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Huang HY, Chen JH, Chi NF, Chen YC. Cilostazol plus Aspirin vs. Clopidogrel plus Aspirin in Acute Minor Stroke or Transient Ischemic Attack. J Atheroscler Thromb 2024; 31:904-916. [PMID: 38092384 DOI: 10.5551/jat.64502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024] Open
Abstract
AIM This study compared the effectiveness, safety, and mortality risks between cilostazol plus aspirin and clopidogrel plus aspirin treatment for patients with acute minor ischemic stroke or transient ischemic attack (TIA). METHODS This retrospective cohort study employed a new-user design and utilized data from the nationwide Health and Welfare Database in Taiwan. Patients were included if they were discharged with newly initiated cilostazol plus aspirin or clopidogrel plus aspirin after primary acute minor ischemic stroke or TIA hospitalization between 2009 and 2018. Inverse probability of treatment weighting was applied to balance covariats between study groups. Effectiveness outcomes were the risks of acute ischemic stroke, acute myocardial infarction (AMI), TIA, and composite cardiovascular events; Safety outcomes were the risks of intracranial hemorrhage (ICH), gastrointestinal bleeding, and composite bleeding events; Mortality outcomes were the risks of fatal stroke, cardiovascular mortality, and all-cause mortality. RESULTS A total of 3,403 patients were included, of which 578 were treated with cilostazol plus aspirin and 2,825 were treated with clopidogrel plus aspirin. Cilostazol plus aspirin was associated with a higher risk of ICH (HR: 1.82; 95% CI: 1.16-2.84) compared to clopidogrel plus aspirin. No significant differences in the risks of effectiveness or mortality outcomes between the two groups were found. CONCLUSIONS The effectiveness and mortality of the two groups were similar for patients with acute minor ischemic stroke or TIA. However, cilostazol plus aspirin was associated with a higher risk of ICH compared to clopidogrel plus aspirin. Patients treated with cilostazol plus aspirin among this population should be monitored carefully to ensure their safety.
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Affiliation(s)
- Hsin-Yi Huang
- Department of Pharmacy, Shuang Ho Hospital, Taipei Medical University
- School of Pharmacy, National Taiwan University
| | - Jia-Hung Chen
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University
| | - Nai-Fang Chi
- Department of Neurology, Taipei Veterans General Hospital
- Department of Neurology, School of Medicine, National Yang Ming Chiao Tung University
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Huang HY, Wang CC, Katz AJ, Lin SY, Lin FJ, Wu CH. Ticagrelor vs Clopidogrel in Acute Myocardial Infarction Patients With a History of Ischemic Stroke. Mayo Clin Proc 2023; 98:1602-1612. [PMID: 37923519 DOI: 10.1016/j.mayocp.2023.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/06/2023] [Accepted: 07/06/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To investigate whether use of ticagrelor compared to clopidogrel is associated with different risks for thrombotic events or major bleeding among acute myocardial infarction (AMI) patients with a prior history of acute ischemic stroke. PATIENTS AND METHODS This retrospective cohort study used the Health and Welfare Database in Taiwan. Stroke patients prescribed ticagrelor plus aspirin or clopidogrel plus aspirin after a primary hospitalization for AMI between July 1, 2013, and December 31, 2018, were included. Inverse probability of treatment weighting was applied to balance covariates between treatment groups. The primary effectiveness outcome included a composite measure of AMI, acute ischemic stroke, or all-cause mortality. The primary safety outcome included a composite measure of intracranial hemorrhage (ICH) and major gastrointestinal bleeding. The secondary effectiveness and safety outcomes comprised each of the individual components that make up the primary effectiveness and safety outcomes, respectively. RESULTS A total of 1691 eligible patients were included in the study, of whom 734 (43.4%) received ticagrelor plus aspirin and 957 received clopidogrel plus aspirin. There were no significant differences observed in the primary and secondary effectiveness outcomes between the two study groups. However, the use of ticagrelor was associated with a higher risk of ICH (ticagrelor: 8.68 per 1000 person-year; clopidogrel: 2.17 per 1,000 person-year; HR, 3.34; 95% CI, 1.27 to 8.81, P = .01) compared with clopidogrel. CONCLUSION In AMI patients with a history of acute ischemic stroke, the risks of cardiovascular events were comparable between ticagrelor plus aspirin and clopidogrel plus aspirin. However, ticagrelor was associated with a higher risk of ICH. Ticagrelor should be used cautiously in AMI patients with a history of acute ischemic stroke.
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Affiliation(s)
- Hsin-Yi Huang
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan
| | - Chi-Chuan Wang
- Department of Pharmacy, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan; Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Aaron J Katz
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, USA; Department of Radiation Oncology, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Shin-Yi Lin
- Department of Pharmacy, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan; Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Fang-Ju Lin
- Department of Pharmacy, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan; Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chung-Hsuen Wu
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan.
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Aloizou AM, Palaiodimou L, Aloizou D, Dardiotis E, Gold R, Tsivgoulis G, Krogias C. Acute reperfusion treatment and secondary prevention of cancer-related stroke: comprehensive overview and proposal of clinical algorithm. Ther Adv Neurol Disord 2023; 16:17562864231180717. [PMID: 37342814 PMCID: PMC10278431 DOI: 10.1177/17562864231180717] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/20/2023] [Indexed: 06/23/2023] Open
Abstract
Cancer-related stroke (CRS), referring to ischemic stroke occurring in cancer patients without other clear etiology, represents a clinical challenge, as it is associated with unfavorable clinical outcomes including high rates of recurrence and mortality. There are scarce international recommendations and limited consensus statements on CRS management. For this comprehensive overview, the available studies/reviews/meta-analyses on the use of acute reperfusion and secondary prevention treatments for cancer patients with ischemic stroke, focusing on antithrombotic agents, were collected and summarized. A practical management algorithm was designed per the available data. In short, acute reperfusion in the form of intravenous thrombolysis and mechanical thrombectomy appears to be safe in CRS and can be considered for eligible patients, though the functional outcomes are often poor, and mostly defined by the preexisting condition. Many patients carry indications for anticoagulation, in which case vitamin K antagonists are not preferred, while low-molecular weight heparins remain the treatment of choice; direct oral anticoagulants can be alternatively considered but are contraindicated for gastrointestinal malignancies. For patients without clear anticoagulation indications, no net benefit for anticoagulation compared to aspirin has been shown. Other targeted treatment options should be evaluated in an individualized approach, alongside the appropriate management of conventional cerebrovascular risk factors. Oncological treatment should be swiftly initiated/continued. In conclusion, acute CRS remains a clinical challenge, with many patients suffering recurrent stroke, despite preventive measures. More randomized-controlled clinical trials are urgently needed to pinpoint the most effective management options for this subset of stroke patients.
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Affiliation(s)
| | - Lina Palaiodimou
- Second Department of Neurology, School of Medicine, ‘Attikon’ University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitra Aloizou
- Department of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | - Efthimios Dardiotis
- Department of Neurology, Laboratory of Neurogenetics, University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Georgios Tsivgoulis
- Second Department of Neurology, School of Medicine, ‘Attikon’ University Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Christos Krogias
- Department of Neurology, Evangelisches Krankenhaus Herne, Ruhr University Bochum, Bochum, Germany
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TOMIOKA A, TAKAHASHI S, IMAI R, NOGAWA H, OKITA H, UENO A, TODA M. A Case of Bilateral Cerebellar Chronic Encapsulated Intracerebral Hematoma with Rapidly Progressive Symptoms. NMC Case Rep J 2022; 9:111-116. [PMID: 35693190 PMCID: PMC9177165 DOI: 10.2176/jns-nmc.2021-0275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 03/03/2022] [Indexed: 12/04/2022] Open
Abstract
Chronic encapsulated intracerebral hematoma (CEIH) is a rare cerebrovascular disease featuring progressively expanding intracranial hematoma. We treated a man in his 70s with bilateral cerebellar CEIH. He had presented at another hospital with dizziness, and imaging showed two independent hemorrhagic space-occupying lesions in the bilateral cerebellar hemispheres. The symptoms progressed relatively rapidly, and there were signs of impending cerebellar herniation; he was transferred to our institution, and emergency surgery was performed. The operative findings included a hematoma with partial capsulation. We diagnosed CEIH from preoperative magnetic resonance imaging and computed tomography findings, clinical course, and pathological findings. The postoperative course was satisfactory. We present this case of bilateral cerebellar CEIH, as an extensive search of the literature suggests that this has not been reported before. Although CEIH is a condition that is usually hard to diagnose preoperatively, good outcomes can be achieved with appropriate surgical treatment. It is therefore important to keep this clinical entity in mind and not miss the right timing to operate.
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Affiliation(s)
- Azuna TOMIOKA
- Department of Neurosurgery, Keio University School of Medicine
| | | | - Ryotaro IMAI
- Department of Neurosurgery, Keio University School of Medicine
| | | | - Hajime OKITA
- Division of Diagnostic Pathology, Keio University School of Medicine
| | - Akihisa UENO
- Division of Diagnostic Pathology, Keio University School of Medicine
| | - Masahiro TODA
- Department of Neurosurgery, Keio University School of Medicine
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The immunolocalization of cluster of differentiation 31, phalloidin and alpha smooth muscle actin on vascular network of normal and ischemic rat brain. Sci Rep 2022; 12:22288. [PMID: 36566295 PMCID: PMC9789995 DOI: 10.1038/s41598-022-26831-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/20/2022] [Indexed: 12/25/2022] Open
Abstract
Cluster of differentiation 31 (CD31), phalloidin and alpha smooth muscle actin (α-SMA) have been widely applied to label the cerebral blood vessels in the past years. Although CD31 is mainly used as endothelial marker in determining the cerebral capillaries, it seems likely that its labeling efficiency is closely correlated with the antibodies from the polyclonal or monoclonal one, as well as the conditions of blood vessels. In order to test this phenomenon, we compared the labeling characteristics of goat polyclonal anti-CD31 (gP-CD31) and mouse monoclonal anti-CD31 (mM-CD31) with those of phalloidin and α-SMA on the rat brain in health and ischemia/reperfusion (I/R) with the middle cerebral artery occlusion. By multiple immunofluorescence staining, it was found that gP-CD31 labeling expressed extensively on the cerebral capillaries forming the vascular networks on the normal and ischemic regions, but mM-CD31 labeling mainly presented on the capillaries in the ischemic region. In contrast to the vascular labeling with gP-CD31, phalloidin and α-SMA were mainly expressed on the wall of cortical penetrating arteries, and less on that of capillaries. By three-dimensional reconstruction analysis, it was clearly shown that gP-CD31 labeling was mainly located on the lumen side of vascular wall and was surrounded by phalloidin labeling and α-SMA labeling. These results indicate that gP-CD31 is more sensitive than mM-CD31 for labeling the cerebral vasculature, and is highly compatible with phalloidin and α-SMA for evaluating the cerebral vascular networks under the physiological and pathological conditions.
