Laboratory and other ancillary testing in intracerebral hemorrhage: an algorithmic approach

Abstract

Cancer-related intracerebral bleeding is an uncommon cause of hemorrhage and represents only a fraction of all non-traumatic intracranial hemorrhages (ICHs). The mechanisms of intratumoral hemorrhage remain unclear, but include tumor necrosis, rupture of tumor blood vessels and invasion of parenchymal blood vessels by tumor. Metastatic brain tumors can cause intracerebral hemorrhage. Brain metastases from any primary tumor can cause bleeding, but the different primaries have a wide variability in their tendency to bleed. A tumor embolus may cause an aneurysm that can lead to potentially fatal intraparenchymal or subarachnoid hemorrhages. The clinical presentation of intratumoral hemorrhage is often indistinguishable from spontaneous ICH from more typical etiologies such as hypertension. Radiotherapy should be administered according to the appropriate protocol regardless of whether the tumor is associated with hemorrhage. The prognosis of a hemorrhagic neoplasm is primarily determined by the prognosis of the underlying malignancy.