IV lung cancer. Following the administration of chemotherapy, the patient presented with acute onset of dyspnea. He was diagnosed with having AHF based on his clinical course and physical findings, and ultimately he died without responding to treatment. The autopsy revealed that NBTE caused acute AS leading to AHF.
Collapse
Affiliation(s)
- Daisuke Taniyama
- Department of Respirology, Tokyo Saiseikai Central Hospital, Japan.
| | | | | | | | | | | | | |
Collapse
|
181
|
Seok JM, Kim SJ, Song P, Chung CS, Kim GM, Lee KH, Bang OY. Clinical presentation and ischemic zone on MRI in cancer patients with acute ischemic stroke. Eur Neurol 2012; 68:368-76. [PMID: 23095856 DOI: 10.1159/000341147] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 06/17/2012] [Indexed: 11/19/2022]
Abstract
AIMS This study was conducted to evaluate the clinical and MRI profiles in acute cancer strokes, and to demonstrate our experience with thrombolytic therapy in cancer stroke patients. METHODS We prospectively studied active cancer patients with acute ischemic stroke who underwent MRI within 48 h of the onset of symptoms. Patients were grouped based on the presence of conventional stroke mechanisms (CSM). Clinical characteristics and MRI profiles were evaluated. RESULTS A total of 70 patients were finally included in this study. Patients without CSM were more frequently presented with encephalopathy than those with CSM (29.4 vs. 2.8%, p = 0.002). The diffusion-perfusion mismatch pattern was more prevalent in patients with CSM (21 patients, 58.3%) than in patients without CSM (8 patients, 23.5%). Patients who had a higher tertiles of D-dimer level were significantly less likely to have the diffusion-perfusion mismatch pattern (p = 0.015). Among patients who presented within 6 h of the onset of stroke, revascularization therapy was performed in 4 of 16 (25%) patients with CSM, but none of the patients without CSM. CONCLUSION Based on the stroke mechanisms, the optimal strategy of thrombolytic therapy should be considered differently in cancer patients with acute ischemic stroke.
Collapse
Affiliation(s)
- Jin Myoung Seok
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | | | | | | | | | | |
Collapse
|
182
|
Schwarzbach CJ, Schaefer A, Ebert A, Held V, Bolognese M, Kablau M, Hennerici MG, Fatar M. Stroke and cancer: the importance of cancer-associated hypercoagulation as a possible stroke etiology. Stroke 2012; 43:3029-34. [PMID: 22996958 DOI: 10.1161/strokeaha.112.658625] [Citation(s) in RCA: 190] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE The importance of cancer-associated hypercoagulability as a possible stroke etiology in patients with cancer has received relatively little attention to date. A recent study has suggested that cancer-associated hypercoagulation may be of special importance in the absence of conventional stroke mechanisms. METHODS We identified patients with ischemic stroke sequentially admitted to our stroke center with the additional diagnosis of active and malignant cancer from 2002 to 2011. By using our prospectively collected stroke, MRI, and laboratory data banks, the etiology and risk factors of stroke, types of cancer, deep vein thrombosis/pulmonary embolism, d-dimer levels, and diffusion-weighted imaging lesion patterns were compared to an age- and sex-matched control group. Patients with cancer with a conventional stroke etiology and patients with an unidentified and/or cancer-associated stroke etiology were analyzed separately. RESULTS One hundred forty patients with cancer and 140 control subjects were included. Unidentified stroke (P<0.001) and infarction in multiple vascular territories (P<0.001) were significantly more frequent and d-dimer levels significantly higher (P<0.05) in patients with cancer. Vice versa, risk factors such as hypertension (P<0.05) and hyperlipidemia (P<0.01) were more prevalent in control subjects. Deep vein thrombosis and pulmonary embolism were more frequent (P<0.01) and d-dimer levels higher (P<0.01) in the patients with unidentified and/or cancer-associated stroke etiology compared to the patients with cancer with a conventional stroke etiology. Lung and pancreatic cancer were significantly overrepresented and d-dimer levels higher in these patients compared with other patients with cancer (P<0.01). CONCLUSIONS Our data confirm the concept of cancer-associated hypercoagulation as a widely underestimated important stroke risk factor in patients with cancer, especially in those with severely elevated d-dimer levels and in the absence of conventional risk factors.
