Abstract
Diffusion‐weighted imaging (DWI) MRI is very sensitive for detecting small embolic brain infarctions. Stroke as the first manifestation of cancer is extremely rare. We performed a retrospective study to identify the clinical and DWI features of patients with acute ischemic stroke as the first manifestation of occult cancer. A total of five patients in our hospital from January 2017 to May 2019 were analyzed. We also reviewed the literature and seven case series (16 patients) were included. Most of these patients were aged in their sixties and lung cancer was the most common type of occult cancer. Patients showed various presentations of ischemic stroke. All of the patients showed small multiple lesions on DWI that involved mostly the anterior or both anterior and posterior territories. The lesions were mostly in both the supratentorium and infratentorium, with the mechanisms of embolic and watershed infarcts. These features were useful for identifying the causes of embolic stroke. Therefore, patients with small bilateral embolic stroke, especially those involved in multiple vascular territories, should be examined for concealed malignancy.
Highlights
Diffusion-weighted imaging (DWI) MRI is a sensitive and indispensable tool for evaluating embolic brain infarctions, especially small single or multiple infarcts in the cortex or subcortex.[1]
It is very rare that infarction presents as the first manifestation of a concealed cancer
We present five patients with multiple cerebral infarctions as an initial presentation of occult cancer. All of these five patients were diagnosed with lung cancer
Summary
Diffusion-weighted imaging (DWI) MRI is a sensitive and indispensable tool for evaluating embolic brain infarctions, especially small single or multiple infarcts in the cortex or subcortex.[1]. We report five cancer patients with ischemic stroke as the first presentation. Patients whose cancers had been diagnosed 1 month after the presentation of acute ischemic stroke were excluded. Studies reporting stroke as the first presentation of cancer and pictures of DWI were included for further evaluation.
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