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Jin K, Brennan PM, Poon MTC, Figueroa JD, Sudlow CLM. Impact of tumour characteristics and cancer treatment on cerebrovascular mortality after glioma diagnosis: Evidence from a population-based cancer registry. Front Oncol 2022; 12:1025398. [PMID: 36568237 PMCID: PMC9780584 DOI: 10.3389/fonc.2022.1025398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022] Open
Abstract
Objective We aimed to examine brain tumour grade, a marker of biological aggressiveness, tumour size and cancer treatment are associated with cerebrovascular mortality among patients with malignant glioma, the most common and aggressive type of brain tumour. Methods We conducted a retrospective, observational cohort study using the US National Cancer Institute's state and regional population-based cancer registries. We identified adult patients with glioma in 2000 to 2018 (N=72,916). The primary outcome was death from cerebrovascular disease. Cox regression modelling was used to estimate the associations with cerebrovascular mortality of tumour grade, tumour size and treatment (surgery, radiotherapy, chemotherapy), calculating hazard ratios (HR) adjusted for these factors as well as for age, sex, race, marital status and calendar year. Results Higher grade (Grade IV vs Grade II: HR=2.47, 95% CI=1.69-3.61, p<0.001) and larger brain tumours (size 3 to <6 cm: HR=1.40, 95% CI=1.03 -1.89, p<0.05; size ≥ 6 cm: HR=1.47, 95% CI=1.02-2.13, p<0.05 compared to size < 3cm) were associated with increased cerebrovascular mortality. Cancer treatment was associated with decreased risk (surgery: HR= 0.60, p<0.001; chemotherapy: HR=0.42, p<0.001; radiation: HR= 0.69, p<0.05). However, among patents surviving five years or more from cancer diagnosis radiotherapy was associated with higher risk of cerebrovascular mortality (HR 2.73, 95% CI 1.49-4.99, p<0.01). Conclusion More aggressive tumour characteristics are associated with increased cerebrovascular mortality. Radiotherapy increased risk of cerebrovascular mortality five-year after cancer diagnosis. Further research is needed to better understand the long-term cardiovascular consequences of radiation therapy, and whether the consequent risk can be mitigated.
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Affiliation(s)
- Kai Jin
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- Brain Tumour Centre of Excellence, Cancer Research United Kingdom Edinburgh Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Paul M. Brennan
- Brain Tumour Centre of Excellence, Cancer Research United Kingdom Edinburgh Centre, University of Edinburgh, Edinburgh, United Kingdom
- Translational Neurosurgery, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Michael T. C. Poon
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- Brain Tumour Centre of Excellence, Cancer Research United Kingdom Edinburgh Centre, University of Edinburgh, Edinburgh, United Kingdom
- Translational Neurosurgery, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Jonnie D. Figueroa
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- Brain Tumour Centre of Excellence, Cancer Research United Kingdom Edinburgh Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Cathie L. M. Sudlow
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- Brain Tumour Centre of Excellence, Cancer Research United Kingdom Edinburgh Centre, University of Edinburgh, Edinburgh, United Kingdom
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Yan Y, Zhang X, Zhong D, Wang A, Wu S, Wu B. Adenomyosis-Associated Ischemic Stroke: Pathophysiology, Detection and Management. Brain Sci 2022; 12:1410. [PMID: 36291343 PMCID: PMC9599589 DOI: 10.3390/brainsci12101410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 03/18/2024] Open
Abstract
Female-specific risk factors for stroke have gradually received attention. The relationship between ischemic stroke and adenomyosis, a benign uterine disorder commonly present in parous women, is underrecognized. We aimed to provide an overview of the epidemiology, pathophysiological mechanisms, clinical characteristics, diagnostic considerations, and potential therapeutic strategies of adenomyosis-associated ischemic stroke. We shared our experience with the diagnosis and management of a patient, and summarized current findings and knowledge gaps of this disease based on previous literature. The relevant studies were searched in English and Chinese databases up to April 2022 using the keywords "ischemic stroke", "cerebral infarction" and "adenomyosis". Then, we provided a narrative review of the retrieved articles. Finally, the data of 32 cases were analyzed. We found that increased levels of carbohydrate antigen 125 and D-dimer and decreased level of hemoglobin are biomarkers of adenomyosis-associated ischemic stroke. In addition, hypercoagulability might be a key mechanism leading to thromboembolism in the cerebrovascular system. Additional studies are needed to find optimal prevention strategies for the disease. A better understanding of this "rare" pathogenesis of ischemic stroke may inform a more precise diagnosis and effective prevention strategy in middle-aged women with embolic stroke of undetermined source.
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Affiliation(s)
| | | | | | | | | | - Bo Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China
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Huang HY, Lin SY, Katz AJ, Sheu JJ, Lin FJ, Wang CC, Wu CH. Effectiveness and Safety of Clopidogrel vs Aspirin in Elderly Patients With Ischemic Stroke. Mayo Clin Proc 2022; 97:1483-1492. [PMID: 35933134 DOI: 10.1016/j.mayocp.2022.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/06/2021] [Accepted: 01/12/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVE To evaluate the risks of recurrent stroke and major bleeding events with clopidogrel and aspirin use among patients aged 80 years or older. PATIENTS AND METHODS This retrospective cohort study was conducted using the Full Population Data of the Health and Welfare Database in Taiwan. Patients aged 80 years or older who received monotherapy with clopidogrel or aspirin following hospitalization for primary acute ischemic stroke between January 1, 2009, and December 31, 2018, were included. Inverse probability of treatment weighting was used to balance measured covariates between clopidogrel and aspirin users. Measured outcomes included recurrent acute ischemic stroke, acute myocardial infarction, composite cardiovascular events (recurrent stroke or acute myocardial infarction), intracranial hemorrhage, major gastrointestinal tract bleeding, and composite major bleeding events (intracranial hemorrhage or major gastrointestinal tract bleeding). RESULTS A total of 15,045 patients were included in the study, 1979 of whom used clopidogrel and 13,066 who used aspirin following hospitalization for primary acute ischemic stroke. Clopidogrel use was associated with significantly lower risk of recurrent acute ischemic stroke (hazard ratio [HR], 0.89; 95% CI, 0.83 to 0.96; P=.002), composite cardiovascular events (HR, 0.88; 95% CI, 0.82 to 0.95; P<.001), intracranial hemorrhage (HR, 0.71; 95% CI, 0.56 to 0.90; P=.005), and composite major bleeding events (HR, 0.89; 95% CI, 0.80 to 0.99; P=.04) compared with aspirin use. CONCLUSION In patients aged 80 years or older with primary acute ischemic stroke, clopidogrel users had lower risks of recurrent stroke and the composite cardiovascular events compared with aspirin users. Clopidogrel users also had lower risks of intracranial hemorrhage and the composite major bleeding events compared with aspirin users.
