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Intracranial Hemorrhage Focused on Cancer and Hemato-Oncologic Patients

  • Yasser Mohamad Khorchid
  • Marc Malkoff
Living reference work entry

Abstract

Intracranial hemorrhage (ICH) is the most fatal type of stroke and has the highest rate of disability. It is seen in less than 10% of cancer patients, including known intracranial neoplasms. Intratumoral hemorrhage and coagulopathy are the most common etiologies. ICH most commonly occurs supratentorially, in the cerebral parenchyma. The most common cancers associated with ICH are intracranial metastases, followed by glioblastoma multiforme and hematologic malignancies. Among hemorrhagic metastases, melanoma, lung, and breast cancers are the most common primary tumors. The exact mechanism of intratumoral hemorrhage is unknown, although vascular endothelial growth factor (VEGF) and matrix metalloproteinases (MMP) appear to play an important role. Most cancer patients with ICH are symptomatic. Change in mental status, hemiparesis, and headaches are the most common clinical presentations. A non-contrast head computed tomography (CT) scan is the initial diagnostic step if ICH is suspected. There are no specific guidelines for ICH management in cancer patients. Blood pressure needs to be controlled, and coagulopathy has to be corrected. Surgical interventions might be life-saving, especially in large hemorrhages in the posterior fossa. Overall, cancer patients have worse clinical outcomes than the general population when they develop ICH. Patients with coagulopathy have the poorest prognosis.

Keywords

Intracranial hemorrhage Cancer Brain tumor Glioblastoma multiforme Brain metastases Intratumoral hemorrhage Coagulopathy Thrombocytopenia 

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of NeurologyUniversity of Tennessee Health Science CenterMemphisUSA

Section editors and affiliations

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

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