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Intracranial Hemorrhage Focused on Cancer and Hemato-oncologic Patients

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Oncologic Critical Care

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.

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References

  1. Minimally invasive surgery plus Rt-PA for ICH evacuation phase III (MISTIE III). Clinical Trials. gov Identifier: NCT 01827046

    Google Scholar 

  2. Abrahams NA, Prayson R. The role of histopathologic examination of intracranial blood clots removed for hemorrhage of unknown etiology: a clinical pathologic analysis of 31 cases. Ann Diagn Pathol. 2000;4:361–6.

    Article  CAS  PubMed  Google Scholar 

  3. Anderson CS, Heeley E, Huang Y, et al. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med. 2013;368:2355–65.

    Article  CAS  PubMed  Google Scholar 

  4. Atlas SW, Grossman RI, Gomori JM, et al. Hemorrhagic intracranial malignant neoplasms: spin-echo MR imaging. Radiology. 1987;164:71–7.

    Article  CAS  PubMed  Google Scholar 

  5. Barnholtz-Sloan JS, Sloan A, Davis FG, et al. Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System. J Clin Oncol. 2004;22:2865–72.

    Article  PubMed  Google Scholar 

  6. Boulouis G, Morotti A, Goldstein JN, Charidimou A. Intensive blood pressure lowering in patients with acute intracerebral haemorrhage: clinical outcomes and haemorrhage expansion systematic review and meta-analysis of randomised trials. J Neurol Neurosurg Psychiatry. 2017;88:339–45.

    Article  PubMed  Google Scholar 

  7. Brophy GM, Bell R, Claassen J, Neurocritical Care Society Status Epilepticus Guideline Writing Committee, et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care. 2012;17:3.

    Article  PubMed  Google Scholar 

  8. Brouwers HB, Chang Y, Falcone GJ, et al. Predicting hematoma expansion after primary intracerebral hemorrhage. JAMA Neurol. 2014;71:158–64.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Bug G, Anargyrou K, Tonn T, et al. Impact of leukapheresis on early death rate in adult acute myeloid leukemia presenting with hyperleukocytosis. Transfusion. 2007;47:1843–50.

    Article  PubMed  Google Scholar 

  10. Cao R, Eriksson A, Kubo H, Alitalo K, Cao Y, Thyberg J. Comparative evaluation of FGF-2-, VEGF-A-, and VEGF-C-induced angiogenesis, lymphangiogenesis, vascular fenestrations, and permeability. Circ Res. 2004;94:664–70.

    Article  CAS  PubMed  Google Scholar 

  11. Chang L, Chen Y-L, Kao M-CC. Intracranial metastasis of hepatocellular carcinoma: review of 45 cases. Surg Neurol. 2004;62:172–7.

    Article  PubMed  Google Scholar 

  12. Chang MC, Chen T, Tang JL, et al. Leukapheresis and cranial irradiation in patients with hyperleukocytic acute myeloid leukemia: no impact on early mortality and intracranial hemorrhage. Am J Hematol. 2007;82:976–80.

    Article  PubMed  Google Scholar 

  13. Connolly ES Jr, Rabinstein A, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, Hoh BL, Kirkness CJ, Naidech AM, Ogilvy CS, Patel AB, Thompson BG, Vespa P, American Heart Association Stroke Council, Council on Cardiovascular Radiology and Intervention, Council on Cardiovascular Nursing, Council on Cardiovascular Surgery and Anesthesia, Council on Clinical Cardiology. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2012;43:1711–37.

    Article  PubMed  Google Scholar 

  14. Connolly SJ, Milling TJ, Eikelboom JW, ANNEXA-4 Investigators, et al. Andexanet alfa for acute major bleeding associated with factor Xa inhibitors. N Engl J Med. 2016;375:1131–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Coussens LM, Fingleton B, Matrisian LM. Matrix metalloproteinase inhibitors and cancer: trials and tribulations. Science. 2002;295:2387–92.

    Article  CAS  PubMed  Google Scholar 

  16. Croce MA, Dent D, Menke PG, Robertson JT, Hinson MS, Young BH, Donovan TB, Pritchard FE, Minard G, Kudsk KA, et al. Acute subdural hematoma: nonsurgical management of selected patients. J Trauma. 1994;36:820–6.

    Article  CAS  PubMed  Google Scholar 

  17. Dammann P, Asgari S, Bassiouni H, et al. Spontaneous cerebellar hemorrhage: experience with 57 surgically treated patients and review of the literature. Neurosurg Rev. 2011;34:77–86.

    Article  PubMed  Google Scholar 

  18. Diringer MN, Edwards D. Admission to a neurologic/neurosurgical intensive care unit is associated with reduced mortality rate after intracerebral hemorrhage. Crit Care Med. 2001;29:635–40.

