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Sawada J, Katayama T, Kikuchi-Takeguchi S, Kano K, Saito M, Mitsui N, Hiroshima S, Kinoshita M, Nakagawa N. Clinical features and prognostic factors of patients with cancer-associated stroke. Neurol Sci 2024; 45:2747-2757. [PMID: 38267601 DOI: 10.1007/s10072-024-07332-y] [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] [Received: 09/22/2023] [Accepted: 01/12/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Cerebrovascular diseases in cancer patients significantly aggravate their condition and prognosis; therefore, prompt and accurate diagnosis and treatment are important. The purpose of this study was to investigate patient demographics, laboratory data, brain magnetic resonance imaging (MRI) findings, and prognosis among patients with stroke and cancer, especially cancer-associated ischemic stroke (CAIS). METHODS We performed a retrospective, single-center study. We enrolled consecutive patients who had acute stroke and were admitted to our hospital between January 2011 and December 2021. We collected general demographic characteristics, cancer histopathological type, laboratory data, brain MRI findings, and prognosis data. RESULTS Among 2040 patients with acute stroke, a total of 160 patients (7.8%) had active cancer. The types of strokes were cerebral infarction, cerebral hemorrhage, subarachnoid hemorrhage, and transient ischemic attack in 124, 25, 5, and 6 patients, respectively. Among the patients with ischemic stroke, there were 69 cases of CAIS. Pancreas and adenocarcinoma were the most frequent types of primary tumor and histopathology. Patients with adenocarcinoma and those with cerebral infarctions in both bilateral anterior and posterior cerebral circulation areas showed higher D-dimer levels. Pancreatic cancer and high plasma D-dimer levels were associated with poor survival rate. CONCLUSION CAIS was seen more frequently in patients with pancreatic cancer and adenocarcinoma. Pancreatic cancer and high plasma D-dimer levels were potential factors of poor prognosis in patients with CAIS.
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Affiliation(s)
- Jun Sawada
- Division of Cardiology, Nephrology, Pulmonology, and Neurology, Department of Internal Medicine, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.
| | - Takayuki Katayama
- Department of Neurology, Asahikawa City Hospital, Asahikawa, Hokkaido, Japan
| | - Shiori Kikuchi-Takeguchi
- Division of Cardiology, Nephrology, Pulmonology, and Neurology, Department of Internal Medicine, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
| | - Kohei Kano
- Division of Cardiology, Nephrology, Pulmonology, and Neurology, Department of Internal Medicine, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
| | - Masato Saito
- Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Nobuyuki Mitsui
- Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Satoru Hiroshima
- Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Manabu Kinoshita
- Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Naoki Nakagawa
- Division of Cardiology, Nephrology, Pulmonology, and Neurology, Department of Internal Medicine, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
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Vaz CG, Rodrigues J, Pereira D, Matos I, Oliveira C, Bento MJ, Magalhães R, Correia M, Maia LF. The crosstalk between Stroke and Cancer: Incidence of cancer after a first-ever cerebrovascular event in a population-based study. Eur Stroke J 2023; 8:792-801. [PMID: 37317526 PMCID: PMC10472965 DOI: 10.1177/23969873231181628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/26/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES To determine the cancer incidence after the first-ever cerebrovascular event (CVE) and compare it to the cancer incidence in the population from the same region. METHODS We evaluated 1069 patients with a first-ever CVE (Ischaemic or haemorrhagic stroke and Transient Ischaemic Attack) from a prospective population registry of stroke and transient focal neurological attacks, diagnosed between 2009 and 2011. We conducted a structured search to identify cancer-related variables and case-fatality for a period of 8 years following CVE. Cancer incidence in CVE patients was compared to the North Region Cancer Registry (RORENO). RESULTS We found that 90/1069 (8.4%) CVE patients developed cancer after a first-ever CVE. Overall cancer annual incidence rate was higher after a CVE (820/100,000, 95%CI: 619-1020) than in general population (513/100,000, 95%CI: 508-518). In the 45-54 age group cancer incidence post-CVE was 3.2-fold (RR, 95%CI: 1.6-6.4) higher compared to the general population, decreasing gradually in older age-groups. Median time between CVE and cancer was 3.2 years (IQR = 1.4-5.2). Lower respiratory tract and colorectal were the most frequent cancer types. In univariable models, male sex (sHR = 1.78, 95%CI: 1.17-2.72, p = 0.007), tobacco use (sHR = 2.04, 95%CI: 1.31-3.18, p = 0.002) and peripheral artery disease (sHR = 2.37, 95%CI: 1.10-5.13, p = 0.028) were associated to higher cancer risk after CVE. After adjustment, tobacco use (sHR = 1.84, 95%CI: 1.08-3.14, p = 0.026) remained associated to a higher risk of cancer. CONCLUSIONS At the population level, patients presenting a first-ever CVE have higher cancer incidence, that is particularly prominent in younger age-groups. Higher cancer incidence, delayed cancer diagnosis and increased mortality post-CVE warrants further research on long-term cancer surveillance in first-ever CVE survivors.
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Affiliation(s)
- Catarina Guedes Vaz
- Serviço de Neurologia, Hospital Santo António – Centro Hospitalar Universitário de Santo António (HSA-CHUdSA), Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar – Universidade do Porto (ICBAS-UP), Porto, Portugal
| | - Jéssica Rodrigues
- Grupo de Epidemiologia do Cancro, Centro de Investigação do Instituto Português de Oncologia do Porto, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Diogo Pereira
- Serviço de Neurologia, Hospital Santo António – Centro Hospitalar Universitário de Santo António (HSA-CHUdSA), Porto, Portugal
| | - Ilda Matos
- Serviço de Neurologia, Unidade Local de Saúde do Nordeste – Mirandela, Mirandela, Portugal
| | - Carla Oliveira
- i3S – Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- Ipatimup – Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal
| | - Maria José Bento
- Instituto de Ciências Biomédicas Abel Salazar – Universidade do Porto (ICBAS-UP), Porto, Portugal
- Grupo de Epidemiologia do Cancro, Centro de Investigação do Instituto Português de Oncologia do Porto, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Rui Magalhães
- Instituto de Ciências Biomédicas Abel Salazar – Universidade do Porto (ICBAS-UP), Porto, Portugal
| | - Manuel Correia
- Serviço de Neurologia, Hospital Santo António – Centro Hospitalar Universitário de Santo António (HSA-CHUdSA), Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar – Universidade do Porto (ICBAS-UP), Porto, Portugal
| | - Luis F Maia
- Serviço de Neurologia, Hospital Santo António – Centro Hospitalar Universitário de Santo António (HSA-CHUdSA), Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar – Universidade do Porto (ICBAS-UP), Porto, Portugal
- i3S – Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
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Takeshima S, Kawate N. Decision-making for intensive rehabilitation in patients with Trousseau syndrome: Insights from a case series. Medicine (Baltimore) 2023; 102:e34097. [PMID: 37390272 PMCID: PMC10313241 DOI: 10.1097/md.0000000000034097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/05/2023] [Indexed: 07/02/2023] Open
Abstract
RATIONALE Patients with Trousseau syndrome, a common complication of advanced cancer, typically have poor survival. For that reason, there is a need to determine the effectiveness of rehabilitation treatment and develop a comprehensive treatment strategy earlier than that in the general stroke population. We investigated the relationship between physical function and its outcome 1 month after the start of intensive rehabilitation treatment in patients with Trousseau syndrome, to obtain insights for determining the indications for intensive rehabilitation in these patients. PATIENT CONCERNS The development of Trousseau syndrome may worsen the performance status (PS), often necessitating a reevaluation of the indications for treatment of the primary cancer. Furthermore, the primary cancer may progress during rehabilitation therapy. DIAGNOSES These patients were diagnosed with Trousseau syndrome. INTERVENTIONS All patients underwent training under the supervision of a therapist for 2 to 3 hours per day, 7 days per week, with a focus on exercise therapy. The functional independence measure (FIM) 1 month after admission to the convalescent rehabilitation ward, modified Rankin scale (mRS) score on admission and on the date of last assessment, and its outcome was examined. OUTCOMES The time from stroke onset to admission to rehabilitation ranged from 22 to 60 days. Primary cancers were lung, bladder, prostate, ovarian, uterine, and unknown primary. Four patients had advanced cancer with distant metastasis. Two patients were discharged to home with independent activities of daily living (ADL) status. Two patients were transferred to palliative care, and 3 patients died. The 2 patients with independent ADL status had a mean motor score of 90 and a mean cognitive score of 30 on FIM, while the other 5 patients had a mean motor score of 29 and a mean cognitive score of 21 at 1 month of admission. Patients with mRS > 3 on admission did not have independent ADL status at 1 month. LESSONS Intensive rehabilitation therapy may be indicated for patients with Trousseau syndrome who are expected to improve physical function after approximately 1 month of rehabilitation. Palliative care should be considered if recovery is inadequate.