Collapse
Affiliation(s)
- Christopher J Schwarzbach
- Department of Neurology, UniversitätsMedizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
183
|
Legriel S, Azoulay E. Complications neurologiques des traitements anticancéreux. MEDECINE INTENSIVE REANIMATION 2012. [DOI: 10.1007/s13546-012-0508-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
184
|
Kuroda H, Aoki M. [Internal medicine and neurological diseases: progress in diagnosis and treatment. Topics: XI. Cancer-associated neurological disorders]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2012; 101:2249-2256. [PMID: 22973698 DOI: 10.2169/naika.101.2249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Hiroshi Kuroda
- Department of Neurology, Tohoku University Graduate School of Medicine, Japan
| | | |
Collapse
|
185
|
Total palliative care for a patient with multiple cerebral infarctions that occurred repeatedly in association with gastric cancer (Trousseau's syndrome). Palliat Support Care 2012; 11:169-72. [DOI: 10.1017/s1478951512000624] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:Malignancy-related thromboembolism, also referred to as Trousseau's syndrome, can present as acute cerebral infarction, nonbacterial thrombotic endocarditis (NBTE), and migratory thrombophlebitis. Therefore, many physical, neurological, and psychological symptoms associated with Trousseau's syndrome may occur in the clinical course.Method:To illustrate this, we report a case of a male patient in his 50s with carcinomatous peritonitis caused by gastric cancer, with multiple cerebral infractions that developed during disease progression. The patient was admitted to our hospital for the treatment of side effects of chemotherapy, although he strongly hoped to go home as soon as possible. In addition to making social supports plans, we were required to perform intensive total palliative care, because of his physical pain, general fatigue, anorexia, abdominal and neck pain, and psychological issues (insomnia, delirium, depression, suicidal thoughts, self-mutilation, panic attacks, agoraphobia, fear of death, and feelings of hopelessness).Results:To the best of our knowledge, based on the literature search, this is the first reported case of Trousseau's syndrome described in the context of total palliative care, especially psychological care.Significance of results:We propose that neurological symptoms of Trousseau's syndrome cause these extensive mental disorders. Furthermore, because of the prognosis of Trousseau's syndrome, we should utilize our expertise fulfill the patient's wishes.
Collapse
|
186
|
Streletz LJ, Terzic D, Salem K, Raza A, Deleu DT. CNS lymphoma masquerading as hemorrhagic stroke. Clin Neurol Neurosurg 2012; 114:262-4. [DOI: 10.1016/j.clineuro.2011.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 10/07/2011] [Accepted: 10/10/2011] [Indexed: 10/16/2022]
|
187
|
Risk of haemorrhagic and ischaemic stroke in patients with cancer: a nationwide follow-up study from Sweden. Eur J Cancer 2012; 48:1875-83. [PMID: 22296948 DOI: 10.1016/j.ejca.2012.01.005] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 01/03/2012] [Accepted: 01/05/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Stroke is common in cancer patients, but risk estimates for different cancer sites/types have not been determined. The aim of this nationwide study was to examine whether there is an association between cancer and first hospitalisation for haemorrhagic or ischaemic stroke. METHODS All 820,491 individuals in Sweden with a diagnosis of cancer between 1st January 1987 and 31st December 2008 were followed for first hospitalisation for haemorrhagic or ischaemic stroke. The reference population was the total population of Sweden without cancer. Standardised incidence ratios (SIRs) for haemorrhagic and ischaemic strokes were calculated. RESULTS Overall risk of haemorrhagic stroke and ischaemic stroke during the first 6 months after diagnosis of cancer was 2.2 (95% confidence interval (CI)= 2.0-2.3) and 1.6 (CI = 1.5-1.6), respectively. For 18 and 20 of the 34 cancers studied, respectively, risk of haemorrhagic and ischaemic strokes was increased. Overall stroke risk decreased rapidly, but remained elevated, even 10+years after diagnosis of cancer 1.2 (CI = 1.1-1.3) for haemorrhagic stroke and 1.1 (CI = 1.1-1.2) for ischaemic stroke. The risk of stroke was highest during the first 6 months after diagnosis of cancer of the nervous system (29 (CI = 25-34) for haemorrhagic stroke and 4.1 (CI = 3.4-4.8) for ischaemic stroke)) or leukaemia (13 (CI = 10-16) for haemorrhagic stroke and 3.0 (CI = 2.5-3.7) for ischaemic stroke)). Metastasis was associated with an increased risk of haemorrhagic stroke 2.2 (CI = 1.8-2.7) and ischaemic stroke 1.5 (CI = 1.3-1.7). INTERPRETATION Several cancer sites/types are associated with an increased risk of haemorrhagic and ischaemic strokes.