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Affiliation(s)
- Hsin-Yi Huang
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan; Department of Pharmacy, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan
| | - Shin-Yi Lin
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Aaron J Katz
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS USA; Department of Radiation Oncology, University of Kansas School of Medicine, Kansas City, KS USA
| | - Jau-Jiuan Sheu
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Fang-Ju Lin
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chi-Chuan Wang
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chung-Hsuen Wu
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan.
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Gutiérrez ML, Carrasco-Moro R, Ruz-Caracuel I, San Millán JSM. Stroke secondary to leptomeningeal carcinomatosis with radiologic signs of arterial invasion. Surg Neurol Int 2022; 13:290. [PMID: 35855115 PMCID: PMC9282822 DOI: 10.25259/sni_336_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 06/17/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Compared to the general population, cancer patients are more likely to suffer from cerebral ischemia, either caused by the tumor itself or by the treatments applied. Case Description: We hereby present the clinical case of a patient treated for lung adenocarcinoma, who, years later, developed a case of the right frontal-temporal-insular ischemia secondary to leptomeningeal spread of the primary neoplasm, with an invasion of the walls of the right-middle cerebral artery and its branches. Conclusion: This should be considered an extremely rare form of recurrence of a primary solid tumor with clinical and radiological features that can mimic those of vascular inflammatory entities.
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Chen S, Zhang J, Lu X, Cen G, Song Y, Deng X, Xie Y, Liu L, Liu Q, Huang J, Li J, Yang H, Shi S, Pan L, Liang Z. Cancer Related Subarachnoid Hemorrhage: A Multicenter Retrospective Study Using Propensity Score Matching Analysis. Front Cell Neurosci 2022; 16:813084. [PMID: 35197827 PMCID: PMC8859848 DOI: 10.3389/fncel.2022.813084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 01/11/2022] [Indexed: 12/22/2022] Open
Abstract
Objective To investigate the clinical features, risk factors and underlying pathogenesis of cancer related subarachnoid hemorrhage (SAH). Methods Clinical data of SAH in patients with active cancer from January 2010 to December 2020 at four centers were retrospectively reviewed. Patients with active cancer without SAH were matched to SAH patients with active cancer group. Logistic regression was applied to investigate the independent risk factors of SAH in patients with active cancer, after a 1:1 propensity score matching (PSM). A receiver operator characteristic curve was configured to calculate the optimal cut-off value of the joint predictive factor for cancer related SAH. Results A total of 82 SAH patients with active cancer and 309 patients with active cancer alone were included. Most SAH patients with cancer had poor outcomes, with 30-day mortality of 41.5%, and with 90-day mortality of 52.0%. The PSM yielded 75 pairs of study participants. Logistic regression revealed that a decrease in platelet and prolonged prothrombin time were the independent risk factors of cancer related SAH. In addition, receiver operator characteristic curve of the joint predictive factor showed the largest AUC of 0.8131, with cut-off value equaling to 11.719, with a sensitivity of 65.3% and specificity of 89.3%. Conclusion Patients with cancer related SAH often have poor outcomes. The decrease in platelet and prolonged prothrombin time are the independent risk factors of cancer related SAH, and the joint predictive factor with cutoff value equal to 11.719 should hence serve as a novel biomarker of cancer related SAH.
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Affiliation(s)
- Shijian Chen
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jian Zhang
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xianfu Lu
- Department of Neurology, Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Gengyu Cen
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yiting Song
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xuhui Deng
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yiju Xie
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Liuyu Liu
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qianqian Liu
- Department of Neurology, Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Junling Huang
- Department of Neurology, Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Jing Li
- Department of Neurology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Hong Yang
- Department of Neurology, Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Shengliang Shi
- Department of Neurology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Liya Pan
- Department of Neurology, Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Zhijian Liang
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Peng H, Jiang J, Huang X. Uterine rhabdomyosarcoma complicated by cerebral venous thrombosis and uterine inversion in a young woman: case report and literature review. BMC WOMENS HEALTH 2021; 21:314. [PMID: 34445980 PMCID: PMC8390075 DOI: 10.1186/s12905-021-01459-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/20/2021] [Indexed: 11/28/2022]
Abstract
Background Uterine rhabdomyosarcoma is an extremely rare malignant tumor that usually affects young women and has a poor prognosis. Case presentation A 19-year-old nulliparous woman presented to the emergency department under sedation due to seizures. Imaging examination revealed cerebral venous thrombosis. During thrombolytic therapy, she developed vaginal bleeding followed by uterine inversion secondary to uterine rhabdomyosarcoma. The inverted uterus was mistaken for a cervical tumour and was removed vaginally. The patient’s disease progressed despite chemotherapy with vincristine, actinomycin D and cyclophosphamide and she died within 6 months. To our knowledge, this is the first case of uterine rhabdomyosarcoma complicated with cerebral venous thrombosis. Conclusions Malignancy is an important diagnostic in patients with cerebral venous thrombosis with no obvious cause. This case demonstrates the importance of considering uterine neoplasms in the differential diagnosis of adolescent girls with abnormal uterine bleeding. Further, careful anatomical evaluation of vaginal masses should be performed prior to surgical intervention.