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Affiliation(s)
- Shinichi Takeshima
- Department of Rehabilitation Medicine, Showa University School of Medicine, Yokohama, Kanagawa, Japan
| | - Nobuyuki Kawate
- Department of Rehabilitation Medicine, Showa University School of Medicine, Yokohama, Kanagawa, Japan
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Stroke mortality in cancer survivors: A population-based study in Japan. Thromb Res 2023; 222:140-148. [PMID: 36682150 DOI: 10.1016/j.thromres.2023.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/22/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023]
Abstract
INTRODUCTION The association between cancer survivors and stroke deaths remains unclear. We aimed to evaluate the risk of fatal stroke in patients with cancer. MATERIALS AND METHODS This study was conducted using data from the Osaka Cancer Registry and vital statistics in Japan, collected from 1985 to 2013. We extracted patient data and investigated the causes of death. Standardized mortality ratios were calculated to compare the risk of stroke in patients with cancer to that in the general population. Poisson regression models were used to estimate the risk of stroke in patients with cancer and other cancer subgroups. Stroke types were used for risk stratification. RESULTS We identified 688,473 eligible patients with cancer. The cohort contributed 2,668,126 person-years at risk. During the study period, 337,117 patients died; stroke was the cause of death in 5496 patients. Stroke types included cerebral infarction (3259), intracerebral hemorrhage (1539), subarachnoid hemorrhage (364), and other cerebrovascular diseases (334). The crude mortality rate from fatal stroke was 205.99 per 100,000 person-years. The standardized mortality ratio (95 % confidence interval) for fatal stroke was 1.75 (1.71-1.80). When stratified by stroke types, the ratios for cerebral infarction, intracerebral hemorrhage, and subarachnoid hemorrhage were 1.83 (1.76-1.89), 2.38 (2.26-2.50), and 2.28 (2.03-2.56), respectively. The risk of fatal stroke increased with time after cancer diagnosis. The multivariate Poisson regression model indicated that men were more likely to die of stroke than women. CONCLUSIONS Cancer survivors have a higher risk of fatal stroke than the general population across all stroke types.
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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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Zhang C, Wang L, Guo Y, Feng W. Systematic analysis of brain and skull ischemic injury expression profiles reveals associations of the tumor immune microenvironment and cell death with ischemic stroke. Front Immunol 2022; 13:1082546. [PMID: 36605216 PMCID: PMC9809284 DOI: 10.3389/fimmu.2022.1082546] [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: 10/28/2022] [Accepted: 11/23/2022] [Indexed: 01/07/2023] Open
Abstract
Background Previous studies have shown that stroke is a potential first sign of neoplasia, but the relationship between stroke and cancer remains unclear. As a complex brain disease, ischemic stroke involves cell death and immunity. Thus, it is necessary to investigate the association of the tumor immune microenvironment and cell death with ischemic stroke. Methods We established a photothrombosis-induced ischemic injury model in mouse brain and skull. Subsequently, we sequenced the whole transcriptome of the injured mouse brain and skull and analyzed the expression profiles. To investigate the association of stroke with cell death and cancer, we systematically performed gene set enrichment analysis in pan-cell death (i.e., apoptosis, cuproptosis, ferroptosis, necroptosis, and pyroptosis) and the cancer hallmark pathways. The time-dependent immune cell abundance variations after ischemic injury were estimated. Furthermore, pan-cancer genomic and prognostic analyses of the ischemic injury-related gene sets were also performed. Results In this study, we found that there exist temporal and spatial differences in the gene expression patterns of both the brain and skull with ischemic injury. The skull ischemic injury-induced changes in the brain transcriptome were particularly great, but could recover in a short period, while the skull transcriptome variation resulting from brain ischemic injury was long-lasting. In addition, the expression of the genes related to ischemic injury was also associated with pan-cell death and the cancer hallmark pathways. The changes in the abundance of immune cells indicate that brain ischemic injury may disrupt the immune microenvironment for a longer time, while the skull can balance the stability of the immune microenvironment better. Moreover, the brain ischemic injury-related gene sets were highly correlated with a variety of tumors, particularly glioblastoma multiforme (GBM), kidney renal clear cell carcinoma (KIRC), brain lower grade glioma (LGG), and uveal melanoma (UVM), which carry a greater mortality risk after stroke. Conclusion This systematic analysis not only helps in the understanding of the changes in the gene expression profiles of both the brain and skull with ischemic injury but also reveals the association of the tumor immune microenvironment and cell death with ischemic stroke.
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Affiliation(s)
- Chao Zhang
- Zhanjiang Institute of Clinical Medicine, Central People’s Hospital of Zhanjiang, Zhanjiang, Guangdong, China,Zhanjiang Central Hospital, Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Lisi Wang
- Zhanjiang Institute of Clinical Medicine, Central People’s Hospital of Zhanjiang, Zhanjiang, Guangdong, China,Zhanjiang Central Hospital, Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Yunmiao Guo
- Zhanjiang Institute of Clinical Medicine, Central People’s Hospital of Zhanjiang, Zhanjiang, Guangdong, China,Zhanjiang Central Hospital, Guangdong Medical University, Zhanjiang, Guangdong, China,*Correspondence: Yunmiao Guo, ; Wei Feng, ;
| | - Wei Feng
- Zhanjiang Institute of Clinical Medicine, Central People’s Hospital of Zhanjiang, Zhanjiang, Guangdong, China,Zhanjiang Central Hospital, Guangdong Medical University, Zhanjiang, Guangdong, China,*Correspondence: Yunmiao Guo, ; Wei Feng, ;
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Tanimura J, Yamamoto T, Hashimoto T. Clinical features and prognostic factors in patients with cancer-associated multiple ischemic stroke: A retrospective observational study. J Stroke Cerebrovasc Dis 2022; 31:106813. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 09/11/2022] [Accepted: 09/23/2022] [Indexed: 11/06/2022] Open
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Toda Y, Kano Y. Three-territory sign in Trousseau's syndrome. BMJ Case Rep 2022; 15:e253520. [PMID: 36368738 PMCID: PMC9660682 DOI: 10.1136/bcr-2022-253520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yuki Toda
- Department of Internal Medicine, Mito Kyodo General Hospital, Mito, Ibaraki, Japan
| | - Yasuhiro Kano
- Department of Internal Medicine, Mito Kyodo General Hospital, Mito, Ibaraki, Japan
- Department of General Internal Medicine, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
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Cancer and stroke: What do we know and where do we go? Thromb Res 2022; 219:133-140. [PMID: 36179651 DOI: 10.1016/j.thromres.2022.09.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 11/23/2022]
Abstract
Cancer is an increasingly recognized cause for ischemic stroke, with recent acknowledgement of cancer-related stroke as an emerging stroke subtype with unique pathophysiologic mechanisms. In addition, cancer-related stroke may differ from stroke in the general population as cancer patients may not receive guideline-recommended stroke care, and the occurrence of stroke may also preclude patients from receiving optimal cancer treatments. Due to the high degree of morbidity and mortality associated with both conditions, understanding the relationship between stroke and cancer is crucial. In this narrative review, we discuss the association between cancer and stroke, the unique pathophysiologic mechanisms underlying this phenomenon, treatment options including acute reperfusion therapies and secondary prevention strategies, compare outcomes between cancer-related stroke and stroke in the general population, and review new and emerging evidence in this field.
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Tanaka T, Suzuki H, Miwa K, Ushijima T, Nagasu S, Fukahori M, Ishii K, Nakamura T, Iwamoto H, Masuda A, Sakaue T, Koga H, Akagi Y, Murotani K, Torimura T. Hyperlipidemia as a risk factor for Trousseau syndrome‑related cerebral infarction in patients with advanced gastrointestinal cancer. Oncol Lett 2022; 24:318. [PMID: 35949619 PMCID: PMC9353866 DOI: 10.3892/ol.2022.13437] [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: 12/27/2021] [Accepted: 06/15/2022] [Indexed: 11/23/2022] Open
Abstract
Trousseau syndrome-related cerebral infarction rarely occurs during chemotherapy in patients with gastrointestinal (GI) cancer, and its clinical features remain unclear. The present study aimed to examine the clinical features of Trousseau syndrome-related cerebral infarction developed during chemotherapy for GI cancer. The present retrospective cohort study consecutively enrolled 878 patients with unresectable GI cancer who received chemotherapy at the Multidisciplinary Treatment Cancer Center, Kurume University Hospital (Kurume, Japan) between April 2014 and March 2020. Patients with colorectal cancer (n=308) were the most common, followed by those with pancreatic (n=242), gastric (n=222) and biliary tract (n=59) cancer, neuroendocrine tumors (n=34) and duodenal cancer (n=11). Among the 878 patients, Trousseau syndrome-related cerebral infarction occurred in 8 (0.9%) patients with a median age of 70.5 years (range, 58–75 years), and 50% of the patients were male (4/8). In total, 3 patients had gastric cancer, 3 had pancreatic cancer and 2 had biliary tract cancer. A greater percentage of patients with Trousseau syndrome-related cerebral infarction had hyperlipidemia (38.0%) than those without (8.2%; P=0.005). Hyperlipidemia was a risk factor for occurrence of Trousseau syndrome-related cerebral infarction with an odds ratio of 7.009 (95% confidence interval, 1.785-27.513). Trousseau syndrome-related cerebral infarction developed during GI chemotherapy was rare and hyperlipidemia may predict its onset.
