Abstract
IntroductionAn increasing trend of cancer associated stroke has been noticed in the past decade.ObjectivesTo evaluate the risk factors and the incidence of neoplasia in stroke patients.Material and MethodA retrospective, observational study was undertaken on 249 patients with stroke and active cancer (SAC) and 1563 patients with stroke without cancer (SWC). The general cardiovascular risk factors, the site of cancer, and the general clinical data were registered and evaluated. According to the “Oxfordshire Community Stroke Project” (OCSP) classification, all patients were classified into the clinical subtypes of stroke. The aetiology of stroke was considered as large-artery atherosclerosis, small vessel disease, cardio-embolic, cryptogenic or other determined cause.ResultsThe severity of neurological deficits at admission were significantly higher in the SAC group (p<0.01). The haemoglobin level was significantly lower, and platelet level and erythrocyte sedimentation rate were significantly higher in the SAC group. Glycaemia, cholesterol and triglycerides levels were significantly higher in the SWC group. The personal history of hypertension was more frequent in the SWC group. In the SAC group, 28.9% had a cryptogenic aetiology, compared to 9.1% in SWC group. Cardio-embolic strokes were more frequent in the SAC group (24%) than the SWC group (19.6%). In the SAC group, 15,6% were diagnosed with cancer during the stroke hospitalization, and 78% of the SAC patients were without metastasis.ConclusionsThe most frequent aetiologies of stroke in cancer patients were cryptogenic stroke, followed by large-artery atherosclerosis. SAC patients had more severe neurological deficits and worse clinical outcomes than SWC patients. Stroke in cancer patients appears to be more frequently cryptogenic, probably due to cancer associated thrombosis. The association between stroke and cancer is important, especially in stroke of cryptogenic mechanism, even in the presence of traditional cardiovascular risk factors.
Highlights
An increasing trend of cancer associated stroke has been noticed in the past decade
This study aimed to evaluate two groups of newly diagnosed stroke patients, one group being cancer free and the other having associated cancer, from the perspective of neurological deficits, clinical outcome and paraclinical biomarkers
Two hundred forty-nine patients with stroke and active cancer diagnosis, or those who were diagnosed with cancer during stroke hospitalization and 1563 patients with stroke and without active cancer
Summary
An increasing trend of cancer associated stroke has been noticed in the past decade. Objectives: To evaluate the risk factors and the incidence of neoplasia in stroke patients. Cardio-embolic strokes were more frequent in the SAC group (24%) than the SWC group (19.6%). Conclusions: The most frequent aetiologies of stroke in cancer patients were cryptogenic stroke, followed by large-artery atherosclerosis. Stroke in cancer patients appears to be more frequently cryptogenic, probably due to cancer associated thrombosis. The association between stroke and cancer is important, especially in stroke of cryptogenic mechanism, even in the presence of traditional cardiovascular risk factors. In the past three decades, anatomic-pathological and clinical studies revealed an increasing trend in cancer associated arterial thrombosis, including ischemic stroke [2, 3]. Almost 10% of the patients with ischemic stroke have a personal history of neoplasia, and this clinical association seems to be more frequent than previously described [4, 5, 6]. Due to the significant progress made in cancer diagnosis and treatment in the last years, most of these patients will survive for over five years following a positive diagnosis [7]
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