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Affiliation(s)
- Hongfa Peng
- Department of Obstetrics and Gynecology, Second Hospital of Hebei Medical University, Heping West Road No. 215, Shijiazhuang City, 050000, Hebei Province, China.
| | - Jingjing Jiang
- Department of Obstetrics and Gynecology, Hebei General Hospital, Shijiazhuang, 050051, China
| | - Xianghua Huang
- Department of Obstetrics and Gynecology, Second Hospital of Hebei Medical University, Heping West Road No. 215, Shijiazhuang City, 050000, Hebei Province, China
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12
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Unravelling the tangled web of hypertension and cancer. Clin Sci (Lond) 2021; 135:1609-1625. [PMID: 34240734 DOI: 10.1042/cs20200307] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 01/11/2023]
Abstract
Cardiovascular disease remains the primary cause of mortality globally, being responsible for an estimated 17 million deaths every year. Cancer is the second leading cause of death on a global level with roughly 9 million deaths per year being attributed to neoplasms. The two share multiple common risk factors such as obesity, poor physical exercise, older age, smoking and there exists rare monogenic hypertension syndromes. Hypertension is the most important risk factor for cardiovascular disease and affects more than a billion people worldwide and may also be a risk factor for the development of certain types of cancer (e.g. renal cell carcinoma (RCC)). The interaction space of the two conditions becomes more complicated when the well-described hypertensive effect of certain antineoplastic drugs is considered along with the extensive amount of literature on the association of different classes of antihypertensive drugs with cancer risk/prevention. The cardiovascular risks associated with antineoplastic treatment calls for efficient management of relative adverse events and the development of practical strategies for efficient decision-making in the clinic. Pharmacogenetic interactions between cancer treatment and hypertension-related genes is not to be ruled out, but the evidence is not still ample to be incorporated in clinical practice. Precision Medicine has the potential to bridge the gap of knowledge regarding the full spectrum of interactions between cancer and hypertension (and cardiovascular disease) and provide novel solutions through the emerging field of cardio-oncology. In this review, we aimed to examine the bidirectional associations between cancer and hypertension including pharmacotherapy.
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Kleindorfer DO, Towfighi A, Chaturvedi S, Cockroft KM, Gutierrez J, Lombardi-Hill D, Kamel H, Kernan WN, Kittner SJ, Leira EC, Lennon O, Meschia JF, Nguyen TN, Pollak PM, Santangeli P, Sharrief AZ, Smith SC, Turan TN, Williams LS. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association. Stroke 2021; 52:e364-e467. [PMID: 34024117 DOI: 10.1161/str.0000000000000375] [Citation(s) in RCA: 1161] [Impact Index Per Article: 387.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Huang CC, Yang YC, MacDonald I, Lai CY, Tu CH, Chen YH. Traditional Chinese Medicine Reduces the Incidence of Chemotherapy-Induced Stroke: A Five-Year Nationwide Population-Based Cohort Study From Taiwan. Front Pharmacol 2021; 12:614606. [PMID: 34122061 PMCID: PMC8187954 DOI: 10.3389/fphar.2021.614606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 05/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Chemotherapy is suspected to be a risk factor for stroke in patients with cancer, athough the results from large-scale studies are controversial. Few strategies are available for reducing the stroke-related risks. Methods: We analyzed stroke incidence rates in Taiwan’s Longitudinal Health Insurance database 2000 (LHID2000) for patients aged ≥20 years with newly-diagnosed cancer between Jan 1, 2000 and Dec 31, 2006, who did or did not receive chemotherapy. Moreover, we compared stroke incidence rates among chemotherapy users who did or did not use traditional Chinese medicine. All study participants were followed-up for 5 years or until they had a stroke. Results: In adjusted Kaplan-Meier analysis, the incidence of stroke was higher within the first year of cancer diagnosis among chemotherapy recipients compared with those who did not receive chemotherapy (31.1 vs. 9.75; adjusted subdistribution hazard ratio [sHR] 2.21; 95% confidence interval [CI], 1.52–3.20; p < 0.001). This between-group difference persisted at 4 years of follow-up (13.6 vs. 5.42; adjusted sHR 1.94; 95% CI, 1.53–2.46; p < 0.001). Similarly, the 5-year incidence rate of stroke was significantly lower among chemotherapy recipients using TCM vs. non-TCM users (0.19 vs. 0.46; adjusted sHR 0.45; 95% CI, 0.26–0.79; p < 0.001), as was the mortality rate (adjusted sHR 0.55; 95% CI, 0.44–0.68; p < 0.001). Conclusion: These Taiwanese data suggest that chemotherapy is a risk factor for stroke and that the use of TCM can significantly mitigate this risk. TCM also appears to reduce the mortality risk associated with chemotherapy.