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Affiliation(s)
- Toshimitsu Tanaka
- Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Fukuoka 830‑0011, Japan
| | - Hiroyuki Suzuki
- Department of Medicine, Division of Gastroenterology, Kurume University School of Medicine, Fukuoka 830‑0011, Japan
| | - Keisuke Miwa
- Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Fukuoka 830‑0011, Japan
| | - Tomoyuki Ushijima
- Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Fukuoka 830‑0011, Japan
| | - Sachiko Nagasu
- Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Fukuoka 830‑0011, Japan
| | - Masaru Fukahori
- Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Fukuoka 830‑0011, Japan
| | - Kaito Ishii
- Department of Medicine, Division of Gastroenterology, Kurume University School of Medicine, Fukuoka 830‑0011, Japan
| | - Toru Nakamura
- Department of Medicine, Division of Gastroenterology, Kurume University School of Medicine, Fukuoka 830‑0011, Japan
| | - Hideki Iwamoto
- Department of Medicine, Division of Gastroenterology, Kurume University School of Medicine, Fukuoka 830‑0011, Japan
| | - Atsutaka Masuda
- Department of Medicine, Division of Gastroenterology, Kurume University School of Medicine, Fukuoka 830‑0011, Japan
| | - Takahiko Sakaue
- Department of Medicine, Division of Gastroenterology, Kurume University School of Medicine, Fukuoka 830‑0011, Japan
| | - Hironori Koga
- Department of Medicine, Division of Gastroenterology, Kurume University School of Medicine, Fukuoka 830‑0011, Japan
| | - Yoshito Akagi
- Department of Surgery, Kurume University School of Medicine, Fukuoka 830‑0011, Japan
| | - Kenta Murotani
- Biostatistics Center, Kurume University, Kurume, Fukuoka 830‑0011, Japan
| | - Takuji Torimura
- Department of Medicine, Division of Gastroenterology, Kurume University School of Medicine, Fukuoka 830‑0011, Japan
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Willems RA, Winckers K, Biesmans C, de Vos-Geelen J, ten Cate H. Evolving data on cardiovascular complications in cancer. Thromb Res 2022; 213 Suppl 1:S87-S94. [DOI: 10.1016/j.thromres.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/18/2021] [Accepted: 01/03/2022] [Indexed: 11/25/2022]
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Mattingly TK, Risco JE, Burch JE, Whyte R, Kohli GS, Susa S, Bhalla T, Bender MT. Endovascular Therapy is Effective for Large Vessel Occlusion Despite Concurrent Cancer. J Stroke Cerebrovasc Dis 2022; 31:106439. [PMID: 35313233 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106439] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/19/2022] [Accepted: 02/23/2022] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Ischemic stroke and concurrent cancer is increasingly recognized. However, optimal management is uncertain. As mechanical thrombectomy has become the standard of care for large vessel occlusion, more patients with cancer are presenting for embolectomy. However, it is unknown whether this subgroup has the same benefit profile described in multiple randomized trials for thrombectomy for large vessel occlusion. Our objective was to retrospectively evaluate a North American embolectomy database for safety and outcomes in patients with active cancer. MATERIALS AND METHODS A case series of 284 embolectomies over 30 months at a single North American stroke center were divided into thrombectomy patients with active cancer(n=25) and those without active cancer (n=259). We compared patient characteristics, procedural characteristics, and procedural outcomes between patients with and without active cancer. Univariate and multivariate analysis of angiographic outcomes, postoperative hemorrhage, and functional outcome was performed. RESULTS Of the 284 thrombectomy cases, 9% were performed on patients with active cancer. Active cancer patients had a similar recanalization grade and post-operative hemorrhage rate, compared to patients without cancer. Active cancer patients had a significantly higher 90 day mortality (40% vs 20%, p=0.018). On multivariate analysis, good functional outcome (mRS 0-2) was not impacted by active cancer. However, when mRS was evaluated as an ordinal shift analysis, worse functional outcome was associated with active cancer (OR 2.98; 95% CI, 1.29 to 6.59), greater age, NIHSS> 10, and ASPECTS<9. CONCLUSIONS This single center retrospective series of active cancer patients undergoing thrombectomy for large vessel occlusion demonstrates similar rates of recanalization, post-operative hemorrhage, and good outcomes. While the active cancer group has a high short-term mortality, the potential to maintain quality of life in the survivors makes thrombectomy reasonable in this patient population. Awareness of ischemic stroke as a complication of cancer and the safety of thrombectomy in this population are important as this population subtype is expected to grow with improved oncology and stroke care.
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Affiliation(s)
- Thomas K Mattingly
- Dept of Neurosurgery, University of Rochester, Rochester, NY. 585-273-1900, United States.
| | - Jorge E Risco
- Dept of Neurology, University of Rochester, Rochester, NY. 585-275-2776, United States
| | - Jaclyn E Burch
- Dept of Neurology, University of Rochester, Rochester, NY. 585-275-2776, United States
| | - Raquel Whyte
- Dept of Neurosurgery, University of Rochester, Rochester, NY. 585-273-1900, United States
| | - Gurkirat S Kohli
- Dept of Neurosurgery, University of Rochester, Rochester, NY. 585-273-1900, United States
| | - Stephen Susa
- Dept of Neurosurgery, University of Rochester, Rochester, NY. 585-273-1900, United States
| | - Tarun Bhalla
- Dept of Neurosurgery, University of Rochester, Rochester, NY. 585-273-1900, United States
| | - Matthew T Bender
- Dept of Neurosurgery, University of Rochester, Rochester, NY. 585-273-1900, United States
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Young gastric cancer patient with high CA19-9 complicated by Trousseau syndrome. Clin J Gastroenterol 2021; 15:85-89. [PMID: 34731429 DOI: 10.1007/s12328-021-01541-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/19/2021] [Indexed: 10/19/2022]
Abstract
A 47-year-old Japanese woman presented with epigastric discomfort and anorexia. Upper endoscopy showed type 4 advanced gastric cancer in the gastric antrum with stenosis of the pyloric portion. Abdominopelvic CT revealed peritoneal dissemination, and stage IV advanced gastric cancer was diagnosed. Laparoscopic gastrojejunostomy and enterostomy were performed. Trousseau syndrome occurred 7 days post-surgery. Despite appropriate treatment, the patient developed a pulmonary embolism 13 days later and died 18 days post-surgery. Even in young cancer patients without lifestyle disease complications, it is important to pay attention to Trousseau syndrome as part of cancer management.
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Intracranial Mönckeberg's Atherosclerosis Is Frequently Found in Autopsy Cases of Advanced Stage Malignancy with Cerebral Infarction. Cancers (Basel) 2021; 13:cancers13205234. [PMID: 34680388 PMCID: PMC8534181 DOI: 10.3390/cancers13205234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/11/2021] [Accepted: 10/18/2021] [Indexed: 02/05/2023] Open
Abstract
Simple Summary We pathologically compared the cerebral infarction (CI) status in autopsy cases with and without malignancy focusing on the status of intracranial Mönckeberg’s atherosclerosis. Most of Mönckeberg’s atherosclerosis were found in the basal ganglia. Its prevalence in CI cases with malignancy was significantly higher than in malignancy cases without CI and was apparently higher than CI cases without malignancy. The results indicated that Mönckeberg’s atherosclerosis was frequently found in the basal ganglia of CI patients with malignancy and that intracranial Mönckeberg’s atherosclerosis is a potential risk factor for CI in patients with advanced stage malignancy. Abstract Cerebral infarction (CI) severely affects the prognosis of patients with malignancy. The aim of the study was to compare the pathology of CI between cases with and without malignancy focusing on intracranial Mönckeberg’s atherosclerosis. Among 778 autopsy cases of craniotomy, 53 cases of “cerebral infarction without malignancy group” (CI group), 50 cases of “malignant tumor without CI group” (MT group), and 39 cases of “cerebral infarction with malignancy group” (CM group) were identified. Mönckeberg’s atherosclerosis was mainly found in the basal ganglia and its prevalence in the CM group (38.5%) was significantly higher than in the MT group (12.0%, p = 0.005), and apparently higher than in the CI group (18.9%, p = 0.057). The CI group was significantly older, had higher BMIs, and a greater prevalence of hypertension and atrial fibrillation compared to the CM group. In addition, the prevalence of chronic renal disease was significantly lower in the CM group (2.6%, p = 0.012) than in the CI group (20.8%). Our results indicated that Mönckeberg’s atherosclerosis was often found in the basal ganglia of CM cases and that intracranial Mönckeberg’s atherosclerosis is a potential risk factor for CI in patients with advanced stage malignancy.
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Uchida T, Amagasaki K, Hosono A, Nakaguchi H. Primary diffuse large B-cell lymphoma of the cranial vault with Trousseau syndrome: a case report. J Med Case Rep 2021; 15:431. [PMID: 34404459 PMCID: PMC8371799 DOI: 10.1186/s13256-021-02979-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/22/2021] [Indexed: 11/14/2022] Open
Abstract
Background It is extremely rare for primary non-Hodgkin’s lymphomas to occur singly in the cranial vault. One case diagnosed as primary diffuse large B-cell lymphoma is reported, initially misdiagnosed as metastatic skull tumor, complicated with Trousseau syndrome. Case description The patient was a 60-year-old Japanese woman with no particular previous medical history. In a head computed tomography examination for vertigo, bone destructive skull tumor covering the right frontal, parietal, and temporal bones was incidentally discovered. As positron emission tomography indicated an abnormal accumulation in the large intestine and multiple cerebral infarctions suspicious of Trousseau syndrome were observed on magnetic resonance images, a metastatic skull tumor due to colorectal cancer was first considered. However, various tumor markers were negative, and colonoscopic biopsy indicated no colorectal abnormality. After pathological examination of the resected tumor, it was diagnosed as diffuse large B-cell lymphoma. The tumor affected muscles and skin but did not develop in the brain or the dura mater. As further general examination revealed no other abnormalities, we considered that it was primary diffuse large B-cell lymphoma in the cranial vault associated with Trousseau syndrome. Treatment with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone and high-dose methotrexate reduced the residual lesion; coagulation abnormalities, which are frequently associated with Trousseau syndrome, also improved. Conclusions Skull tumors can result from a variety of malignancies, and their diagnosis may be complicated with Trousseau syndrome. However, even in cases of a single lesion in the cranial vault without invasion of the central nervous system, diffuse large B-cell lymphoma should be considered as a differential diagnosis.