Collapse
|
188
|
Rogers LR. Neurovascular complications of solid tumors and hematological neoplasms. HANDBOOK OF CLINICAL NEUROLOGY 2012; 105:805-23. [PMID: 22230535 DOI: 10.1016/b978-0-444-53502-3.00025-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
189
|
Kono T, Ohtsuki T, Hosomi N, Takeda I, Aoki S, Sueda Y, Ishihara K, Nakamura T, Yamawaki T, Matsumoto M. Cancer-associated ischemic stroke is associated with elevated D-dimer and fibrin degradation product levels in acute ischemic stroke with advanced cancer. Geriatr Gerontol Int 2012; 12:468-74. [PMID: 22233138 DOI: 10.1111/j.1447-0594.2011.00796.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
AIM Although several studies have reported various causes of ischemic stroke in patients with cancer, only a few have evaluated the clinical relevance of ischemic stroke pathogenesis to cancer. The aim of the present study was to elucidate the clinical characteristics of cancer-associated ischemic stroke. METHODS We evaluated 154 ischemic stroke patients without cancer and 57 ischemic stroke patients with cancer who had either received continuous treatment for cancer within 5 years before to the onset of ischemic stroke, or who had been diagnosed with cancer within 1 year after the onset of ischemic stroke. Cancer patients were grouped into "cancer-associated ischemic stroke," the "conventional ischemic stroke," or "other." RESULTS A total of 15 patients (26%) were classified into the cancer-associated ischemic stroke in cancer patients. In univariate analysis of the cancer-associated ischemic stroke and the others, there were significant differences in the prevalence of hypertension, hyperlipidemia and advanced cancer (clinical stage IV), and the levels of d-dimer, fibrin degradation product and hemoglobin. With multivariate regression analysis of those factors, the prevalence of hypertension, hyperlipidemia and advanced cancer (clinical stage IV), and the levels of D-dimer and fibrin degradation product remained as statistically independent factors, which were associated with cancer-associated ischemic stroke (n = 111, χ(2) =67.21, P < 0.0001). CONCLUSION In acute ischemic stroke, the cancer-associated ischemic stroke is associated with elevated D-dimer and fibrin degradation products, even after controlling hypertension, hyperlipidemia and advanced cancer (clinical stage IV).
