Ischemic stroke and cancer: stroke severely impacts cancer patients, while cancer increases the number of strokes

Abstract

Background: Cancer and ischemic stroke are two of the most common causes of death among the elderly, and associations between them have been reported. However, the main pathomechanisms of stroke in cancer patients are not well known, and can only be established based on accurate knowledge of the characteristics of cancer-related strokes. We review herein recent studies concerning the clinical, laboratory, and radiological features of patients with cancer-related stroke.

Main contents: This review covers the epidemiology, underlying mechanisms, and acute and preventive treatments for cancer-related stroke. First, the characteristics of stroke (clinical and radiological features) and systemic cancer (type and extent) in patients with cancer-specific stroke are discussed. Second, the role of laboratory tests in the early identification of patients with cancer-specific stroke is discussed. Specifically, serum D-dimer levels (as a marker of a hypercoagulable state) and embolic signals on transcranial Doppler (suggestive of embolic origin) may provide clues regarding changes in the levels of coagulopathy related to cancer and anticoagulation. Finally, strategies for stroke treatment in cancer patients are discussed, emphasizing the importance of preventive strategies (i.e., the use of anticoagulants) over acute revascularization therapy in cancer-related stroke.

Conclusion: Recent studies have revealed that the characteristics of cancer-related stroke are distinct from those of conventional stroke. Our understanding of the characteristics of cancer-related stroke is essential to the correct management of these patients. The studies presented in this review highlight the importance of a personalized approach in treating stroke patients with cancer.

Keywords: anticoagulants; cancer; embolism; hypercoagulopathy; ischemic; stroke.

Fig. 1

Stroke subtypes in patients with vs. without cancer (data from the Samsung Stroke Center). Figure modified from Kim et al. CSM: conventional stroke mechanisms.

Fig. 2

Diffusion-weighted imaging (DWI) lesion patterns in patients with and without conventional stroke mechanisms.

Fig. 3

Numbers of embolic signals (ES) on transcranial Doppler ultrasound (A) and D-dimer levels (B) for each stroke subtype. The scatterplot shows the correlation between the number of ES and D-dimer levels by subtype of ischemic stroke. (C) Patients without conventional stroke mechanisms (CSM) and (D) those with CSM. Figure modified from Seok et al.