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. 2023 Jun;13(3):e200165.
doi: 10.1212/CPJ.0000000000200165. Epub 2023 Apr 27.

Stroke in Patients With Common Noncancerous Gynecologic Diseases: A Multicenter Study in Japan

Kazuo Yamashiro  1 , Takeo Sato  1 , Chikako Nito  1 , Yuji Ueno  1 , Hiroyuki Kawano  1 , Tetsuya Chiba  1 , Takahito Nishihira  1 , Takafumi Mizuno  1 , Kentaro Ishizuka  1 , Yasuyuki Iguchi  1 , Kazumi Kimura  1 , Kazuo Kitagawa  1 , Masatoshi Koga  1 , Teruyuki Hirano  1 , Tomoaki Kameda  1 , Hidehiro Takekawa  1 , Takao Urabe  1 , Akiyo Taneichi  1 , Hiroyuki Fujiwara  1 , Shigeru Fujimoto  1 , Nobutaka Hattori  1 , Ryota Tanaka  1
Affiliations

Stroke in Patients With Common Noncancerous Gynecologic Diseases: A Multicenter Study in Japan

Kazuo Yamashiro et al. Neurol Clin Pract. 2023 Jun.

Abstract

Background and objectives: Gynecologic diseases such as uterine fibroids, endometriosis, and adenomyosis are common in women of reproductive age. Case reports and small case series have reported ischemic stroke in women with such common noncancerous gynecologic diseases, and their cause of stroke is frequently attributed to cryptogenic stroke or unconventional mechanisms related to hypercoagulability. However, stroke etiology and prognosis are not well known. We assessed the prevalence of and stroke mechanisms related to common noncancerous gynecologic diseases using hospital-based clinical data.

Methods: We retrospectively identified consecutive female patients with common noncancerous gynecologic diseases (uterine fibroids, endometriosis, and adenomyosis) diagnosed with ischemic stroke/transient ischemic attack (TIA) between the ages of 20 and 59 years admitted to 10 stroke centers in Japan by reviewing prospectively collected data between 2017 and 2019. The clinical, laboratory, and neuroimaging features were evaluated and compared between patients with conventional stroke mechanisms (CSMs) (large artery atherosclerosis, small vessel occlusion, cardioembolism, and other determined etiology) and non-CSMs (cryptogenic stroke and causes related to hypercoagulability such as nonbacterial thrombotic endocarditis and paradoxical embolism) according to the Trial of Org 10172 in Acute Stroke Treatment criteria.

Results: Of the 470 female patients with ischemic stroke/TIA, 39 (8%) (37 ischemic stroke and 2 TIA) had common noncancerous gynecologic diseases. The most common gynecologic diseases were uterine fibroids in 24 (62%) patients, followed by endometriosis in 9 (23%) and adenomyosis in 6 (15%). Twenty patients (51%) were assigned to the non-CSMs group, and 19 patients (49%) were assigned to the CSMs group. Adenomyosis and endometriosis were more frequent in the non-CSMs group than in the CSMs group. CA125 and D-dimer levels were higher in the non-CSMs group than in the CSMs group. Multiple vascular territory infarcts were frequent in patients with adenomyosis (60%) and endometriosis (43%) in the non-CSMs group. No stroke recurrence or death was observed within 3 months after discharge in both the CSMs and non-CSMs groups. Outcomes at 3 months after discharge were similar in both groups.

Discussion: In patients with common noncancerous gynecologic diseases, hypercoagulopathy may play a role in the pathogenesis of ischemic stroke/TIA without CSMs.

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Conflict of interest statement

The authors report no disclosures relevant to the manuscript. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.TAKE-HOME POINTS→ Among female patients with ischemic stroke/TIA, 8% had common noncancerous gynecologic diseases, such as uterine fibroids, endometriosis, and adenomyosis.→ Half of the patients with ischemic stroke/TIA and common noncancerous gynecologic diseases had non-CSMs that included cryptogenic stroke, NBTE, and paradoxical embolism.→ Patients with non-CSMs had higher frequencies of adenomyosis and endometriosis, and higher CA125 and D-dimer levels than those with CSMs.→ Hypercoagulopathy may play a role in the pathogenesis of ischemic stroke/TIA in patients with common noncancerous gynecologic diseases and non-CSMs.

Figures

Figure 1
Figure 1. Patient Selection
Patients were classified into 2 groups according to stroke mechanisms: conventional stroke mechanism group (large artery atherosclerosis, small vessel occlusion, cardiogenic embolism, and other determined etiology) and nonconventional stroke mechanism group (cryptogenic stroke and causes related to hypercoagulability such as nonbacterial thrombotic endocarditis and paradoxical embolism).
Figure 2
Figure 2. Distributions of the Levels of CA125 and D-Dimer in the Uterine Fibroid, Endometriosis, and Adenomyosis Groups by Stroke Mechanism
CSMs = conventional stroke mechanisms.
See this image and copyright information in PMC

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