151
|
Jiang H, Qin C, Cheng D, Lu Q, Huang G, Wang D, Yang H, Liang Z. Potential Pathogenesis and Biomarkers of Kidney Cancer-Related Stroke. Med Sci Monit 2017; 23:2292-2298. [PMID: 28505148 PMCID: PMC5441415 DOI: 10.12659/msm.904710] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Stroke risk and stroke recurrence are increased in cancer patients, but the pathogenesis and biomarkers of kidney cancer-related stroke (KCS) are generally unclear. The aim of the present research was to investigate the pathogenesis and plasma biomarkers of kidney cancer-related stroke. MATERIAL AND METHODS A retrospective review was conducted on acute stroke patients with kidney cancer (KC) who were admitted to the hospital between January 2006 and December 2015. A total of 106 patients with KCS (active KC patients with acute stroke but without conventional vascular risks) were identified. In addition, 106 age- and sex-matched patients with KC alone were recruited. RESULTS KCS patients had higher plasma D-dimer, cancer antigen (CA) 125, and CEA levels and greater proteinuria levels than did KC patients. Multiple logistic regression analysis showed that the risk of stroke in patients with KC increased independently by 0.8% (odds ratio [OR] 1.008; 95% confidence interval [CI] 1.002, 1.013; p=0.004) with a 1 ng/mL increase in D-dimer levels, by 1.2% (OR 1.012; 95% CI 1.007, 1.018; p=0.000) with a 1 U/mL increase in CA125, by 2.5% (OR 1.025; 95% CI 1.012, 1.038; p=0.000) with a 1 U/mL increase in CEA by 1.4% (OR 1.014; 95% CI 1.005, 1.024; p=0.004) with a 1 mg increase in urine protein in 24 hours. CONCLUSIONS Elevated plasma D-dimer, CA125 and CEA levels, and increased urine protein levels might lead to hypercoagulability and then KCS; however, they may also be biomarkers of KCS.
Collapse
Affiliation(s)
- Haihong Jiang
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Chao Qin
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Daobin Cheng
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Qiuhong Lu
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Gelun Huang
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Dacheng Wang
- Department of Neurology, Ninth Affiliated Hospital of Guangxi Medical University, Beihai, Guangxi, China (mainland)
| | - Hong Yang
- Department of Neurology, Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, China (mainland)
| | - Zhijian Liang
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| |
Collapse
|
152
|
Fitzpatrick T, Carrier M, Le Gal G. Cancer, atrial fibrillation, and stroke. Thromb Res 2017; 155:101-105. [PMID: 28528288 DOI: 10.1016/j.thromres.2017.05.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 05/05/2017] [Accepted: 05/06/2017] [Indexed: 12/13/2022]
Abstract
Cancer patients appear to be at increased risk for atrial fibrillation. Although surgery and chemotherapy exacerbate this risk, this association is observed even in the absence of any cancer-specific treatment. The underlying mechanism of this is likely multifactorial, but systemic inflammation and autonomic dysregulation are hypothesized to play critical roles. Cancer and atrial fibrillation are both independent risk factors for ischemic stroke; however, it is not clear whether this translates to an increased risk of stroke in patients with both comorbidities. As such, commonly used risk stratification tools including the CHADS2 score currently do not take cancer into account as a variable and it is possible that stroke risk is underestimated in this population. There is a paucity of data regarding anticoagulant choice in cancer patients with atrial fibrillation. Vitamin K antagonists are often preferred over direct oral anticoagulants; however, this may be changing in the near future as new trials specific to this patient population emerge.
Collapse
Affiliation(s)
- Tess Fitzpatrick
- Division of Neurology (TS), Division of Hematology (MC, GLG), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Marc Carrier
- Division of Neurology (TS), Division of Hematology (MC, GLG), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Grégoire Le Gal
- Division of Neurology (TS), Division of Hematology (MC, GLG), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
| |
Collapse
|
153
|
Yaghi S, Bernstein RA, Passman R, Okin PM, Furie KL. Cryptogenic Stroke: Research and Practice. Circ Res 2017; 120:527-540. [PMID: 28154102 DOI: 10.1161/circresaha.116.308447] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/23/2016] [Accepted: 10/04/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cryptogenic stroke accounts for 30% to 40% of ischemic stroke. It is essential to determine the possible culprit because this will improve secondary stroke prevention strategies. METHODS We performed a narrative nonsystematic review of the literature that included randomized trials, exploratory comparative studies, and case series on cryptogenic stroke. RESULTS There are several possible mechanisms implicated in cryptogenic stroke, including occult paroxysmal atrial fibrillation, patent foramen ovale, aortic arch atherosclerosis, atrial cardiopathy, and substenotic atherosclerosis. The heterogeneity of these mechanisms leads to differences in stroke prevention strategies among cryptogenic stroke patients. CONCLUSIONS A thorough diagnostic evaluation is essential to determine the pathogenesis in cryptogenic stroke. This approach, in addition to risk factor management and lifestyle modifications, will lead to improved stroke prevention strategies in patients with cryptogenic stroke. This will allow for targeted clinical trials to improve stroke prevention strategies in this patient population.