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Affiliation(s)
- Chien-Chen Huang
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan.,Department of Traditional Chinese Medicine, An Nan Hospital, China Medical University, Tainan, Taiwan
| | - Yu-Cih Yang
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Iona MacDonald
- Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan
| | - Ching-Yuan Lai
- Center for Emergency and Critical Care Medicine, China Medical University Beigang Hospital, Yunlin, Taiwan
| | - Cheng-Hao Tu
- Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan
| | - Yi-Hung Chen
- Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan.,Department of Photonics and Communication Engineering, Asia University, Taichung, Taiwan
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Lamotte G, Coon EA, Suarez MD, Sandroni P, Benarroch EE, Cutsforth-Gregory JK, Mauermann ML, Berini SE, Shouman K, Sletten D, Goodman BP, Low PA, Singer W. Natural History of Afferent Baroreflex Failure in Adults. Neurology 2021; 97:e136-e144. [PMID: 33947784 DOI: 10.1212/wnl.0000000000012149] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/29/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe the natural history of afferent baroreflex failure (ABF) based on systematic review of clinical and laboratory data in patients with a diagnosis of ABF at Mayo Clinic Rochester. METHODS We performed a retrospective chart review of all patients who underwent standardized autonomic reflex testing between 2000 and 2020 and had confirmation of the diagnosis of ABF by an autonomic disorders specialist. Patients were identified using a data repository of medical records. Variables included demographic, all-cause mortality, medications, ABF manifestations, comorbidities, and laboratory (autonomic testing, blood pressure monitoring, echocardiogram, brain imaging, plasma catecholamines, serum sodium level, and kidney function tests). RESULTS A total of 104 patients with ABF were identified. Head and neck radiation was the most common etiology (86.5%), followed by neck surgery (5.8%) and other causes (7.7%). The most common findings were hypertension (87.5%), fluctuating blood pressure (78.8%), orthostatic hypotension (91.3%), syncope (58.6%), headache (22.1%), and tachycardia (20.2%). Patients commonly received antihypertensives (66.3%), pressor agents (41.3%), or a combination of both (19.2%). The median latency from completion of radiation to ABF was longer compared to the latency in the surgery group (p < 0.0001). Comorbidities, including complications from neck radiation, were frequently seen and all-cause mortality was 39.4% over a 20-year period. CONCLUSIONS ABF should be suspected in patients with prior head and neck cancer treated by radiation or surgery who present with labile hypertension and orthostatic hypotension. Management may require both antihypertensive and pressor medications. The morbidity and mortality in ABF are high.
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Affiliation(s)
- Guillaume Lamotte
- From the Department of Neurology (G.L., E.A.C., M.D.S., P.S., E.E.B., J.K.C.-G., M.L.M., S.E.B., K.S., D.S., P.A.L., W.S.), Mayo Clinic, Rochester, MN; and Department of Neurology (B.P.G.), Mayo Clinic, Scottsdale, AZ
| | - Elizabeth A Coon
- From the Department of Neurology (G.L., E.A.C., M.D.S., P.S., E.E.B., J.K.C.-G., M.L.M., S.E.B., K.S., D.S., P.A.L., W.S.), Mayo Clinic, Rochester, MN; and Department of Neurology (B.P.G.), Mayo Clinic, Scottsdale, AZ
| | - Mariana D Suarez
- From the Department of Neurology (G.L., E.A.C., M.D.S., P.S., E.E.B., J.K.C.-G., M.L.M., S.E.B., K.S., D.S., P.A.L., W.S.), Mayo Clinic, Rochester, MN; and Department of Neurology (B.P.G.), Mayo Clinic, Scottsdale, AZ
| | - Paola Sandroni
- From the Department of Neurology (G.L., E.A.C., M.D.S., P.S., E.E.B., J.K.C.-G., M.L.M., S.E.B., K.S., D.S., P.A.L., W.S.), Mayo Clinic, Rochester, MN; and Department of Neurology (B.P.G.), Mayo Clinic, Scottsdale, AZ
| | - Eduardo E Benarroch
- From the Department of Neurology (G.L., E.A.C., M.D.S., P.S., E.E.B., J.K.C.-G., M.L.M., S.E.B., K.S., D.S., P.A.L., W.S.), Mayo Clinic, Rochester, MN; and Department of Neurology (B.P.G.), Mayo Clinic, Scottsdale, AZ
| | - Jeremy K Cutsforth-Gregory
- From the Department of Neurology (G.L., E.A.C., M.D.S., P.S., E.E.B., J.K.C.-G., M.L.M., S.E.B., K.S., D.S., P.A.L., W.S.), Mayo Clinic, Rochester, MN; and Department of Neurology (B.P.G.), Mayo Clinic, Scottsdale, AZ
| | - Michelle L Mauermann
- From the Department of Neurology (G.L., E.A.C., M.D.S., P.S., E.E.B., J.K.C.-G., M.L.M., S.E.B., K.S., D.S., P.A.L., W.S.), Mayo Clinic, Rochester, MN; and Department of Neurology (B.P.G.), Mayo Clinic, Scottsdale, AZ
| | - Sarah E Berini
- From the Department of Neurology (G.L., E.A.C., M.D.S., P.S., E.E.B., J.K.C.-G., M.L.M., S.E.B., K.S., D.S., P.A.L., W.S.), Mayo Clinic, Rochester, MN; and Department of Neurology (B.P.G.), Mayo Clinic, Scottsdale, AZ
| | - Kamal Shouman
- From the Department of Neurology (G.L., E.A.C., M.D.S., P.S., E.E.B., J.K.C.-G., M.L.M., S.E.B., K.S., D.S., P.A.L., W.S.), Mayo Clinic, Rochester, MN; and Department of Neurology (B.P.G.), Mayo Clinic, Scottsdale, AZ
| | - David Sletten
- From the Department of Neurology (G.L., E.A.C., M.D.S., P.S., E.E.B., J.K.C.-G., M.L.M., S.E.B., K.S., D.S., P.A.L., W.S.), Mayo Clinic, Rochester, MN; and Department of Neurology (B.P.G.), Mayo Clinic, Scottsdale, AZ
| | - Brent P Goodman
- From the Department of Neurology (G.L., E.A.C., M.D.S., P.S., E.E.B., J.K.C.-G., M.L.M., S.E.B., K.S., D.S., P.A.L., W.S.), Mayo Clinic, Rochester, MN; and Department of Neurology (B.P.G.), Mayo Clinic, Scottsdale, AZ
| | - Phillip A Low
- From the Department of Neurology (G.L., E.A.C., M.D.S., P.S., E.E.B., J.K.C.-G., M.L.M., S.E.B., K.S., D.S., P.A.L., W.S.), Mayo Clinic, Rochester, MN; and Department of Neurology (B.P.G.), Mayo Clinic, Scottsdale, AZ
| | - Wolfgang Singer
- From the Department of Neurology (G.L., E.A.C., M.D.S., P.S., E.E.B., J.K.C.-G., M.L.M., S.E.B., K.S., D.S., P.A.L., W.S.), Mayo Clinic, Rochester, MN; and Department of Neurology (B.P.G.), Mayo Clinic, Scottsdale, AZ.