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Affiliation(s)
- Tatsuya Uchida
- Department of Neurosurgery, Mitsui Memorial Hospital, 1 Kandaizumicho, Chiyoda-ku, Tokyo, Japan.
| | - Kenichi Amagasaki
- Department of Neurosurgery, Mitsui Memorial Hospital, 1 Kandaizumicho, Chiyoda-ku, Tokyo, Japan
| | - Atsushi Hosono
- Department of Neurosurgery, Mitsui Memorial Hospital, 1 Kandaizumicho, Chiyoda-ku, Tokyo, Japan
| | - Hiroshi Nakaguchi
- Department of Neurosurgery, Mitsui Memorial Hospital, 1 Kandaizumicho, Chiyoda-ku, Tokyo, Japan
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Kataoka Y, Sonoda K, Takahashi JC, Ishibashi-Ueda H, Toyoda K, Yakushiji Y, Kusaka H, Koga M. Histopathological analysis of retrieved thrombi from patients with acute ischemic stroke with malignant tumors. J Neurointerv Surg 2021; 14:neurintsurg-2020-017195. [PMID: 34050032 DOI: 10.1136/neurintsurg-2020-017195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/18/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The procoagulant state in cancer increases the thrombotic risk, and underlying cancer could affect treatment strategies and outcomes in patients with ischemic stroke. However, the histopathological characteristics of retrieved thrombi in patients with cancer have not been well studied. This study aimed to assess the histopathological difference between thrombi in patients with and without cancer. METHODS We studied consecutive patients with acute major cerebral artery occlusion who were treated with endovascular therapy between October 2010 and December 2016 in our single-center registry. The retrieved thrombi were histopathologically investigated with hematoxylin and eosin and Masson's trichrome staining. The organization and proportions of erythrocyte and fibrin/platelet components were studied using a lattice composed of 10×10 squares. RESULTS Of the 180 patients studied, 17 (8 women, age 76.5±11.5 years) had cancer and 163 (69 women, age 74.1±11.2 years) did not. Those with cancer had a higher proportion of fibrin/platelets (56.6±27.4% vs 40.1±23.9%, p=0.008), a smaller proportion of erythrocytes (42.1±28.3% vs 57.5±25.1%, p=0.019), and higher serum D-dimer levels (5.9±8.2 vs 2.4±4.3 mg/dL, p=0.005) compared with the non-cancer cases. Receiver operating characteristic curve analysis showed the cut-off ratio of fibrin/platelet components related to cancer was 55.7% with a sensitivity of 74.8%, specificity 58.8% and area under the curve (AUC) value of 0.67 (95% CI 0.53 to 0.81), and the cut-off ratio of erythrocyte components was 44.7% with a sensitivity of 71.2%, specificity 58.9% and AUC value of 0.66 (95% CI 0.51 to 0.80). CONCLUSIONS Thromboemboli of major cerebral arteries in patients with cancer were mainly composed of fibrin/platelet-rich components.
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Affiliation(s)
- Yuko Kataoka
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan .,Department of Neurology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Kazutaka Sonoda
- Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.,Department of Neurology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Jun C Takahashi
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.,Department of Neurosurgery, Kindai University Faculty of Medicine Hospital, Osaka-Sayama, Osaka, Japan
| | - Hatsue Ishibashi-Ueda
- Department of Pathology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.,Department of Pathology, Hokusetsu General Hospital, Takatsuki, Osaka, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yusuke Yakushiji
- Department of Neurology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Hirofumi Kusaka
- Department of Neurology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Risk Factors for Gastric Cancer-Associated Thrombotic Diseases in a Han Chinese Population. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5544188. [PMID: 34095299 PMCID: PMC8164527 DOI: 10.1155/2021/5544188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/08/2021] [Accepted: 05/12/2021] [Indexed: 11/18/2022]
Abstract
The aim of the present work was to investigate the risk factors for gastric cancer- (GC-) associated thrombotic diseases in a Han Chinese population. A total of 333 patients diagnosed with GC, 68 with thrombotic diseases included in the case group and the remaining 265 in the control group, were enrolled. The relevant data for the participants, including general information (gender, age, smoking, and drinking), comorbidities (diabetes, hypertension, and anemia), tumor-related data (tumor site, histology, degree of differentiation, and clinical stage), and treatment-related data (surgery, chemotherapy, hormones, transfusion, and peripherally inserted central venous catheter (PICC)), were collected. Statistically significant factors derived from univariate analyses were then subjected to multivariate logistic regression analyses. The results demonstrate a statistically significant difference in age, diabetes, hypertension, histology, surgery, chemotherapy, and PICC (P < 0.05), compared with control. Age, diabetes, surgery, and PICC serve as independent risk factors for GC-associated thrombotic diseases (P < 0.05). The present work demonstrates that GC-associated thrombotic diseases are significantly associated with age, diabetes, surgery, and PICC, suggesting a potential target for early detection and preventive strategy for GC patients with thrombophilia.
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18
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AOKI T, KUWAYAMA K, KOBATA H, ITO A, FUJI K, SAKAMOTO M, FURUNO Y, MATSUMOTO K. Endovascular Mechanical Thrombectomy for Basilar Artery Occlusion Caused by Thrombosis as an Initial Manifestation of Acute Myelogenous Leukemia: A Case Report. NMC Case Rep J 2021; 8:767-772. [PMID: 35079546 PMCID: PMC8769465 DOI: 10.2176/nmccrj.cr.2021-0212] [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: 07/08/2021] [Accepted: 09/07/2021] [Indexed: 11/20/2022] Open
Abstract
We report a rare case of a basilar artery occlusion (BAO) caused by thrombosis as an initial magnification of acute myelogenous leukemia (AML) and performed mechanical thrombectomy (MT) to treat it. A 67-year-old female presented left hemiparalysis of her arm and right-sided blindness. Magnetic resonance imaging (MRI) and magnetic resonance angiography revealed acute infarction in the left occipital and anterior lobes of the cerebellum and incomplete BAO. Her blood test showed hyperleukocytosis with precursor cells and high levels of C-reactive protein, and we diagnosed AML and disseminated intravascular coagulation (DIC). We decided to treat conservatively with rapid rehydration and heparin, but three hours after admission, she suddenly lost consciousness. We performed acute MT with a direct aspiration first-pass technique (ADAPT). A white elastic embolus was aspirated, and DSA showed successful recanalization of the basilar artery. The next day, MRI revealed acute infarction in the midbrain and bilateral thalamus. The patient remained unconscious after MT and so chemotherapy to treat the acute leukemia could not be performed. The patient died of the primary disease 14 days after BAO. Thrombosis in association with AML is very rare disease and could occur in arterial vessels because of hypercoagulation, and this tendency may not respond to anticoagulation therapy. Although ADAPT might be performed safety without complications even in cases of DIC, indications for treatment with MT should be carefully considered in patients in whom hemorrhage is a possibility.
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Affiliation(s)
- Takuma AOKI
- Department of Neurosurgery, Japan Community Health Care Organization Kobe Central Hospital, Kobe, Hyogo, Japan
| | - Kazuyuki KUWAYAMA
- Department of Neurosurgery, Japan Community Health Care Organization Kobe Central Hospital, Kobe, Hyogo, Japan
| | - Hiroshi KOBATA
- Department of Hematology, Japan Community Health care Organization Kobe Central Hospital, Kobe, Hyogo, Japan
| | - Ai ITO
- Department of Hematology, Japan Community Health care Organization Kobe Central Hospital, Kobe, Hyogo, Japan
| | - Keisuke FUJI
- Department of Neurosurgery, Japan Community Health Care Organization Kobe Central Hospital, Kobe, Hyogo, Japan
| | - Manato SAKAMOTO
- Department of Neurosurgery, Japan Community Health Care Organization Kobe Central Hospital, Kobe, Hyogo, Japan
| | - Yuichi FURUNO
- Department of Neurosurgery, Japan Community Health Care Organization Kobe Central Hospital, Kobe, Hyogo, Japan
| | - Keigo MATSUMOTO
- Department of Neurosurgery, Japan Community Health Care Organization Kobe Central Hospital, Kobe, Hyogo, Japan
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Wassef C, Grenga A, Goldman B, Mattingly T. Triple Thrombectomy for Trousseau Syndrome: Case Report and Review of the Literature of Stroke Intervention in Cancer-associated Thrombus. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 14:301-306. [PMID: 37502176 PMCID: PMC10370598 DOI: 10.5797/jnet.cr.2019-0111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/08/2020] [Indexed: 07/29/2023]
Abstract
Objective There are few papers regarding repeat mechanical thrombectomy or thrombectomy for Trousseau's related stroke. We present a unique case of repeat thrombectomy due to Trousseau's syndrome affecting the same vessel in a patient with metastatic cancer. Case Presentation A 47-year-old male presented with a full left middle cerebral artery syndrome and a National Institute of Health Stroke Scale of 17, despite regular apixaban use. He underwent mechanical thrombectomy successfully but developed recurrent symptoms on postoperative day (POD) 6 while on warfarin. He underwent two additional thrombectomies, the final one requiring glycoprotein IIa/IIIb inhibitor for emergent implantation of intracranial stent. Successful recanalization (thrombolysis in cerebral infarction 2b) was achieved, and the patient was discharged home on dual antiplatelet therapy and enoxaparin on POD 10 after last thrombectomy, ambulatory and independent in his activities of daily living. The patient expired as a result of his metastatic disease 109 days after the third procedure and was ambulatory for 91 of those days. Conclusion This case illustrates the palliative aspects of mechanical thrombectomy and the complexities of anticoagulation management in patients with the metastatic disease Trousseau's syndrome.
