Skip to main content

Stroke in Critically Ill Cancer Patients

  • Living reference work entry
  • First Online:
Oncologic Critical Care
  • 243 Accesses

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

References

  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.

    Article  PubMed  Google Scholar 

  2. Amer M. Cancer-associated thrombosis: clinical presentation and survival. Cancer Manag Res. 2013; 5: 165. https://doi.org/10.2147/cmar.s47094.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  7. Bick RL. Cancer-associated thrombosis. N Engl J Med. 2003;349:109–11. https://doi.org/10.1056/nejmp030086.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  9. Bradley WG. MR appearance of hemorrhage in the brain. Radiology. 1993;189:15–26. https://doi.org/10.1148/radiology.189.1.8372185.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  13. Donati MB, Falanga A. Pathogenetic mechanisms of thrombosis in malignancy. Acta Haematol. 2001; 106: 18–24. https://doi.org/10.1159/000046585.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  15. Gonzalez-Quintela A, Candela M, Vidal C, et al. Non-bacterial thrombotic endocarditis in cancer patients. Acta Cardiol. 1991;46:1–9.

    CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Kase CS. Intracerebral hemorrhage: non-hypertensive causes. Stroke. 1986;17:590–5. https://doi.org/10.1161/01.str.17.4.590.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  26. Mohr JP. Stroke: pathophysiology, diagnosis, and management. Philadelphia: Elsevier/Saunders; 2011.

    Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  43. Sioka C, Kyritsis AP. Central and peripheral nervous system toxicity of common chemotherapeutic agents. Cancer Chemother Pharmacol. 2008;63:761–7.

    Article  Google Scholar 

  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. 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.

    PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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. 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.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to James C. Grotta .

Editor information

Editors and Affiliations

Section Editor information

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Bowry, R., Grotta, J.C. (2019). Stroke in Critically Ill Cancer Patients. In: Nates, J., Price, K. (eds) Oncologic Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-74698-2_35-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-74698-2_35-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74698-2

  • Online ISBN: 978-3-319-74698-2

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics