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Characteristics of cryptogenic stroke in cancer patients
#MMPMID27081658
Gon Y
; Okazaki S
; Terasaki Y
; Sasaki T
; Yoshimine T
; Sakaguchi M
; Mochizuki H
Ann Clin Transl Neurol
2016[Apr]; 3
(4
): 280-7
PMID27081658
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OBJECTIVE: To clarify the characteristics of cryptogenic stroke in patients with
active cancer. METHODS: Patients with or without cancer diagnosed with acute
ischemic stroke between January 2006 and February 2015 were extracted from a
prospectively collected stroke database of Osaka University Hospital. Patients
were categorized according to the presence of active cancer and known stroke
mechanisms. RESULTS: Among 1191 patients with acute ischemic stroke, 145 (12%)
had active cancer. Patients with active cancer were diagnosed more often with
cryptogenic stroke than were patients without cancer (47% vs. 12%, P < 0.001).
Compared with cryptogenic stroke patients without cancer, cryptogenic stroke
patients with active cancer had fewer atherosclerotic risk factors, lower
nutrition status, higher plasma D-dimer levels, and multiple vascular lesions. In
a multivariate logistic analysis, plasma D-dimer level (odds ratio [OR] per 1
standard deviation increase: 6.30; 95% confidence interval [CI]: 2.94-15.69;
P < 0.001), and the presence of multiple vascular lesions (OR: 6.40; 95% CI:
2.35-18.35; P < 0.001) were independent predictors of active cancer. When
comparing active cancer patients who had known stroke mechanisms with those who
had cryptogenic stroke, high plasma D-dimer levels, multiple vascular lesions,
and receiving chemotherapy and/or radiation therapy were associated with
cryptogenic stroke etiology. INTERPRETATION: In cryptogenic stroke, patients with
active cancer has a unique pathology characterized by high plasma D-dimer levels
and multiple vascular lesions. The hypercoagulable state and malnutrition due to
cancer and its treatments potentially influence the development of cryptogenic
stroke in cancer patients.
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