Stroke and Cancer- A Complicated Relationship

Abstract

The interrelationship between stroke and cancer is complex. Cancer and stroke may occur independently in a given patient, or cancer may directly or indirectly lead to stroke via: hypercoaguability, non-bacterial thrombotic endocarditis (NBTE), direct tumor compression of blood vessels, or treatment-related effects which potentiate stroke. Patients with cryptogenic stroke are relatively common, and under the right circumstances, may provide an opportunity to screen for occult malignancy. In this review, we discuss relevant data linking stroke and cancer as well as propose a testable algorithm for cancer screening in the patient with cryptogenic stroke. Future directions should focus on validating patient-care algorithms in prospective clinical trials to provide an evidence base for this important issue.

Keywords: Cancer; Hypercoagulable States; Non- Bacterial Thrombotic Endocarditis; Stroke; Venous Thromboemoblism.

Figure 1. An approach for malignancy screening in patients with cryptogenic stroke

In this approach, every patient with an embolic appearing cryptogenic stroke (regardless of age), undergoes an expanded history, physical examination, and serological work-up (D-Dimer). Patients with one or more finding on history, physical examination, or serum testing suspicious for malignancy should undergo further evaluation with imaging.