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Stroke in Critically Ill Cancer Patients

  • Ritvij Bowry
  • James C. Grotta
Living reference work entry

Abstract

Stroke and cancer have significant morbidity and mortality with heterogeneous risk factors. While conventional risk factors such as atherosclerosis and cardiac disease are important mechanisms in the occurrence of stroke, cancer is an unconventional risk factor that leads to both ischemic and hemorrhagic stroke in a myriad of ways. Although cancer-associated strokes have unique underlying mechanisms, the clinical features, diagnosis, and management scheme are similar for non-cancer-associated strokes. Prognosis is complex and is dependent on the stage and type of cancer, expected treatment course, and stroke burden.

Keywords

Cancer Stroke Tissue plasminogen activator Ischemic stroke Intracerebral hemorrhage Hypercoagulability Arterial embolism Venous thromboembolism 

References

  1. 1.
    Albers GW, Marks MP, Kemp S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med. 2018;378:708–18.  https://doi.org/10.1056/nejmoa1713973.CrossRefPubMedGoogle Scholar
  2. 2.
    Amer M. Cancer-associated thrombosis: clinical presentation and survival. Cancer Manag Res. 2013; 5: 165.  https://doi.org/10.2147/cmar.s47094.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Atterman A, Gigante B, Asplund K, et al. Cancer diagnosis as a risk factor of ischemic stroke in atrial fibrillation patients with low stroke risk score. Thromb Res. 2018;164:S209.  https://doi.org/10.1016/j.thromres.2018.02.064.CrossRefGoogle Scholar
  4. 4.
    Ay C, Dunkler D, Pirker R, et al. High D-dimer levels are associated with poor prognosis in cancer patients. Haematologica. 2012;97:1158–64.  https://doi.org/10.3324/haematol.2011.054718.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Bang OY, Seok JM, Kim SG, et al. Ischemic stroke and cancer: stroke severely impacts cancer patients, while cancer increases the number of strokes. J Clin Neurol. 2011;7:53.  https://doi.org/10.3988/jcn.2011.7.2.53.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Bartynski W. Posterior reversible encephalopathy syndrome, part 2: controversies surrounding pathophysiology of vasogenic edema. Am J Neuroradiol. 2008;29:1043–9.  https://doi.org/10.3174/ajnr.a0929.CrossRefPubMedGoogle Scholar
  7. 7.
    Bick RL. Cancer-associated thrombosis. N Engl J Med. 2003;349:109–11.  https://doi.org/10.1056/nejmp030086.CrossRefPubMedGoogle Scholar
  8. 8.
    Blom JW. Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA. 2005;293:715.  https://doi.org/10.1001/jama.293.6.715.CrossRefPubMedGoogle Scholar
  9. 9.
    Bradley WG. MR appearance of hemorrhage in the brain. Radiology. 1993;189:15–26.  https://doi.org/10.1148/radiology.189.1.8372185.CrossRefPubMedGoogle Scholar
  10. 10.
    Cheng SW, Wu LL, Ting AC, et al. Irradiation-induced extracranial carotid stenosis in patients with head and neck malignancies. Am J Surg. 1999;178:323–8.  https://doi.org/10.1016/s0002-9610(99)00184-1.CrossRefPubMedGoogle Scholar
  11. 11.
    Cocho D, Gendre J, Boltes A, et al. Predictors of occult cancer in acute ischemic stroke patients. J Stroke Cerebrovasc Dis. 2015;24:1324–8.  https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.02.006.CrossRefPubMedGoogle Scholar
  12. 12.
    Demaerschalk BM, Kleindorfer DO, Adeoye OM, et al. Scientific rationale for the inclusion and exclusion criteria for intravenous alteplase in acute ischemic stroke. Stroke. 2015;47:581–641.  https://doi.org/10.1161/str.0000000000000086.CrossRefPubMedGoogle Scholar
  13. 13.
    Donati MB, Falanga A. Pathogenetic mechanisms of thrombosis in malignancy. Acta Haematol. 2001; 106: 18–24.  https://doi.org/10.1159/000046585.CrossRefPubMedGoogle Scholar
  14. 14.
    Gemmete JJ, Pandey AS, Chaudhary N, et al. Paradoxical embolus to the brain from embolization of a carotid body tumor. J Neurointerv Surg. 2011;4:e12.CrossRefGoogle Scholar
  15. 15.
    Gonzalez-Quintela A, Candela M, Vidal C, et al. Non-bacterial thrombotic endocarditis in cancer patients. Acta Cardiol. 1991;46:1–9.PubMedGoogle Scholar
  16. 16.