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Affiliation(s)
- Catherine Wassef
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Audrey Grenga
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Bruce Goldman
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA
| | - Thomas Mattingly
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA
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20
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Watanabe Y, Matsunuma K, Kaneda T. A case of successful anesthetic management in a patient with Trousseau's syndrome who underwent surgery for malignant ovarian tumor. JA Clin Rep 2020; 6:32. [PMID: 32388737 PMCID: PMC7211214 DOI: 10.1186/s40981-020-00339-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/30/2020] [Indexed: 11/29/2022] Open
Abstract
Background Trousseau’s syndrome, also known as cancer-associated thrombosis, has several perioperative considerations, including the timing of surgery, anticoagulant therapy, and anesthetic technique. While appropriate anesthetic management is critical, few clinical reports have addressed the issue. Here, we report a patient with Trousseau’s syndrome who successfully underwent gynecological surgery 1 month after a massive cerebral infarction. Case presentation A 46-year-old woman with malignant ovarian tumor and deep venous thrombosis developed systemic thromboembolism, including a massive right cerebral infarction, despite receiving direct oral anticoagulant therapy. She was diagnosed with Trousseau’s syndrome and was transferred to our hospital 17 days after the onset of cerebral infarction with left incomplete hemiparesis. Semi-radical gynecological surgery was scheduled in another 14 days (31 days after the cerebral infarction). A temporary inferior vena cava filter was placed, and both direct oral anticoagulant and antiplatelet drugs were substituted with unfractionated heparin infusion. She underwent surgery uneventfully under general anesthesia with desflurane and remifentanil. Postoperative analgesia was achieved with a peripheral nerve block and continuous intravenous infusion of fentanyl. The tumors were fully resected, thereby only anticoagulant therapy for residual venous thrombus was continued. She had a good perioperative course and was discharged without cerebral complications or thromboembolism. Conclusions In patients with Trousseau’s syndrome, both early radical surgery and preventing perioperative cerebrovascular complications are critical. In our present case, Trousseau’s syndrome was successfully operated under general anesthesia 1 month after a massive cerebral infarction.
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Affiliation(s)
- Yasuhiro Watanabe
- Department of Anesthesia, Japanese Red Cross Shizuoka Hospital, 8-2 Oute-machi Aoi-ku, Shizuoka, 420-0853, Japan.
| | - Kayoko Matsunuma
- Department of Anesthesia, Japanese Red Cross Shizuoka Hospital, 8-2 Oute-machi Aoi-ku, Shizuoka, 420-0853, Japan
| | - Toru Kaneda
- Department of Anesthesia, Japanese Red Cross Shizuoka Hospital, 8-2 Oute-machi Aoi-ku, Shizuoka, 420-0853, Japan
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21
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Synchronous Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma and Metastatic Squamous Cell Carcinoma of the Cervix Involving the Coronary Arteries Leading to Acute Myocardial Infarction. Case Rep Oncol Med 2020; 2020:6192754. [PMID: 32158573 PMCID: PMC7060405 DOI: 10.1155/2020/6192754] [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: 08/19/2019] [Accepted: 02/11/2020] [Indexed: 12/04/2022] Open
Abstract
A 66-year-old woman presented to the hospital with a one-month history of shortness of breath, fatigue, and postmenopausal vaginal bleeding and a one-week history of chest pain. This case report discusses the rare synchronous occurrence of two different malignancies in the setting of non-ST segment elevation myocardial infarction and the relation between these unfortunate events. Besides the case presented in this report, there have been only 13 reported cases of synchronous chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) associated with metastatic squamous cell carcinoma. While it is well known that malignancy causes a hypercoagulable state, there are other mechanisms which may have contributed to the patient's myocardial ischemia including external vascular compression, tumor lysis syndrome, and anemia. This case report discusses the rarity of synchronous malignancies but the importance of understanding and consideration of cardiac events in this population.
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22
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[TROUSSEAU'S SYNDROME ACCOMPANIED BY ADVANCED PROSTATE CANCER THAT DEVELOPED ISCHEMIC STROKE; A CASE REPORT]. Nihon Hinyokika Gakkai Zasshi 2020; 110:28-31. [PMID: 31956215 DOI: 10.5980/jpnjurol.110.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Trousseau's syndrome is known as a thromboembolic disorder due to hypercoagulation accompanied with advanced cancer. A 67-year-old man presented with disequilibrium and back pain, and magnetic resonance imaging of his brain indicated multiple cerebral infarctions at the acute stage. A computed tomography scan showed enlargement of multiple paraaortic lymph nodes. From these findings, we suspected that this patient had Trousseau's syndrome. The patient started anticoagulant treatment involving constant infusion with heparin Na. We also examined the origin of enlarged multiple paraaortic lymph nodes by investigating the tumor markers, which showed that the prostate specific antigen value (PSA) was extremely high. We conducted a prostatic biopsy and the pathological findings showed prostate cancer. The Combined Androgen Blockade (CAB) therapy was effective in reducing PSA value and shrinkage of the paraaortic lymph nodes. After the blood coagulation ability was improved to a normal state, we changed the anticoagulant treatment to subcutaneous injection of heparin Ca. There was no recurrence of cerebral infarction and no regrowth of prostate cancer 6 months after CAB therapy. Trousseau's syndrome is known as a poor prognosis syndrome because there is no effective therapy for the advanced stage of the accompanying cancer. However, CAB therapy is effective for advanced prostate cancer and long-term prognosis is expected. Starting anticoagulant treatment at the acute stage and maintaining anticoagulant treatment at the chronic stage are important in the treatment of Trousseau's syndrome accompanied with prostate cancer.
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Zaorsky NG, Zhang Y, Tchelebi LT, Mackley HB, Chinchilli VM, Zacharia BE. Stroke among cancer patients. Nat Commun 2019; 10:5172. [PMID: 31729378 PMCID: PMC6858303 DOI: 10.1038/s41467-019-13120-6] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 10/22/2019] [Indexed: 01/01/2023] Open
Abstract
We identify cancer patients at highest risk of fatal stroke. This is a population-based study using nationally representative data from the Surveillance, Epidemiology, and End Results program, 1992-2015. Among 7,529,481 cancer patients, 80,513 died of fatal stroke (with 262,461 person-years at risk); the rate of fatal stroke was 21.64 per 100,000-person years, and the standardized mortality ratio (SMR) of fatal stroke was 2.17 (95% CI, 2.15, 2.19). Patients with cancer of the prostate, breast, and colorectum contribute to the plurality of cancer patients dying of fatal stroke. Brain and gastrointestinal cancer patients had the highest SMRs (>2-5) through the follow up period. Among those diagnosed at <40 years of age, the plurality of strokes occurs in patients treated for brain tumors and lymphomas; if >40, from cancers of the prostate, breast, and colorectum. For almost all cancers survivors, the risk of stroke increases with time.
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Affiliation(s)
- Nicholas G Zaorsky
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA.
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
| | - Ying Zhang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Leila T Tchelebi
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA
| | - Heath B Mackley
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Brad E Zacharia
- Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
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Corley AM, Sullivan MJ, Friedman SE, O'Rourke DJ, Palac RT, Gemignani AS. Relation of Venous Thromboembolism Risk to Ischemic Stroke Risk in Hospitalized Patients with Cancer. Am J Cardiol 2019; 123:679-683. [PMID: 30528279 DOI: 10.1016/j.amjcard.2018.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/31/2018] [Accepted: 11/05/2018] [Indexed: 12/21/2022]
Abstract
Patients with cancer are at increased risk for venous thromboembolism (VTE). However, the relationship of cancer type to the risk of arterial thrombosis in patients with high VTE risk has not been described. The goal of this study is to determine the rate of arterial thrombosis in patients with different types of solid tumors stratified by VTE risk. Using the 2012 National Inpatient Sample, we identified 373,789 hospitalizations involving patients ≥18 years associated with solid tumors, stratified by type. Data were collected on clinical characteristics, VTE (deep vein thrombosis [DVT] and pulmonary embolism [PE]), and arterial thrombosis (primary diagnosis of myocardial infarction [MI] and ischemic stroke). Subjects with solid tumors (stages I to IV) were stratified by VTE risk - high versus low. Certain solid tumor types (esophageal, lung, melanoma, ovarian, pancreatic, stomach, and uterine) were found to be associated with a higher rate of VTE compared with other cancer types (6.8% vs 3.9%, p < 0.001). Multivariate analysis applied to the high VTE risk group showed no increased risk for MI (odds ratio [OR] 0.93, p = 0.74), however, the rate of ischemic stroke was increased (OR 1.22, p < 0.001). Those in the high VTE risk group who had metastatic disease were at higher risk for arterial thrombosis (MI OR 1.35, p < 0.001, ischemic stroke OR 2.43, p < 0.001). In conclusion, different cancer types are associated with increased risk of both venous and arterial thrombosis and the risk is further increased by the presence of metastatic disease.
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Affiliation(s)
- Alyssa M Corley
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Malachy J Sullivan
- Department of Internal Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Scott E Friedman
- Division of Cardiovascular Medicine, White River Junction VA Medical Center, White River Junction, Vermont; Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Daniel J O'Rourke
- Division of Cardiovascular Medicine, White River Junction VA Medical Center, White River Junction, Vermont; Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Robert T Palac
- Division of Cardiovascular Medicine, White River Junction VA Medical Center, White River Junction, Vermont
| | - Anthony S Gemignani
- Division of Cardiovascular Medicine, White River Junction VA Medical Center, White River Junction, Vermont; Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
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Wang JY, Zhang GJ, Zhuo SX, Wang K, Hu XP, Zhang H, Qu LD. D-dimer >2.785 μg/ml and multiple infarcts ≥3 vascular territories are two characteristics of identifying cancer-associated ischemic stroke patients. Neurol Res 2018; 40:948-954. [PMID: 30317943 DOI: 10.1080/01616412.2018.1504179] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The patterns and mechanisms underlying stroke in cancer patients differ from those of the conventional etiology. In this study, we further investigated the characteristics distinguishing cancer-associated ischemic stroke (CAIS) and the relationship of D-dimer value with CAIS. METHODS Sixty-one acute ischemic stroke patients with cancer (cancer group) and 76 stroke patients without cancer (control group) were recruited. Cerebrovascular distribution was divided into 3 circulations and 23 vascular territories, and acute multiple brain infarcts (AMBIs) were defined as discrete MRI diffusion-weighted imaging (DWI) lesions in >1 vascular territory. RESULTS Cancer patients had higher average D-dimer and fibrinogen degradation product values, and fewer stroke risk factors. The numbers of infarct-affected vascular territories, AMBIs, and AMBIs in multiple circulations were significantly higher in the cancer group. Receiver operating characteristic analysis showed that the cutoff value of D-dimer was 2.785 μg/ml; and above features were particularly evident in cancer patients whose D-dimer values were >2.785 μg/ml, while those with D-dimer values ≤2.785 μg/ml were similar to controls. CONCLUSIONS D-dimer >2.785 μg/ml may be an effective cutoff value and a sensitive index for identifying CAIS patients. AMBIs in ≥3 vascular territories and AMBIs in both the anterior and posterior circulations are two imaging characteristics of CAIS.