Collapse
Affiliation(s)
- Shadi Yaghi
- From the Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI (S.Y., K.L.F.); Department of Neurology (R.A.B.) and Department of Internal Medicine, Division of Cardiovascular Medicine (R.P.), The Feinberg School of Medicine, Northwestern University, Chicago, IL; and Department of Internal Medicine, Division of Cardiology, Weill Cornell Medicine, New York, NY (P.M.O.)
| | - Richard A Bernstein
- From the Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI (S.Y., K.L.F.); Department of Neurology (R.A.B.) and Department of Internal Medicine, Division of Cardiovascular Medicine (R.P.), The Feinberg School of Medicine, Northwestern University, Chicago, IL; and Department of Internal Medicine, Division of Cardiology, Weill Cornell Medicine, New York, NY (P.M.O.)
| | - Rod Passman
- From the Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI (S.Y., K.L.F.); Department of Neurology (R.A.B.) and Department of Internal Medicine, Division of Cardiovascular Medicine (R.P.), The Feinberg School of Medicine, Northwestern University, Chicago, IL; and Department of Internal Medicine, Division of Cardiology, Weill Cornell Medicine, New York, NY (P.M.O.)
| | - Peter M Okin
- From the Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI (S.Y., K.L.F.); Department of Neurology (R.A.B.) and Department of Internal Medicine, Division of Cardiovascular Medicine (R.P.), The Feinberg School of Medicine, Northwestern University, Chicago, IL; and Department of Internal Medicine, Division of Cardiology, Weill Cornell Medicine, New York, NY (P.M.O.)
| | - Karen L Furie
- From the Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI (S.Y., K.L.F.); Department of Neurology (R.A.B.) and Department of Internal Medicine, Division of Cardiovascular Medicine (R.P.), The Feinberg School of Medicine, Northwestern University, Chicago, IL; and Department of Internal Medicine, Division of Cardiology, Weill Cornell Medicine, New York, NY (P.M.O.).
| |
Collapse
|
154
|
Three-Month Outcomes Are Poor in Stroke Patients with Cancer Despite Acute Stroke Treatment. J Stroke Cerebrovasc Dis 2017; 26:809-815. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.10.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 09/20/2016] [Accepted: 10/19/2016] [Indexed: 12/12/2022] Open
|
155
|
Nam KW, Kim CK, Kim TJ, An SJ, Oh K, Mo H, Kang MK, Han MK, Demchuk AM, Ko SB, Yoon BW. Predictors of 30-day mortality and the risk of recurrent systemic thromboembolism in cancer patients suffering acute ischemic stroke. PLoS One 2017; 12:e0172793. [PMID: 28282388 PMCID: PMC5345775 DOI: 10.1371/journal.pone.0172793] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 02/09/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Stroke in cancer patients is not rare but is a devastating event with high mortality. However, the predictors of mortality in stroke patients with cancer have not been well addressed. D-dimer could be a useful predictor because it can reflect both thromboembolic events and advanced stages of cancer. AIM In this study, we evaluate the possibility of D-dimer as a predictor of 30-day mortality in stroke patients with active cancer. METHODS We included 210 ischemic stroke patients with active cancer. The 30-day mortality data were collected by reviewing medical records. We also collected follow-up D-dimer levels in 106 (50%) participants to evaluate the effects of treatment response on D-dimer levels. RESULTS Of the 210 participants, 30-day mortality occurred in 28 (13%) patients. Higher initial NIHSS scores, D-dimer levels, and CRP levels as well as frequent cryptogenic mechanism, systemic metastasis, multiple vascular territory lesion, hemorrhagic transformation, and larger infarct volume were related to 30-day mortality. In the multivariate analysis, D-dimer [adjusted OR (aOR) = 2.19; 95% CI, 1.46-3.28, P < 0.001] predicted 30-day mortality after adjusting for confounders. The initial NIHSS score (aOR = 1.07; 95% CI, 1.00-1.14, P = 0.043) and hemorrhagic transformation (aOR = 3.02; 95% CI, 1.10-8.29, P = 0.032) were also significant independent of D-dimer levels. In the analysis of D-dimer changes after treatment, the mortality group showed no significant decrease in D-dimer levels, despite treatment, while the survivor group showed the opposite response. CONCLUSIONS D-dimer levels may predict 30-day mortality in acute ischemic stroke patients with active cancer.