    Graus F, Rogers LR, Posner JB. Cerebrovascular complications in patients with cancer. Medicine. 1985; 64:16–35.  https://doi.org/10.1097/00005792-198501000-00002.CrossRefPubMedGoogle Scholar
  17. 17.
    Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359:1317–29.  https://doi.org/10.1056/nejmoa0804656.CrossRefPubMedGoogle Scholar
  18. 18.
    Haynes JC, Machtay M, Weber RS, et al. Relative risk of stroke in head and neck carcinoma patients treated with external cervical irradiation. Laryngoscope. 2002;112:1883–7.  https://doi.org/10.1097/00005537-200210000-00034.CrossRefPubMedGoogle Scholar
  19. 19.
    Hemphill JC, Greenberg SM, Anderson CS, et al. Guidelines for the management of spontaneous intracerebral hemorrhage. Stroke. 2015;46:2032–60.  https://doi.org/10.1161/str.0000000000000069.CrossRefPubMedGoogle Scholar
  20. 20.
    Jang H, Lee JJ, Lee MJ, et al. Comparison of enoxaparin and warfarin for secondary prevention of cancer-associated stroke. J Oncol. 2015;2015:1–6.  https://doi.org/10.1155/2015/502089.CrossRefGoogle Scholar
  21. 21.
    Jauch EC, Saver JL, Adams HP, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44:870–947.  https://doi.org/10.1161/str.0b013e318284056a.CrossRefPubMedGoogle Scholar
  22. 22.
    Kabre R, Kamble K. Gemcitabine and Cisplatin induced posterior reversible encephalopathy syndrome: a case report with review of literature. J Res Pharm Pract. 2016;5:297.  https://doi.org/10.4103/2279-042x.192464.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Kase CS. Intracerebral hemorrhage: non-hypertensive causes. Stroke. 1986;17:590–5.  https://doi.org/10.1161/01.str.17.4.590.CrossRefPubMedGoogle Scholar
  24. 24.
    Kim K, Lee J-H. Risk factors and biomarkers of ischemic stroke in cancer patients. J Stroke. 2014;16:91.  https://doi.org/10.5853/jos.2014.16.2.91.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Kim J-M, Jung K-H, Park KH, et al. Clinical manifestation of cancer related stroke: retrospective case–control study. J Neurooncol. 2013;111:295–301.  https://doi.org/10.1007/s11060-012-1011-4.CrossRefPubMedGoogle Scholar
  26. 26.
    Mohr JP. Stroke: pathophysiology, diagnosis, and management. Philadelphia: Elsevier/Saunders; 2011.Google Scholar
  27. 27.
    Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics – 2016 update. Circulation. 2015;133:e38.  https://doi.org/10.1161/cir.0000000000000350.CrossRefPubMedGoogle Scholar
  28. 28.
    Murata J-I, Sawamura Y, Takahashi A, et al. Intracerebral hemorrhage caused by a neoplastic aneurysm from small-cell lung carcinoma. Neurosurgery. 1993;32:124–6.  https://doi.org/10.1227/00006123-199301000-00019.CrossRefPubMedGoogle Scholar
  29. 29.
    Navi BB, Singer S, Merkler AE, et al. Recurrent thromboembolic events after ischemic stroke in patients with cancer. Neurology. 2014a;83:26–33.  https://doi.org/10.1212/wnl.0000000000000539.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Navi BB, Singer S, Merkler AE, et al. Cryptogenic subtype predicts reduced survival among cancer patients with ischemic stroke. Stroke. 2014b;45: 2292–7.  https://doi.org/10.1161/strokeaha.114.005784.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Navi BB, Reiner AS, Kamel H, et al. Risk of arterial thromboembolism in patients with cancer. J Am Coll Cardiol. 2017;70:926–38.  https://doi.org/10.1016/j.jacc.2017.06.047.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Navi BB, Marshall RS, Bobrow D, et al. Enoxaparin vs aspirin in patients with cancer and ischemic stroke. JAMA Neurol. 2018;75:379.  https://doi.org/10.1001/jamaneurol.2017.4211.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Nguyen T, DeAngelis LM. Stroke in cancer patients. Curr Neurol Neurosci Rep. 2006;6:187–92.  https://doi.org/10.1007/s11910-006-0004-0.CrossRefPubMedGoogle Scholar
  34. 34.
    Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018;378:11–21.  https://doi.org/10.1056/nejmoa1706442.CrossRefPubMedGoogle Scholar
  35. 35.
    Patel SC, Levine SR, Tilley BC, et al. Lack of clinical significance of early ischemic changes on computed tomography in acute stroke. JAMA. 2001;286:2830–8.  https://doi.org/10.1001/jama.286.22.2830.CrossRefPubMedGoogle Scholar
  36. 36.