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Allen BD, Acharya MM, Montay-Gruel P, Jorge PG, Bailat C, Petit B, Vozenin MC, Limoli C. Maintenance of Tight Junction Integrity in the Absence of Vascular Dilation in the Brain of Mice Exposed to Ultra-High-Dose-Rate FLASH Irradiation. Radiat Res 2021; 194:625-635. [PMID: 33348373 DOI: 10.1667/rade-20-00060.1] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 07/01/2020] [Indexed: 01/12/2023]
Abstract
Persistent vasculature abnormalities contribute to an altered CNS microenvironment that further compromises the integrity of the blood-brain barrier and exposes the brain to a host of neurotoxic conditions. Standard radiation therapy at conventional (CONV) dose rate elicits short-term damage to the blood-brain barrier by disrupting supportive cells, vasculature volume and tight junction proteins. While current clinical applications of cranial radiotherapy use dose fractionation to reduce normal tissue damage, these treatments still cause significant complications. While dose escalation enhances treatment of radiation-resistant tumors, methods to subvert normal tissue damage are clearly needed. In this regard, we have recently developed a new modality of irradiation based on the use of ultra-high-dose-rate FLASH that does not induce the classical pathogenic patterns caused by CONV irradiation. In previous work, we optimized the physical parameters required to minimize normal brain toxicity (i.e., FLASH, instantaneous intra-pulse dose rate, 6.9 · 106 Gy/s, at a mean dose rate of 2,500 Gy/s), which we then used in the current study to determine the effect of FLASH on the integrity of the vasculature and the blood-brain barrier. Both early (24 h, one week) and late (one month) timepoints postirradiation were investigated using C57Bl/6J female mice exposed to whole-brain irradiation delivered in single doses of 25 Gy and 10 Gy, respectively, using CONV (0.09 Gy/s) or FLASH (>106 Gy/s). While the majority of changes found one day postirradiation were minimal, FLASH was found to reduce levels of apoptosis in the neurogenic regions of the brain at this time. At one week and one month postirradiation, CONV was found to induce vascular dilation, a well described sign of vascular alteration, while FLASH minimized these effects. These results were positively correlated with and temporally coincident to changes in the immunostaining of the vasodilator eNOS colocalized to the vasculature, suggestive of possible dysregulation in blood flow at these latter times. Overall expression of the tight junction proteins, occludin and claudin-5, which was significantly reduced after CONV irradiation, remained unchanged in the FLASH-irradiated brains at one and four weeks postirradiation. Our data further confirm that, compared to isodoses of CONV irradiation known to elicit detrimental effects, FLASH does not damage the normal vasculature. These data now provide the first evidence that FLASH preserves microvasculature integrity in the brain, which may prove beneficial to cognition while allowing for better tumor control in the clinic.
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Affiliation(s)
- Barrett D Allen
- Department of Radiation Oncology, University of California, Irvine, Irvine, California 92697-2695
| | - Munjal M Acharya
- Department of Radiation Oncology, University of California, Irvine, Irvine, California 92697-2695
| | - Pierre Montay-Gruel
- Laboratory of Radiation Oncology, Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Patrik Goncalves Jorge
- Laboratory of Radiation Oncology, Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Institute of Radiation Physics/CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - Claude Bailat
- Institute of Radiation Physics/CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - Benoît Petit
- Laboratory of Radiation Oncology, Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Marie-Catherine Vozenin
- Laboratory of Radiation Oncology, Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Charles Limoli
- Department of Radiation Oncology, University of California, Irvine, Irvine, California 92697-2695
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Zhao Y, Xie H, Pan C, Yao Y, Gong Z, Li Y, Jia Y. Clinical Characteristics and Risk Factors of Cerebral Hemorrhage in Patients with Occult Malignant Tumors. Neuropsychiatr Dis Treat 2021; 17:2729-2738. [PMID: 34434047 PMCID: PMC8382450 DOI: 10.2147/ndt.s321571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/01/2021] [Indexed: 11/23/2022] Open
Abstract
PROPOSE To investigate the clinical characteristics and potential risk factors of the first onset of cerebral hemorrhage in patients with occult malignant tumors. PATIENTS AND METHODS In this retrospective study, 23 patients with occult malignant tumors with the first onset of cerebral hemorrhage were enrolled in the tumor group, and 92 patients without occult tumors in the same period were enrolled in the control group. There were no statistical differences in age and sex between both groups by propensity score matching. Collected clinical data included age, sex, smoking history, drinking history, hypertension history, diabetes history, past medical history, routine blood tests, neutrophil-to-lymphocyte ratio (NLR), liver and kidney function, fasting blood glucose level, coagulation function, tumor markers, imaging examinations, National Institute of Health stroke scale (NIHSS) score on admission, modified Rankin Scale (mRS) score 90 days after intracerebral hemorrhage and final mRS score. RESULTS Compared with the control group, the tumor group had fewer patients with hypertension (52.2% vs 81.5%, P<0.05), and the NLR was significantly decreased in the tumor group (2.74 vs 5.46, P<0.05). The tumor group had a greater number of patients with the bleeding sites located in the lobar regions (43.5% vs.19.6%, P<0.05) and a higher coagulation dysfunction (52.2% vs 29.3%, P<0.05) than the control group. Multivariate logistic regression analysis revealed that no history of hypertension (OR: 3.141, 95% CI: 1.107-8.916), lobar cerebral hemorrhage (OR: 3.465 95% CI:1.172-10.243), and coagulation dysfunction (OR: 3.176, 95% CI: 1.131-8.913) were independent predictors of occult tumors, and the receiver operating characteristic (ROC) curve showed that the area under the curve of the three-index combined diagnosis was 0.748, C-statistic analysis also showed the same result. CONCLUSION No history of hypertension, lobar cerebral hemorrhage, and coagulation dysfunction may be predictors of the risk of occult malignancies in patients with cerebral hemorrhage.