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Affiliation(s)
- Jing-Ye Wang
- a Department of Neurology , First Affiliated Hospital of Anhui Medical University , Hefei , China
| | - Gao-Jia Zhang
- a Department of Neurology , First Affiliated Hospital of Anhui Medical University , Hefei , China.,b Department of Neurology , Nanjing Lishui People,s Hospital , Nanjing , China
| | - Sheng-Xia Zhuo
- c Department of Oncology , First Affiliated Hospital of Anhui Medical University , Hefei , China
| | - Kai Wang
- a Department of Neurology , First Affiliated Hospital of Anhui Medical University , Hefei , China
| | - Xiao-Peng Hu
- d Department of Radiology , First Affiliated Hospital of Anhui Medical University , Hefei , China
| | - Hui Zhang
- d Department of Radiology , First Affiliated Hospital of Anhui Medical University , Hefei , China
| | - Lin-di Qu
- a Department of Neurology , First Affiliated Hospital of Anhui Medical University , Hefei , China
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Cacho-Díaz B, Spínola-Maroño H, Mendoza-Olivas LG. Clinical presentation, risk factors and outcome of central nervous system metastasis vs stroke in cancer patients. Curr Probl Cancer 2018; 43:324-330. [PMID: 30482399 DOI: 10.1016/j.currproblcancer.2018.09.001] [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] [Received: 09/05/2018] [Accepted: 09/24/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND PURPOSE Cancer and stroke are the second and third causes of death worldwide; brain metastases (BM) occur in one third of patients with cancer, any neurologic deficit in these population always prompts the clinician to discard metastases for their presence carries a bad outcome. Both might share clinical presentation and differences in their outcome are not entirely known. The aim was to compare risk factors, clinical presentation, and outcome of cancer patients with BM vs stroke. METHODS A descriptive study with prospectively acquired data from a cancer referral center included patients seen at the neuro-oncologic unit from March 2011 to February 2018 with confirmed cancer who had BM or stroke. RESULTS Six hundred and thirteen BM patients were compared with 268 with stroke and cancer. Demographic factors, cancer type, risk factors, clinical presentation, and outcome are presented. Median overall survival in months for those with any stroke was 15 (95%confidence interval [CI] 8.6-21.4)-5 (95%CI 0.12.4) for hemorrhagic stroke and 22 (95%CI 13.4-30.6) in the ischemic group-and for those with BM 12 (95%CI 10.4-13.6). Hemorrhagic stroke commonly found in stroke patients as well as focal motor weakness, aphasia, and altered mental status. BM was more common in breast and lung cancer with headache, visual complaint, and/or vertigo. CONCLUSION Survival in cancer patients with BM is not that different than those with stroke, but clinical presentation and risk factors were found different.
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Affiliation(s)
- Bernardo Cacho-Díaz
- Neuro-oncology Unit, Research Unit, Instituto Nacional de Cancerología, Mexico City, Mexico.
| | - Héctor Spínola-Maroño
- Neuro-oncology Unit, Research Unit, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Laura G Mendoza-Olivas
- Neuro-oncology Unit, Research Unit, Instituto Nacional de Cancerología, Mexico City, Mexico
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Cacho-Díaz B, Lorenzana-Mendoza NA, Spínola-Maroño H, Reyes-Soto G, Cantú-Brito C. Comorbidities, Clinical Features, and Prognostic Implications of Cancer Patients with Cerebrovascular Disease. J Stroke Cerebrovasc Dis 2018; 27:365-371. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/01/2017] [Accepted: 09/07/2017] [Indexed: 12/12/2022] Open
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Kaneyuki D, Matsuura K, Ueda H, Kohno H, Kanbe M, Matsumiya G. Surgical management of nonbacterial thrombotic endocarditis in malignancy. Surg Case Rep 2017; 3:60. [PMID: 28477331 PMCID: PMC5419953 DOI: 10.1186/s40792-017-0335-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 04/27/2017] [Indexed: 11/26/2022] Open
Abstract
Background Nonbacterial thrombotic endocarditis is commonly seen on heart valves in patients with malignant or collagen diseases. The natural prognosis of nonbacterial thrombotic endocarditis is reported to be poor due to underlying malignancy. Surgical indications and appropriate timing for surgery for nonbacterial thrombotic endocarditis and underlying malignancy have not been formally studied. Case presentation The case was a 45-year-old woman who presented with a history of systemic embolization associated with occult malignancy. A preoperative transesophageal echocardiogram showed multiple mobile vegetations on the aortic and mitral valves. She underwent valve surgery to prevent recurrent embolization. Based on the histopathologic findings, she was diagnosed with nonbacterial thrombotic endocarditis. She subsequently underwent surgery for occult malignancy, which was diagnosed as endometrioid adenocarcinoma. Conclusions Although surgical indications for nonbacterial thrombotic endocarditis remain unclear, valve replacement or repair and multidisciplinary treatment including surgical intervention are essential to prevent recurrent embolization in patients with nonbacterial thrombotic endocarditis associated with malignancy.
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Affiliation(s)
- Daisuke Kaneyuki
- Department of Cardiovascular Surgery, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 2608677, Japan.
| | - Kaoru Matsuura
- Department of Cardiovascular Surgery, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 2608677, Japan
| | - Hideki Ueda
- Department of Cardiovascular Surgery, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 2608677, Japan
| | - Hiroki Kohno
- Department of Cardiovascular Surgery, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 2608677, Japan
| | - Michiyo Kanbe
- Department of Diagnostic Pathology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Goro Matsumiya
- Department of Cardiovascular Surgery, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 2608677, Japan
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Herrmann J, Yang EH, Iliescu CA, Cilingiroglu M, Charitakis K, Hakeem A, Toutouzas K, Leesar MA, Grines CL, Marmagkiolis K. Vascular Toxicities of Cancer Therapies: The Old and the New--An Evolving Avenue. Circulation 2016; 133:1272-89. [PMID: 27022039 DOI: 10.1161/circulationaha.115.018347] [Citation(s) in RCA: 200] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Since the late 1990s, there has been a steady decline in cancer-related mortality, in part related to the introduction of so-called targeted therapies. Intended to interfere with a specific molecular pathway, these therapies have, paradoxically, led to a number of effects off their intended cancer tissue or molecular targets. The latest examples are tyrosine kinase inhibitors targeting the Philadelphia Chromosome mutation product, which have been associated with progressive atherosclerosis and acute vascular events. In addition, agents designed to interfere with the vascular growth factor signaling pathway have vascular side effects ranging from hypertension to arterial events and cardiomyocyte toxicity. Interestingly, the risk of cardiotoxicity with drugs such as trastuzumab is predicted by preexisting cardiovascular risk factors and disease, posing the question of a vascular component to the pathophysiology. The effect on the coronary circulation has been the leading explanation for the cardiotoxicity of 5-fluorouracil and may be the underlying the mechanism of presentation of apical ballooning syndrome with various chemotherapeutic agents. Classical chemotherapeutic agents such as cisplatin, often used in combination with bleomycin and vinca alkaloids, can lead to vascular events including acute coronary thrombosis and may be associated with an increased long-term cardiovascular risk. This review is intended to provide an update on the evolving spectrum of vascular toxicities with cancer therapeutics, particularly as they pertain to clinical practice, and to the conceptualization of cardiovascular diseases, as well. Vascular toxicity with cancer therapy: the old and the new, an evolving avenue.
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Affiliation(s)
- Joerg Herrmann
- From Mayo Clinic, Division of Cardiovascular Diseases, Rochester, MN (J.H.); University of California at Los Angeles, Division of Cardiology, Los Angeles (E.-H.Y.); University of Texas, MD Anderson Cancer Center, Houston (C.A.I.); Arkansas Heart Hospital, Little Rock, AR and Koc University School of Medicine, Istanbul, Turkey (M.C.); University of Texas Health Science Center, Houston (K.C.); University of Arkansas for Medical Sciences, Little Rock (A.H.); Athens Medical School, Hippokration General Hospital, Greece (K.T.); University of Alabama at Birmingham (M.A.L.); Detroit Medical Center, Cardiovascular Institute, MI (C.L.G.); and Citizens Memorial Hospital, Bolivar, MO and University of Missouri, Columbia (K.M.).
| | - Eric H Yang
- From Mayo Clinic, Division of Cardiovascular Diseases, Rochester, MN (J.H.); University of California at Los Angeles, Division of Cardiology, Los Angeles (E.-H.Y.); University of Texas, MD Anderson Cancer Center, Houston (C.A.I.); Arkansas Heart Hospital, Little Rock, AR and Koc University School of Medicine, Istanbul, Turkey (M.C.); University of Texas Health Science Center, Houston (K.C.); University of Arkansas for Medical Sciences, Little Rock (A.H.); Athens Medical School, Hippokration General Hospital, Greece (K.T.); University of Alabama at Birmingham (M.A.L.); Detroit Medical Center, Cardiovascular Institute, MI (C.L.G.); and Citizens Memorial Hospital, Bolivar, MO and University of Missouri, Columbia (K.M.)