    Article  CAS  PubMed  Google Scholar 

  19. Ducruet AF, Grobelny B, Zacharia BE, Hickman ZL, DeRosa PL, Anderson K, Sussman E, Carpenter A, Connolly ES Jr. The surgical management of chronic subdural hematoma. Neurosurg Rev. 2012;35:155–69.

    Article  PubMed  Google Scholar 

  20. Fidler IJ. The pathogenesis of cancer metastasis: the ‘seed and soil’ hypothesis revisited. Nat Rev Cancer. 2003;3:453–8.

    Article  CAS  PubMed  Google Scholar 

  21. Flibotte JJ, Hagan N, O’Donnell J, et al. Warfarin, hematoma expansion, and outcome of intracerebral hemorrhage. Neurology. 2004;63:1059–64.

    Article  CAS  PubMed  Google Scholar 

  22. Freeman WD. Management of intracranial pressure. Continuum (Minneap Minn). 2015;21:1299–323.

    Google Scholar 

  23. Golash A, Thorne J, West CG. Low grade pilocytic astrocytoma presenting as a spontaneous intracerebral haemorrhage in a child. Br J Neurosurg. 1998;12:59–62.

    Article  CAS  PubMed  Google Scholar 

  24. Graus F, Rogers L, Posner JB. Cerebrovascular complications in patients with cancer. Medicine (Baltimore). 1985;64:16–35.

    Article  CAS  Google Scholar 

  25. Hanley DF, Lane K, McBee N, CLEAR III Investigators, et al. Thrombolytic removal of intraventricular haemorrhage in treatment of severe stroke: results of the randomised, multicentre, multiregion, placebo-controlled CLEAR III trial. Lancet. 2017;389:603–11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Hemphill JC 3rd, Greenberg S, Anderson CS, Becker K, Bendok BR, Cushman M, Fung GL, Goldstein JN, Macdonald RL, Mitchell PH, Scott PA, Selim MH, Woo D, American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46:2032–60.

    Article  PubMed  Google Scholar 

  27. Jin Kim Y, Hyun Kim C, Hwan Cheong J, Min Kim J. Relationship between expression of vascular endothelial growth factor and intratumoral hemorrhage in human pituitary adenomas. Tumori. 2011;97:639–46.

    Article  PubMed  Google Scholar 

  28. Joseph DM, O’Neill A, Chandra RV, Lai LT. Glioblastoma presenting as spontaneous intracranial haemorrhage: case report and review of the literature. J Clin Neurosci. 2017;40:1–5.

    Article  PubMed  Google Scholar 

  29. Jung S, Moon K, Jung TY, Kim IY, Lee YH, Rhu HH, et al. Possible pathophysiological role of vascular endothelial growth factor (VEGF) and matrix metalloproteinases (MMPs) in metastatic brain tumor-associated intracerebral hemorrhage. J Neuro-Oncol. 2006;76:257–63.

    Article  CAS  Google Scholar 

  30. Kamel H, Navi B, Hemphill JC. A rule to identify patients who require magnetic resonance imaging after intracerebral hemorrhage. Neurocrit Care. 2013;18:59–63.

    Article  PubMed  Google Scholar 

  31. Kondziolka D, Bernstein M, Resch L, et al. Significance of hemorrhage into brain tumors: clinicopathological study. J Neurosurg. 1987;67:852–7.

    Article  CAS  PubMed  Google Scholar 

  32. Kothbauer P, Jellinger K, Falment H. Primary brain tumour presenting as spontaneous intracerebral haemorrhage. Acta Neurochir. 1979;49:35–45.

    Article  CAS  PubMed  Google Scholar 

  33. Laigle-Donadey F, Taillibert S, Mokhtari K, et al. Dural metastases. J Neuro-Oncol. 2005;75:57–61.

    Article  Google Scholar 

  34. Licata B, Turazzi S. Bleeding cerebral neoplasms with symptomatic hematoma. J Neurosurg Sci. 2003;47:201–10.

    CAS  PubMed  Google Scholar 

  35. Lieu AS, Hwang S, Howng SL, Chai CY. Brain tumors with hemorrhage. J Formos Med Assoc. 1999;98:365–7.

    CAS  PubMed  Google Scholar 

  36. Little JR, Dial B, Bélanger G, Carpenter S. Brain hemorrhage from intracranial tumor. Stroke. 1979;10:283–8.

    Article  CAS  PubMed  Google Scholar 

  37. Liwnicz BH, Wu S, Tew JM Jr. The relationship between the capillary structure and haemorrhage in gliomas. J Neurosurg. 1987;66:536–41.