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Affiliation(s)
- Yi Zhao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Haojie Xie
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Chunyang Pan
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yaobing Yao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Zhe Gong
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yanfei Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yanjie Jia
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
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Wu S, Xing Z, Lin J, Cui F, Liu H. Tumor metastasis has a significant relationship with the development of acute ischemic stroke in Chinese cancer patients: a retrospective study. J Int Med Res 2021; 49:300060520986298. [PMID: 33478293 PMCID: PMC7841866 DOI: 10.1177/0300060520986298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 12/11/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE This study was designed to analyze the relationship between tumor metastasis and acute ischemic stroke (AIS) in Chinese cancer patients. METHODS This retrospective study included 119 cancer patients with AIS and 152 cancer patients without AIS. Basic information was collected and tumor metastasis status was determined for all patients. RESULTS The whole cohort had a median age of 59 (49-69) years with 150 men (55.4%). There were 98 patients (36.2%) with tumor metastasis. Patients with AIS had significantly more males, tumor metastasis, lung cancer, hypertension, diabetes mellitus, higher age, D-dimer, international normalized ratio, prothrombin time, prothrombin activity, and thrombin time, while they had significantly lower levels of hemoglobin, red blood cells, and hematocrit. In multivariate logistic regression analysis, AIS was significantly and positively associated with age, tumor metastasis, D-dimer, and thrombin time. In multivariate Cox regression analysis, tumor metastasis, AIS, D-dimer, thrombin time, and fibrinogen were significantly and positively associated with worse prognosis. CONCLUSIONS This study demonstrates that tumor metastasis was positively and independently associated with AIS in Chinese cancer patients, suggesting that tumor metastasis has a significant relationship with the development of AIS. Additionally, tumor metastasis and AIS had negative independent effects on the prognosis of patients.
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Affiliation(s)
- Siting Wu
- Neurology Department, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China
| | - Zengluan Xing
- Neurology Department, Cadre Sanatorium of Hainan (Geriatric Hospital of Hainan), Haikou, China
| | - Jiacai Lin
- Neurology Department, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China
| | - Fang Cui
- Neurology Department, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China
| | - Hui Liu
- Oncology Department, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China
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Karthikeyan K, Babu CM, Shaji S, Ashok AM, Madhu CS. Case report on 5-fluorouracil induced cerebrovascular accident. J Oncol Pharm Pract 2020; 27:1016-1019. [DOI: 10.1177/1078155220954900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Introduction 5-Fluorouracil is an antineoplastic agent generally used to treat various types of solid tumors. The common adverse drug reaction associated with 5-fluorouracil are myelosuppression, mucositis, diarrhea, and hand-foot syndrome. Neurological side effects such as headache, dizziness, convulsion, encephalopathy, and acute cerebellar syndrome are rare in nature. Case presentation We report a case of 5-fluorouracil induced cerebrovascular accident (CVA) in a patient with no risk factors for CVA before chemotherapy. A 37 years old female patient diagnosed with carcinoma rectum underwent six cycles of chemotherapy with 5- fluorouracil- calcium leucovorin- irinotecan (FOLFIRI regimen). After completing the last cycle, she developed headache, vomiting, and facial deviation along with high blood pressure (260/160 mmHg). MRI brain was done, and it revealed acute non-hemorrhagic lacunar infarct in the left half of pons. 5-fluorouracil induced CVA was suspected and was managed with dual antiplatelet, statin, and antihypertensives. Conclusion The clinicians and clinical pharmacists must be aware about the potential of 5-FU to induce rare side effects such as CVA even in low risk patients in order to avoid permanent harm to the patient
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Affiliation(s)
- Kavya Karthikeyan
- Department of Pharmacy Practice, St. Joseph's College of Pharmacy, Cherthala, India
| | - Christy M Babu
- Department of Pharmacy Practice, St. Joseph's College of Pharmacy, Cherthala, India
| | - Shintu Shaji
- Department of Pharmacy Practice, St. Joseph's College of Pharmacy, Cherthala, India
| | | | - CS Madhu
- Department of Oncology, Lourdes Hospital, Kochi, India
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