| | - Cezar A Iliescu
- From Mayo Clinic, Division of Cardiovascular Diseases, Rochester, MN (J.H.); University of California at Los Angeles, Division of Cardiology, Los Angeles (E.-H.Y.); University of Texas, MD Anderson Cancer Center, Houston (C.A.I.); Arkansas Heart Hospital, Little Rock, AR and Koc University School of Medicine, Istanbul, Turkey (M.C.); University of Texas Health Science Center, Houston (K.C.); University of Arkansas for Medical Sciences, Little Rock (A.H.); Athens Medical School, Hippokration General Hospital, Greece (K.T.); University of Alabama at Birmingham (M.A.L.); Detroit Medical Center, Cardiovascular Institute, MI (C.L.G.); and Citizens Memorial Hospital, Bolivar, MO and University of Missouri, Columbia (K.M.)
| | - Mehmet Cilingiroglu
- From Mayo Clinic, Division of Cardiovascular Diseases, Rochester, MN (J.H.); University of California at Los Angeles, Division of Cardiology, Los Angeles (E.-H.Y.); University of Texas, MD Anderson Cancer Center, Houston (C.A.I.); Arkansas Heart Hospital, Little Rock, AR and Koc University School of Medicine, Istanbul, Turkey (M.C.); University of Texas Health Science Center, Houston (K.C.); University of Arkansas for Medical Sciences, Little Rock (A.H.); Athens Medical School, Hippokration General Hospital, Greece (K.T.); University of Alabama at Birmingham (M.A.L.); Detroit Medical Center, Cardiovascular Institute, MI (C.L.G.); and Citizens Memorial Hospital, Bolivar, MO and University of Missouri, Columbia (K.M.)
| | - Konstantinos Charitakis
- From Mayo Clinic, Division of Cardiovascular Diseases, Rochester, MN (J.H.); University of California at Los Angeles, Division of Cardiology, Los Angeles (E.-H.Y.); University of Texas, MD Anderson Cancer Center, Houston (C.A.I.); Arkansas Heart Hospital, Little Rock, AR and Koc University School of Medicine, Istanbul, Turkey (M.C.); University of Texas Health Science Center, Houston (K.C.); University of Arkansas for Medical Sciences, Little Rock (A.H.); Athens Medical School, Hippokration General Hospital, Greece (K.T.); University of Alabama at Birmingham (M.A.L.); Detroit Medical Center, Cardiovascular Institute, MI (C.L.G.); and Citizens Memorial Hospital, Bolivar, MO and University of Missouri, Columbia (K.M.)
| | - Abdul Hakeem
- From Mayo Clinic, Division of Cardiovascular Diseases, Rochester, MN (J.H.); University of California at Los Angeles, Division of Cardiology, Los Angeles (E.-H.Y.); University of Texas, MD Anderson Cancer Center, Houston (C.A.I.); Arkansas Heart Hospital, Little Rock, AR and Koc University School of Medicine, Istanbul, Turkey (M.C.); University of Texas Health Science Center, Houston (K.C.); University of Arkansas for Medical Sciences, Little Rock (A.H.); Athens Medical School, Hippokration General Hospital, Greece (K.T.); University of Alabama at Birmingham (M.A.L.); Detroit Medical Center, Cardiovascular Institute, MI (C.L.G.); and Citizens Memorial Hospital, Bolivar, MO and University of Missouri, Columbia (K.M.)
| | - Konstantinos Toutouzas
- From Mayo Clinic, Division of Cardiovascular Diseases, Rochester, MN (J.H.); University of California at Los Angeles, Division of Cardiology, Los Angeles (E.-H.Y.); University of Texas, MD Anderson Cancer Center, Houston (C.A.I.); Arkansas Heart Hospital, Little Rock, AR and Koc University School of Medicine, Istanbul, Turkey (M.C.); University of Texas Health Science Center, Houston (K.C.); University of Arkansas for Medical Sciences, Little Rock (A.H.); Athens Medical School, Hippokration General Hospital, Greece (K.T.); University of Alabama at Birmingham (M.A.L.); Detroit Medical Center, Cardiovascular Institute, MI (C.L.G.); and Citizens Memorial Hospital, Bolivar, MO and University of Missouri, Columbia (K.M.)
| | - Massoud A Leesar
- From Mayo Clinic, Division of Cardiovascular Diseases, Rochester, MN (J.H.); University of California at Los Angeles, Division of Cardiology, Los Angeles (E.-H.Y.); University of Texas, MD Anderson Cancer Center, Houston (C.A.I.); Arkansas Heart Hospital, Little Rock, AR and Koc University School of Medicine, Istanbul, Turkey (M.C.); University of Texas Health Science Center, Houston (K.C.); University of Arkansas for Medical Sciences, Little Rock (A.H.); Athens Medical School, Hippokration General Hospital, Greece (K.T.); University of Alabama at Birmingham (M.A.L.); Detroit Medical Center, Cardiovascular Institute, MI (C.L.G.); and Citizens Memorial Hospital, Bolivar, MO and University of Missouri, Columbia (K.M.)
| | - Cindy L Grines
- From Mayo Clinic, Division of Cardiovascular Diseases, Rochester, MN (J.H.); University of California at Los Angeles, Division of Cardiology, Los Angeles (E.-H.Y.); University of Texas, MD Anderson Cancer Center, Houston (C.A.I.); Arkansas Heart Hospital, Little Rock, AR and Koc University School of Medicine, Istanbul, Turkey (M.C.); University of Texas Health Science Center, Houston (K.C.); University of Arkansas for Medical Sciences, Little Rock (A.H.); Athens Medical School, Hippokration General Hospital, Greece (K.T.); University of Alabama at Birmingham (M.A.L.); Detroit Medical Center, Cardiovascular Institute, MI (C.L.G.); and Citizens Memorial Hospital, Bolivar, MO and University of Missouri, Columbia (K.M.)
| | - Konstantinos Marmagkiolis
- From Mayo Clinic, Division of Cardiovascular Diseases, Rochester, MN (J.H.); University of California at Los Angeles, Division of Cardiology, Los Angeles (E.-H.Y.); University of Texas, MD Anderson Cancer Center, Houston (C.A.I.); Arkansas Heart Hospital, Little Rock, AR and Koc University School of Medicine, Istanbul, Turkey (M.C.); University of Texas Health Science Center, Houston (K.C.); University of Arkansas for Medical Sciences, Little Rock (A.H.); Athens Medical School, Hippokration General Hospital, Greece (K.T.); University of Alabama at Birmingham (M.A.L.); Detroit Medical Center, Cardiovascular Institute, MI (C.L.G.); and Citizens Memorial Hospital, Bolivar, MO and University of Missouri, Columbia (K.M.)
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Chang CF, Kuo YL, Pu C, Chou YJ. Neck dissection and stroke in patients with oral cavity cancer: A population-based cohort study. Head Neck 2016; 39:63-70. [DOI: 10.1002/hed.24535] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2016] [Indexed: 11/10/2022] Open
Affiliation(s)
- Chia-Fan Chang
- Department of Otolaryngology, Head and Neck Surgery; Taipei Veterans General Hospital; Taipei Taiwan
- Faculty of Medicine, School of Medicine; National Yang-Ming University; Taipei Taiwan
- Institute of Hospital and Health Care Management, School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Yen-Ling Kuo
- Department of Otolaryngology; National Yang-Ming University Hospital; Yilan County Taiwan
- Faculty of Medicine, School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Christy Pu
- Institute of Public Health, School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Yiing-Jenq Chou
- Institute of Public Health, School of Medicine; National Yang-Ming University; Taipei Taiwan
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31
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Ryu JA, Bang OY, Suh GY, Yang JH, Lee D, Park J, Cho J, Chung CR, Park CM, Jeon K. Ischemic Stroke in Critically Ill Patients with Malignancy. PLoS One 2016; 11:e0146836. [PMID: 26751213 PMCID: PMC4709055 DOI: 10.1371/journal.pone.0146836] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 12/21/2015] [Indexed: 11/18/2022] Open
Abstract
Background Cerebrovascular diseases are a frequent cause of neurological symptoms in patients with cancer. The clinical characteristics of ischemic stroke (IS) in patients with cancer have been reported in several studies; however, limited data are available regarding critically ill patients with cancer who develop IS during their stay in the intensive care unit (ICU). Methods All consecutive patients who underwent brain magnetic resonance imaging (MRI) for suspicion of IS with acute abnormal neurologic symptoms or who developed signs of IS while in the ICU were retrospectively evaluated. We compared the clinical characteristics and diffusion-weighted imaging (DWI) lesion patterns between patients finally diagnosed as having or not having IS. Results Over the study period, a total of 88 patients underwent brain MRI for suspicion of IS, with altered mental status in 55 (63%), hemiparesis in 28 (32%), and seizure in 20 (23%). A total of 43 (49%) patients were ultimately diagnosed with IS. Multiple DWI lesions (41%) were more common than single lesions (8%). The etiologies of IS were not determined in the majority of patients (n = 27, 63%). In the remaining 16 (37%) patients, the most common aetiology of IS was cardioembolism (n = 8), followed by large-vessel atherosclerosis (n = 3) and small-vessel occlusion (n = 2). However, brain metastases were newly diagnosed in only 7 (8%) patients. Univariate comparison of the baseline characteristics between patients with or without IS did not reveal any significant differences in sex, malignancy type, recent chemotherapy, vascular risk factors, or serum D-dimer levels at the time of suspicion of IS. Thrombotic events were more common in the IS group than in the non-IS group (P = 0.028). However, patients who were ultimately diagnosed with IS had more hemiparesis symptoms at the time of suspicion of IS (P = 0.001). This association was significant even after adjusting for potentially confounding factors (adjusted odds ratio 5.339; 95% confidence interval, 1.521–19.163). Conclusions IS developed during ICU stays in critically ill patients with cancer have particular features that may be associated with cancer-related mechanism.