    Article  CAS  PubMed  Google Scholar 

  38. Maiuri F, D’Andrea F, Gallicchio B, Carandente M. Intracranial haemorrhages in metastatic brain tumours. J Neurosurg Sci. 1985;29:37–41.

    CAS  PubMed  Google Scholar 

  39. Mandybur TI. Intracranial hemorrhage caused by metastatic tumors. Neurology (Minneap). 1977;27:650–5.

    Article  CAS  Google Scholar 

  40. Marneros AG. Tumor angiogenesis in melanoma. Hematol Oncol Clin North Am. 2009;23:431–46.

    Article  PubMed  Google Scholar 

  41. Mayer SA, Brun N, Begtrup K, Broderick J, Davis S, Diringer MN, et al. Efficacy and safety of recombinant activated factor VII for acute intracerebral hemorrhage. N Engl J Med. 2008;358:2127–37.

    Article  CAS  PubMed  Google Scholar 

  42. McCormick WF, Rosenfield D. Massive brain hemorrhage: a review of 144 cases and an examination of their causes. Stroke. 1973;4:946–54.

    Article  CAS  PubMed  Google Scholar 

  43. McIver JI, Scheithauer B, Rydberg CH, et al. Metastatic hepatocellular carcinoma presenting as epidural hematoma: case report. Neurosurgery. 2001;49:447–9.

    CAS  PubMed  Google Scholar 

  44. Mendelow AD, Gregson B, Fernandes HM, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the international surgical trial in intracerebral Haemorrhage (STICH): a randomised trial. Lancet Neurol. 2005;365:387–97.

    Article  Google Scholar 

  45. Mendelow AD, Gregson B, Fernanades HM, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematoma in the international surgical trial in intracerebral hemorrhage (STICH II): a randomised clinical trial. Lancet. 2013;382:397–408.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Minette SE, Kimmel D. Subdural hematoma in patients with systemic cancer. Mayo Clin Proc. 1989;64:637–42.

    Article  CAS  PubMed  Google Scholar 

  47. Murthy SB, Shastri A, Merkler AE, Hanley DF, Ziai WC, Fink ME, Iadecola C, Kamel H, Navi BB. Intracerebral hemorrhage outcomes in patients with systemic cancer. J Stroke Cerebrovasc Dis. 2016;25:2918–24.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Navi BB, Reichman J, Berlin D, Reiner AS, Panageas KS, Segal AZ, DeAngelis LM. Intracerebral and subarachnoid hemorrhage in patients with cancer. Neurology. 2010;74:494–501.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Omofoye OA, Barnett R., Lau W, Trembath D, Jordan JD, Sasaki-Adams DM. Neoplastic cerebral aneurysm from metastatic non-small cell lung carcinoma: case report and literature review. Neurosurgery. 2018;83:E221–25.

    Article  Google Scholar 

  50. Openshaw H, Ressler J, Snyder DS. Lumbar puncture and subdural hygroma and hematomas in hematopoietic cell transplant patients. Bone Marrow Transplant. 2008;41:791–5.

    Article  CAS  PubMed  Google Scholar 

  51. Pantuck AJ, Zeng G, Belldegrun AS, Figlin RA. Pathobiology, prognosis, and targeted therapy for renal cell carcinoma: exploiting the hypoxia-induced pathway. Clin Cancer Res. 2003;9:4641–52.

    CAS  PubMed  Google Scholar 

  52. Pollack CV Jr, Reilly P, van Ryn J, et al. Idarucizumab for dabigatran reversal – full cohort analysis. N Engl J Med. 2017;377:431–41.

    Article  CAS  PubMed  Google Scholar 

  53. Qureshi AI, et al. Isolated and borderline isolated systolic hypertension relative to long-term risk and type of stroke: a 20-year follow-up of the national health and nutrition survey. Stroke. 2002;33:2781–8.

    Article  PubMed  Google Scholar 

  54. Qureshi AI, Palesch Y, Barsan WG, Hanley DF, Hsu CY, Martin RL, Moy CS, Silbergleit R, Steiner T, Suarez JI, Toyoda K, Wang Y, Yamamoto H, Yoon BW, ATACH-2 Trial Investigators and the Neurological Emergency Treatment Trials Network. Intensive blood-pressure lowering in patients with acute cerebral hemorrhage. N Engl J Med. 2016;375:1033–43.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Reichman J, Singer S, Navi B, Reiner A, Panageas K, Gutin PH, DeAngelis LM. Subdural hematoma in patients with cancer. Neurosurgery. 2012;71:74–9.