    Pollack CV, Reilly PA, Ryn JV, et al. Idarucizumab for dabigatran reversal – full cohort analysis. N Engl J Med. 2017;377:431–41.  https://doi.org/10.1056/nejmoa1707278.CrossRefPubMedGoogle Scholar
  37. 37.
    Powers WJ, Derdeyn CP, Biller J, et al. 2015 American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment. Stroke. 2015;46: 3020–35.  https://doi.org/10.1161/str.0000000000000074.CrossRefPubMedGoogle Scholar
  38. 38.
    Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49:e46.  https://doi.org/10.1161/str.0000000000000158.CrossRefPubMedGoogle Scholar
  39. 39.
    Quintas S, Rogado J, Gullón P, et al. Predictors of unknown cancer in patients with ischemic stroke. J Neurooncol. 2018;137:551–7.  https://doi.org/10.1007/s11060-017-2741-0.CrossRefPubMedGoogle Scholar
  40. 40.
    Rha J-H, Saver JL. The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke. 2007;38:967–73.  https://doi.org/10.1161/01.str.0000258112.14918.24.CrossRefPubMedGoogle Scholar
  41. 41.
    Selvik HA, Thomassen L, Bjerkreim AT, et al. Cancer-associated stroke: the Bergen NORSTROKE study. Cerebrovasc Dis Extra. 2015;5:107–13.  https://doi.org/10.1159/000440730.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Shin Y-W, Lee S-T, Jung K-H, et al. Predictors of survival for patients with cancer after cryptogenic stroke. J Neurooncol. 2016;128:277–84.  https://doi.org/10.1007/s11060-016-2106-0.CrossRefPubMedGoogle Scholar
  43. 43.
    Sioka C, Kyritsis AP. Central and peripheral nervous system toxicity of common chemotherapeutic agents. Cancer Chemother Pharmacol. 2008;63:761–7.CrossRefGoogle Scholar
  44. 44.
    Smets G-J, Loyson T, Paesschen WV, et al. Posterior reversible encephalopathy syndrome possibly induced by pemetrexed maintenance therapy for lung cancer: a case report and literature review. Acta Clin Belg. 2017; 1–7.  https://doi.org/10.1080/17843286.2017.1403103.
  45. 45.
    Sorgun MH, Kuzu M, Ozer IS, et al. Risk factors, biomarkers, etiology, outcome and prognosis of ischemic stroke in cancer patients. Asian Pac J Cancer Prev. 2018;19:649–53.PubMedPubMedCentralGoogle Scholar
  46. 46.
    Stefan O, Vera N, Otto B, et al. Stroke in cancer patients: a risk factor analysis. J Neurooncol. 2009;94: 221–6.  https://doi.org/10.1007/s11060-009-9818-3.CrossRefPubMedGoogle Scholar
  47. 47.
    Sun B, Fan S, Li Z, et al. Clinical and neuroimaging features of acute ischemic stroke in cancer patients. Eur Neurol. 2016;75:292–9.  https://doi.org/10.1159/000447126.CrossRefPubMedGoogle Scholar
  48. 48.
    Thaler DE, Saver JL. Cryptogenic stroke and patent foramen ovale. Curr Opin Cardiol. 2008;23:537–44.  https://doi.org/10.1097/hco.0b013e32831311bd.CrossRefPubMedGoogle Scholar
  49. 49.
    Thomalla G, Cheng B, Ebinger M, et al. DWI-FLAIR mismatch for the identification of patients with acute ischaemic stroke within 4·5 h of symptom onset (PRE-FLAIR): a multicentre observational study. Lancet Neurol. 2011;10:978–86.  https://doi.org/10.1016/s1474-4422(11)70192-2.CrossRefPubMedGoogle Scholar
  50. 50.
    Wardlaw JM, Murray V, Berge E, et al. Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and meta-analysis. Lancet. 2012;379:2364–72.  https://doi.org/10.1016/s0140-6736(12)60738-7.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Wardlaw JM, Murray V, Berge E, et al. Thrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev. 2014.  https://doi.org/10.1002/14651858.cd000213.pub3.
  52. 52.
    Wijdicks EFM, Sheth KN, Carter BS, et al. Recommendations for the management of cerebral and cerebellar infarction with swelling: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45:1222–38.  https://doi.org/10.1161/01.str.0000441965.15164.d6.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Neurosurgery, Division of Neurocritical careMcGovern Medical School, University of Texas Health Science CenterHoustonUSA
  2. 2.Clinical Innovation and Research InstituteMemorial Hermann HospitalHoustonUSA

Section editors and affiliations

  • Yenny Cardenas
    • 1
  1. 1.Critical Care DepartmentUniversidad del Rosario Hospital Universitario Fundacion Santa Fe deBogotaColombia

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