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Affiliation(s)
- Jeong-Am Ryu
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Daesang Lee
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jinkyeong Park
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joongbum Cho
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chi-Min Park
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyeongman Jeon
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
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Synchronous Ovarian and Endometrial Endometrioid Adenocarcinoma Presenting with Nonbacterial Thrombotic Endocarditis and Pulmonary Thromboembolism: Adenocarcinoma with Thrombotic Events. Case Rep Obstet Gynecol 2015; 2015:825404. [PMID: 26576308 PMCID: PMC4631876 DOI: 10.1155/2015/825404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 09/30/2015] [Indexed: 11/24/2022] Open
Abstract
Introduction. Nonbacterial thrombotic endocarditis (NBTE) is a rare manifestation of hypercoagulability in patients with malignant neoplasms. Case Report. A fifty-six-year-old woman presented to the emergency service; the clinical workup revealed deep vein thrombosis in right leg and bilateral massive PTE. As the abdominal sections on the spiral CT revealed a giant pelvic mass of ovarian origin, she was referred to our hospital's gynecologic oncology department. She was scheduled for surgery under enoxaparin. She described numbness on one side of her face. Cranial imaging findings revealed acute ischemic cerebral lesions and transesophageal echocardiogram showed vegetation on the aortic cusp. Under anticoagulation treatment, she underwent hysterectomy with bilateral salpingo-oophorectomy and infracolic omentectomy. After tumor resection, her neurological symptoms dissolved with aggressive anticoagulant treatment. Pathology result was synchronous endometrial and ovarian adenocarcinoma. Discussion. NBTE is a rare condition often associated with advanced malignancies. Peripheral embolism and venous thrombosis are complications that have been associated with NBTE due to hypercoagulable state. These disorders could be resistant to routine anticoagulant treatment. In case of a thrombotic complication due to ovarian malignancy, surgical resection of the primary tumor may increase the effect of anticoagulant treatment.
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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
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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
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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.
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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
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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.
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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
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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
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Sheng B, Fong MK, Chu YP, Cheong APYY, Teng SKY, Chu JPS, Yip WM, Chow DHF. Stroke and cancer: misfortunes never come singularly. Int J Stroke 2014; 8:E30. [PMID: 23879755 DOI: 10.1111/ijs.12071] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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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.
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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)
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Erichsen R, Sværke C, Sørensen HT, Sandler RS, Baron JA. Risk of colorectal cancer in patients with acute myocardial infarction and stroke: a nationwide cohort study. Cancer Epidemiol Biomarkers Prev 2013; 22:1994-9. [PMID: 24049127 DOI: 10.1158/1055-9965.epi-13-0444] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND An association between colorectal cancer and acute myocardial infarction (AMI) and stroke has been suggested, but evidence is conflicting. METHOD We conducted a population-based cohort study (1978-2010) of the association between AMI/stroke and colorectal cancer by linking nationwide Danish registries. We calculated standardized incidence ratios (SIR) of colorectal cancer after AMI/stroke as the ratios of observed to expected incidence. RESULTS A total of 297,523 patients with AMI (median age, 69.4 years; 64% men) were followed for a median of 3.1 years (range, 0-33 years) and 4,387 developed colorectal cancer [SIR, 1.08; 95% confidence interval (CI), 1.05-1.11; P < 0.001]. In the first year of follow-up, the SIR was 1.85 (95% CI, 1.73-1.98; P < 0.001), whereas it was 0.98 (95% CI, 0.95-1.02; P = 0.318) in the second and subsequent years. We followed 246,998 patients with stroke (median age, 72.4 years; 52% men) for a median of 2.9 years (range, 0-33 years) and 3,035 developed colorectal cancer (SIR, 1.04; 95% CI, 1.00-1.07; P = 0.053). In the first year of follow-up, the SIR was 1.42 (95% CI, 1.31-1.53; P < 0.001), whereas it was 0.96 (95% CI, 0.93-1.00; P = 0.072) thereafter. We found no difference between the SIRs for ischemic and hemorrhagic stroke. The increased one-year relative risks for AMI and stroke corresponded to a 0.3% absolute risk. CONCLUSIONS Our findings reflect detection of occult cancer at the time of the vascular event. The lack of increased risk after one year suggests that an association based on shared risk factors or chronic inflammation is unlikely. IMPACT In patients with AMI/stroke, the diagnostic workup including screening for colorectal cancer should follow that of the general population.
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Affiliation(s)
- Rune Erichsen
- Authors' Affiliations: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; and Department of Medicine, Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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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.
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Affiliation(s)
- Eun-Jae Lee
- Stroke Center and Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea
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Liu X, Almast J, Ekholm S. Lesions masquerading as acute stroke. J Magn Reson Imaging 2013; 37:15-34. [PMID: 23255413 DOI: 10.1002/jmri.23647] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 02/21/2012] [Indexed: 11/11/2022] Open
Abstract
Rapid and accurate recognition of lesions masquerading as acute stroke is important. Any incorrect or delayed diagnosis of stroke mimics will not only increase the risk of being exposed to unnecessary and possibly dangerous interventional therapies, but will also delay proper treatment. In this article, written from a neuroradiologist's perspective, we classified these lesions masquerading as acute stroke into three groups: lesions that may have "normal imaging," lesions that are "symptom mimics" but on imaging clearly not a stroke, and lesions that are "symptom and imaging mimics" with imaging findings similar to stroke. We focused the review on neuroimaging findings of the latter two groups ending with a suggestion for a diagnostic approach in the form of an algorithm.
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Affiliation(s)
- Xiang Liu
- Division of Diagnostic & Interventional Neuroradiology, Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York 14642-8638, USA
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Devulapalli S, Pinto N, Gandothra C, Jayam-Trouth A, Kurukumbi M. A rare case of occipital stroke as a consequence of nonbacterial thrombotic endocarditis in ovarian clear cell carcinoma: a case report. Case Rep Neurol 2012; 4:84-91. [PMID: 22649346 PMCID: PMC3362228 DOI: 10.1159/000338811] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Hypercoagulability occurs in 15% of patients with malignancy and represents a clinical spectrum ranging from abnormal coagulation tests but no clinically evident thromboembolic disease, to arterial and venous thrombosis, migratory thrombophlebitis, nonbacterial thrombotic endocarditis (NBTE) and disseminated intravascular coagulation. The combination of increased procoagulant activity and decreased fibrinolytic activity accelerates the prothrombotic potential of endothelial cells in malignancy. NBTE is a rare manifestation of cancer-induced hypercoagulability and is commonly seen with mucin-producing adenocarcinomas, but rarely seen with ovarian clear cell carcinoma (OCCC). Cerebrovascular embolization ranges from 14–91% in NBTE. We report a rare case of a 62-year-old female presenting with occipital stroke as a consequence of NBTE in OCCC. Association of NBTE in OCCC has only been reported in 2 cases so far, but presentation with stroke has never been reported in the literature.
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Affiliation(s)
- S Devulapalli
- Department of Neurology, Howard University Hospital, Washington, D.C., USA
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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.
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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]
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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]
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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.
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Affiliation(s)
- Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Damek DM. Cerebral edema, altered mental status, seizures, acute stroke, leptomeningeal metastases, and paraneoplastic syndrome. Hematol Oncol Clin North Am 2010; 24:515-35. [PMID: 20488351 DOI: 10.1016/j.hoc.2010.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Neurologic symptoms commonly occur in oncology patients, and in some cases they may be the presenting symptom of malignancy. Cancer-related neurologic syndromes are rarely pathognomonic and must be differentiated from other benign or serious conditions. This article reviews common neuro-oncologic syndromes that may lead to urgent evaluation in the emergency department, including cerebral edema, altered mental status, seizures, acute stroke, leptomeningeal metastases, and paraneoplastic neurologic syndromes.
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Affiliation(s)
- Denise M Damek
- Neuro-Oncology, University of Colorado Denver School of Medicine, 12631 East 17th Avenue, MS# B-185, Aurora, CO 80045, USA.
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Cerebral Edema, Altered Mental Status, Seizures, Acute Stroke, Leptomeningeal Metastases, and Paraneoplastic Syndrome. Emerg Med Clin North Am 2009; 27:209-29. [DOI: 10.1016/j.emc.2009.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Stefan O, Vera N, Otto B, Heinz L, Wolfgang G. Stroke in cancer patients: a risk factor analysis. J Neurooncol 2009; 94:221-6. [PMID: 19280119 DOI: 10.1007/s11060-009-9818-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2008] [Accepted: 02/20/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND PURPOSE In patients already suffering from cancer, the additional occurrence of stroke can aggravate the burden of the disease. The purpose of this study was to compare risk factors for haemorrhagic and ischemic strokes in cancer and non-cancer patients. METHODS A retrospective analysis, including 1,274 stroke patients admitted to a stroke unit, was conducted from 2004 to 2007. Classical risk factors for stroke and clinical outcome measures were compared between cancer and non-cancer patients. RESULTS Twelve percent of stroke patients had an additional diagnosis of cancer. In the non-cancer population, 84% had ischemic and 16% had haemorrhagic strokes. In cancer patients, 86% had ischemic and 14% had haemorrhagic strokes. Vascular risk factors in cancer patients, including hypertension, atrial fibrillation, coronary vessel disease, smoking, hypercholesterolemia and diabetes mellitus, showed no difference compared to the non-cancer population. Only thrombotic events occurred more often in the cancer cohort. The most frequent cancer types were urogenital, breast and gastrointestinal. Regarding clinical outcome, cancer patients had an inferior neurological condition at discharge and a trend towards a longer stay in the stroke unit. CONCLUSIONS The frequency of ischemic and haemorrhagic stroke in tumour patients is similar to that in the non-cancer population. Cerebrovascular risk factors do not significantly vary between cancer and non-cancer patients. The higher frequency of thrombotic events in cancer patients may reflect a coagulation disorder, commonly found in patients with malignancy. Clinical outcome in cancer patients may be worsened by the pre-existent co-morbidity.
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Affiliation(s)
- Oberndorfer Stefan
- Department Neurology and LBI-Neurooncology, KFJ-Hospital, Kundratstrasse 3, 1100, Vienna, Austria.
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