Collapse
Affiliation(s)
- Tomoyuki Kono
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
190
|
Álvarez-Pérez F, Verde I, Usón-Martín M, Figuerola-Roig A, Ballabriga-Planas J, Espino-Ibañez A. Frequency and Mechanism of Ischemic Stroke Associated with Malignancy: A Retrospective Series. Eur Neurol 2012; 68:209-13. [DOI: 10.1159/000341343] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 06/24/2012] [Indexed: 11/19/2022]
|
191
|
Use of recombinant tissue plasminogen activator in cancer patients with acute stroke. J Neurooncol 2011; 107:571-3. [DOI: 10.1007/s11060-011-0780-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 11/30/2011] [Indexed: 11/25/2022]
|
192
|
Yamashiro K, Tanaka R, Nishioka K, Ueno Y, Shimura H, Okuma Y, Hattori N, Urabe T. Cerebral infarcts associated with adenomyosis among middle-aged women. J Stroke Cerebrovasc Dis 2011; 21:910.e1-5. [PMID: 22142777 DOI: 10.1016/j.jstrokecerebrovasdis.2011.10.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 10/20/2011] [Accepted: 10/27/2011] [Indexed: 12/27/2022] Open
Abstract
Cerebral infarcts associated with hypercoagulability in malignant tumors have been well recognized. However, reports on cerebral infarcts in patients with a benign gynecologic tumor, such as adenomyosis, are extremely limited. We report the cases of 4 patients with adenomyosis and cerebral infarcts, all without obvious evidence of conventional causes of cerebral infarcts. Brain magnetic resonance imaging revealed multiple cerebral infarcts in both cortical and subcortical areas in all the patients and in different arterial territories in 3 patients. Two patients also had systemic embolism in the fingers or kidneys. One patient had thrombi in the brachiocephalic trunk and left subclavian artery. The levels of coagulation markers were elevated in the acute phase of cerebral infarcts. Although cerebral infarcts might be uncommon in adenomyosis patients, these patients might be potentially at risk of developing cerebral infarcts associated with hypercoagulability related to increased mucinous tumor marker levels, menstruation-related coagulopathy, or increased tissue factor expression levels. Additional study is required to determine the mechanism underlying the development of cerebral infarcts in adenomyosis; however, physicians need to pay particular attention to those who have hypercoagulability with adenomyosis among middle-aged women.
Collapse
Affiliation(s)
- Kazuo Yamashiro
- Department of Neurology, Juntendo University Shizuoka Hospital, Izunokunishi, Shizuoka, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
193
|
Baldwin KJ, Zivković SA, Lieberman FS. Neurologic emergencies in patients who have cancer: diagnosis and management. Neurol Clin 2011; 30:101-28, viii. [PMID: 22284057 DOI: 10.1016/j.ncl.2011.09.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The nervous system can be significantly affected by cancer. Neurologic symptoms are present in 30% to 50% of oncologic patients presenting to the emergency department or in neurologic consultation at teaching hospitals. Evaluation and treatment require collaborative effort between specialties. The causes of neurologic emergencies in patients with cancer are mostly related to effects of cancer, toxicities of treatments, infections, and paraneoplastic syndromes. These complications cause significant morbidity and mortality and require prompt and accurate diagnostic and treatment measures. This article reviews the common neurologic emergencies affecting patients with cancer and discusses epidemiology, clinical presentation, diagnosis, and treatment modalities.
Collapse
Affiliation(s)
- Kelly Jo Baldwin
- Department of Neurology, University of Pittsburgh Medical Center, 337C Scaife Hall, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | | | | |
Collapse
|
194
|
Arvold ND, Hsu L, Chen WY, Benzaquen LR, Weiss SE. Marantic endocarditis with cardioembolic strokes mimicking leptomeningeal metastases in breast cancer. J Clin Oncol 2011; 29:e743-6. [PMID: 21788555 DOI: 10.1200/jco.2011.36.4190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Nils D Arvold
- Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA, USA.