    Article  PubMed  Google Scholar 

  56. Rogers LR. Cerebrovascular complications in cancer patients. Neurol Clin. 2003;21:167–92.

    Article  PubMed  Google Scholar 

  57. Schouten LJ, Rutten J, Huveneers HA, Twijnstra A. Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney, and lung and melanoma. Cancer. 2002;94:2698–705.

    Article  PubMed  Google Scholar 

  58. Schrader B, Barth H, Lang EW, Buhl R, Hugo HH, Biederer J, Mehdorn HM. Spontaneous intracranial haematomas caused by neoplasms. Acta Neurochir (Wien). 2000;142:979–85.

    Article  CAS  Google Scholar 

  59. Scott M. Spontaneous intracerebral hematoma caused by cerebral neoplasms. Report of eight verified cases. J Neurosurg. 1975;42:338–42.

    Article  CAS  PubMed  Google Scholar 

  60. Sessa M. Intracerebral hemorrhage and hypertension. Neurol Sci. 2008;29(Suppl 2):S258–9.

    Article  PubMed  Google Scholar 

  61. Shuangshoti S, Panyathanya R, Wichienkur P. Intracranial metastases from unsuspected choriocarcinoma. Neurology (Minneap). 1974;24:649–54.

    Article  CAS  Google Scholar 

  62. Suarez JI. Diagnosis and management of subarachnoid hemorrhage. Continuum (Minneap Minn). 2015;21:1263–87.

    Google Scholar 

  63. Tung GA, Julius B, Rogg JM. MRI of intracerebral hematoma: value of vasogenic edema ratio for predicting the cause. Neuroradiology. 2003;45:357–62.

    Article  CAS  PubMed  Google Scholar 

  64. van Asch CJ, Luitse M, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol. 2010;9:167–76.

    Article  PubMed  Google Scholar 

  65. van den Doel EM, van Merriënboer F, Tulleken CA. Cerebral haemorrhage from unsuspected choriocarcinoma. Clin Neurol Neurosurg. 1985;87:287–90.

    Article  PubMed  Google Scholar 

  66. Velander AJ, DeAngelis L, Navi BB. Intracranial hemorrhage in patients with Cancer. Curr Atheroscler Rep. 2012;14:373–81.

    Article  PubMed  Google Scholar 

  67. Wada R, Aviv R, Fox AJ, et al. CT angiography “spot sign” predicts hematoma expansion in acute intracerebral hemorrhage. Stroke. 2007;38:1257–62.

    Article  PubMed  Google Scholar 

  68. Wakai S, Yamakawa K, Manaka S, Takakura K. Spontaneous intracranial hemorrhage caused by brain tumor: its incidence and clinical significance. Neurosurgery. 1982;10:437–44.

    Article  CAS  PubMed  Google Scholar 

  69. Woo D, et al. Effect of untreated hypertension on hemorrhagic stroke. Stroke. 2004;35:1703–8.

    Article  PubMed  Google Scholar 

  70. Wűrthner JU, Köhler G, Behringer D, Lindemann A, Mertelsmann R, Lűbbert M. Leukostasis followed by hemorrhage complicating the initiation of chemotherapy in patients with acute myeloid leukemia and hyperleukocytosis: a clinicopathologic report of four cases. Cancer. 1999;85:368–74.

    Article  PubMed  Google Scholar 

  71. Yamauchi K, Umeda Y. Symptomatic intracranial haemorrhage in acute non-lymphoblastic leukaemia: analysis of CT and autopsy findings. J Neurol. 1997;244:94–100.

    Article  CAS  PubMed  Google Scholar 

  72. Yuguang L, Meng L, Shugan Z, et al. Intracranial tumoural haemorrhage-a report of 58 cases. J Clin Neurosci. 2002;9:637–9.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA

    Yasser Mohamad Khorchid & Marc Malkoff

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  1. Yasser Mohamad Khorchid
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  2. Marc Malkoff
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Correspondence to Yasser Mohamad Khorchid .

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Editors and Affiliations

  1. Department of Critical Care and Respiratory Care, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Joseph L. Nates

  2. Division of Anesthesiology, Critical Care and Pain Medicine, Department of Critical Care and Respiratory Care, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Kristen J. Price

Section Editor information

  1. Critical Care Department, Universidad del Rosario Hospital Universitario Fundacion Santa Fe de, Bogota, Colombia, Colombia

    Yenny Cardenas

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Khorchid, Y.M., Malkoff, M. (2020). Intracranial Hemorrhage Focused on Cancer and Hemato-oncologic Patients. In: Nates, J., Price, K. (eds) Oncologic Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-74588-6_40

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  • DOI: https://doi.org/10.1007/978-3-319-74588-6_40

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