Ischemic Stroke in Patients with Cancer: A Retrospective Cross-Sectional Study

• Published in: Journal of critical care medicine (Universitatea de Medicină și Farmacie din Târgu-Mureș) Vol. 7; no. 1; pp. 54 - 61
• Main Authors: Motataianu, Anca, Maier, Smaranda, Andone, Sebastian, Barcutean, Laura, Serban, Georgiana, Bajko, Zoltan, Balasa, Adrian
• Format: Journal Article
• Language: English
• Published: Sciendo 01-01-2021
• Subjects: cancer; cancer associated thrombosis; cardiovascular risk factors; cryptogenic stroke; stroke
• ISSN: 2393-1817; 2393-1809; 2393-1817
• DOI: 10.2478/jccm-2021-0002

Abstract
Introduction
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.
Material and Method
A 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.
Results
The 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.
Conclusions
The 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.