| | | | | | | | | |
Collapse
|
195
|
Increase in stroke risk in patients with head and neck cancer: a retrospective cohort study. Br J Cancer 2011; 105:1419-23. [PMID: 21915128 PMCID: PMC3241541 DOI: 10.1038/bjc.2011.361] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This study investigated the stroke risk in patients with head and neck cancers (HNCs) using population-based data. METHODS From claims collected in the Taiwan National Health Insurance database, we identified 13,390 HNC patients with diagnosis made in 2000-2002. A reference cohort of 53,517 non-cancer individuals matched for age, gender, and stroke risk factors was used for assessing stroke risk in follow-up to 2008. RESULTS The overall stroke incidence was 1.44-fold higher in the HNC than in the reference cohort (11.4 vs 7.9 per 1000 person-years). Adjusted hazard ratios (HRs) were 1.54 (95% confidence interval (CI): 1.40-1.68) for ischaemic stroke and 1.36 (95% CI: 1.09-1.69) for haemorrhagic stroke. The cancer-to-reference stroke incidence rate ratio was age dependent and the highest in the age group younger than 40 years (5.45, 95% CI: 3.78-7.87) and decreased with aging. Comparing different therapeutic modalities, HNC patients receiving both radiotherapy (RT) and chemotherapy (CT) had the highest stroke risk (HR: 1.46, 95% CI: 1.22-1.74), followed in sequence by those who had CT alone, RT alone, and without therapy. CONCLUSION Patients with HNC are at increased risk of developing stroke, especially in the young age group and in those who received both RT and CT.
Collapse
|
196
|
Chen PC, Muo CH, Lee YT, Yu YH, Sung FC. Lung cancer and incidence of stroke: a population-based cohort study. Stroke 2011; 42:3034-9. [PMID: 21903961 DOI: 10.1161/strokeaha.111.615534] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE Stroke is a known cerebrovascular complication in lung cancer patients; however, whether lung cancer patients are at elevated risk of developing stroke relative to the noncancer population remains unclear. METHODS The present study used population-based claims data from the Taiwan National Health Insurance, which identified 52,089 patients with an initial diagnosis of lung cancer between 1999 and 2007, and 104,178 matched noncancer subjects from all insured subjects age 20 years and older. Subsequent occurrence of stroke was measured until 2008, and the association between lung cancer and the hazard of developing stroke was estimated using Cox proportional hazard models. RESULTS The incidence of stroke was 1.5 times higher (25.9 versus 17.4 per 1000 person-years) in the lung cancer group compared with the comparison group. The multivariate-adjusted hazard ratio (HR) comparing lung cancer patients with the noncancer group was 1.47 (95% CI, 1.39-1.56) for stroke, 1.78 (95% CI, 1.54-2.05) for hemorrhagic stroke, and 1.43 (95% CI, 1.34-1.51) for ischemic stroke. The risk of stroke fell over time, decreasing after 1 year of follow-up for men and after 2 years of follow-up for women. Within the first year of follow-up, the risk of stroke peaked during the first 3 months for men and within 4 to 6 months for women. CONCLUSIONS Lung cancer is associated with increased risk of subsequent stroke within 1 year after diagnosis for men and 2 years after diagnosis for women.
Collapse
Affiliation(s)
- Pei-Chun Chen
- Department of Health Risk Management, China Medical University, Taichung 404, Taiwan
| | | | | | | | | |
Collapse
|
197
|
Bang OY, Seok JM, Kim SG, Hong JM, Kim HY, Lee J, Chung PW, Park KY, Kim GM, Chung CS, Lee KH. Ischemic stroke and cancer: stroke severely impacts cancer patients, while cancer increases the number of strokes. J Clin Neurol 2011; 7:53-9. [PMID: 21779292 PMCID: PMC3131539 DOI: 10.3988/jcn.2011.7.2.53] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 11/22/2010] [Accepted: 11/22/2010] [Indexed: 12/15/2022] Open
Abstract
Background Cancer and ischemic stroke are two of the most common causes of death among the elderly, and associations between them have been reported. However, the main pathomechanisms of stroke in cancer patients are not well known, and can only be established based on accurate knowledge of the characteristics of cancer-related strokes. We review herein recent studies concerning the clinical, laboratory, and radiological features of patients with cancer-related stroke. Main Contents This review covers the epidemiology, underlying mechanisms, and acute and preventive treatments for cancer-related stroke. First, the characteristics of stroke (clinical and radiological features) and systemic cancer (type and extent) in patients with cancer-specific stroke are discussed. Second, the role of laboratory tests in the early identification of patients with cancer-specific stroke is discussed. Specifically, serum D-dimer levels (as a marker of a hypercoagulable state) and embolic signals on transcranial Doppler (suggestive of embolic origin) may provide clues regarding changes in the levels of coagulopathy related to cancer and anticoagulation. Finally, strategies for stroke treatment in cancer patients are discussed, emphasizing the importance of preventive strategies (i.e., the use of anticoagulants) over acute revascularization therapy in cancer-related stroke. Conclusion Recent studies have revealed that the characteristics of cancer-related stroke are distinct from those of conventional stroke. Our understanding of the characteristics of cancer-related stroke is essential to the correct management of these patients. The studies presented in this review highlight the importance of a personalized approach in treating stroke patients with cancer.
Collapse
Affiliation(s)
- Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
198
|
Vera R, Lago A, Fuentes B, Gállego J, Tejada J, Casado I, Purroy F, Delgado P, Simal P, Martí-Fábregas J, Vivancos J, Díaz-Otero F, Freijo M, Masjuan J. In-hospital stroke: a multi-centre prospective registry. Eur J Neurol 2011; 18:170-6. [PMID: 20550562 DOI: 10.1111/j.1468-1331.2010.03105.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND in-hospital strokes (IHS) are relatively frequent. Avoidable delays in neurological assessment have been demonstrated. We study the clinical characteristics, neurological care and mortality of IHS. METHODS multi-centre 1-year prospective study of IHS in 13 hospitals. Demographic and clinical characteristics, admission diagnosis, quality of care, thrombolytic therapy and mortality were recorded. RESULTS we included 273 IHS patients [156 men; 210 ischaemic strokes (IS), 37 transient ischaemic attacks (TIA) and 26 cerebral haemorrhages]. Mean age was 72 ± 12 years. Cardiac sources of embolism were present in 138 (50.5%), withdrawal of antithrombotic drugs in 77 (28%) and active cancers in 35 (12.8%). Cardioembolic stroke was the most common subtype of IS (50%). Reasons for admission were programmed or urgent surgery in 70 (25%), cardiac diseases in 50 (18%), TIA or stroke in 30 (11%) and other medical illnesses in 71 (26%). Fifty-two per cent of patients were evaluated by a neurologist within 3 h of stroke onset. Thirty-three patients received treatment with tPA (15.7%). Thirty-one patients (14.7%) could not be treated because of a delay in contacting the neurologist. During hospitalization, 50 patients (18.4%) died, 41 of them because of the stroke or its complications. CONCLUSIONS cardioembolic IS was the most frequent subtype of stroke. Cardiac sources of embolism, active cancers and withdrawal of antithrombotic drugs constituted special risk factors for IHS. A significant proportion of patients were treated with thrombolysis. However, delays in contacting the neurologist excluded a similar proportion of patients from treatment. IHS mortality was high, mostly because of stroke.
Collapse
Affiliation(s)
- R Vera
- Hospital Ramón y Cajal, Madrid Hospital La Fe, Valencia Hospital La Paz, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
199
|
Fagniez O, Tertian G, Dreyfus M, Ducreux D, Adams D, Denier C. Hematological disorders related cerebral infarctions are mostly multifocal. J Neurol Sci 2011; 304:87-92. [DOI: 10.1016/j.jns.2011.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 01/28/2011] [Accepted: 02/04/2011] [Indexed: 11/25/2022]
|
200
|
Di Nisio M, Ferrante N, Feragalli B, De Tursi M, Iacobelli S, Cuccurullo F, Porreca E. Arterial thrombosis in ambulatory cancer patients treated with chemotherapy. Thromb Res 2011; 127:382-3. [DOI: 10.1016/j.thromres.2010.10.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 09/14/2010] [Accepted: 10/04/2010] [Indexed: 11/28/2022]
|