Collapse
Affiliation(s)
- Ki-Woong Nam
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital and Korea University College of Medicine, Seoul, Korea
- Calgary Stroke Program, Department of Clinical Neuroscience and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Tae Jung Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Sang Joon An
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University Guro Hospital and Korea University College of Medicine, Seoul, Korea
| | - Heejung Mo
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Min Kyoung Kang
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Moon-Ku Han
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Andrew M. Demchuk
- Calgary Stroke Program, Department of Clinical Neuroscience and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Sang-Bae Ko
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Byung-Woo Yoon
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
- * E-mail:
| |
Collapse
|
156
|
Kassubek R, Bullinger L, Kassubek J, Dreyhaupt J, Ludolph AC, Althaus K, Lewerenz J. Identifying ischemic stroke associated with cancer: a multiple model derived from a case-control analysis. J Neurol 2017; 264:781-791. [PMID: 28247043 DOI: 10.1007/s00415-017-8432-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 02/19/2017] [Accepted: 02/20/2017] [Indexed: 01/25/2023]
Abstract
Ischemic stroke in patients with cancer is thought to be associated with a worse prognosis and might be the initial symptom of an unknown malignancy. However, diagnostic algorithms to reliably identify cancer-associated stroke have not been developed. In this retrospective single-centre analysis, 68 patients with ischemic stroke and an active solid malignancy were identified. Neurological assessment and outcome, cardiovascular risk factors, neuroimaging studies as well as laboratory findings were compared to 68 age- and sex-matched control subjects with ischemic stroke without diagnosis of cancer. Lung, pancreatic and renal cancer showed increased prevalences compared to those of the general population in Germany. Diagnosis of cancer was most often made within the 12 months preceding (32.4%) or during the diagnostic work-up for stroke (17.7%). Cancer-associated stroke was characterized by a more severe clinical deficit, frequent clinical deterioration (13.2 vs. 1.5%) or death (25 vs. 4.4%). Ischemic lesions often involved multiple territories (51.6 vs. 12.7%), more often with co-existing subacute and acute infarctions in imaging studies (54.8 vs. 11.1%). Patients with cancer had significantly higher levels of C-reactive protein, relative granulocytosis and serum lactate dehydrogenase activity. Using receiver operating characteristics-based multiple analysis, we developed a model using these parameters which detected cancer-associated stroke with a sensitivity of 75% and specificity of 95%. Our analysis suggests that a multiple algorithm combining the number of territories involved and laboratory signs of inflammation and cell turnover might identify patients with stroke suffering from previously unknown malignancy.
Collapse
Affiliation(s)
- Rebecca Kassubek
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
| | - Lars Bullinger
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Jens Dreyhaupt
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - Albert C Ludolph
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Katharina Althaus
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Jan Lewerenz
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| |
Collapse
|
157
|
Gon Y, Sakaguchi M, Takasugi J, Kawano T, Kanki H, Watanabe A, Oyama N, Terasaki Y, Sasaki T, Mochizuki H. Plasma D-dimer levels and ischaemic lesions in multiple vascular regions can predict occult cancer in patients with cryptogenic stroke. Eur J Neurol 2016; 24:503-508. [PMID: 28026909 DOI: 10.1111/ene.13234] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 11/23/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Cancer patients with cryptogenic stroke often have high plasma D-dimer levels and lesions in multiple vascular regions. Hence, if patients with cryptogenic stroke display such characteristics, occult cancer could be predicted. This study aimed to investigate the clinical characteristics of cryptogenic stroke as the first manifestation of occult cancer and to determine whether plasma D-dimer levels and lesions in multiple vascular regions can predict occult cancer in patients with cryptogenic stroke. METHODS Between January 2006 and October 2015, data on 1225 patients with acute ischaemic stroke were extracted from the stroke database of Osaka University Hospital. Among them, 184 patients were classified as having cryptogenic stroke, and 120 patients without a diagnosis of cancer at stroke onset were identified. Clinical variables were analyzed between cryptogenic stroke patients with and without occult cancer. RESULTS Among 120 cryptogenic stroke patients without a diagnosis of cancer, 12 patients had occult cancer. The body mass index, hemoglobin levels and albumin levels were lower; plasma D-dimer and high-sensitivity C-reactive protein levels were higher; and lesions in multiple vascular regions were more common in patients with than in those without occult cancer. Multiple logistic regression analysis revealed that plasma D-dimer levels (odds ratio, 3.48; 95% confidence interval, 1.68-8.33; P = 0.002) and lesions in multiple vascular regions (odds ratio, 7.40; 95% confidence interval, 1.70-39.45; P = 0.01) independently predicted occult cancer. CONCLUSIONS High plasma D-dimer levels and lesions in multiple vascular regions can be used to predict occult cancer in patients with cryptogenic stroke.
Collapse
Affiliation(s)
- Y Gon
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - M Sakaguchi
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - J Takasugi
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - T Kawano
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - H Kanki
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - A Watanabe
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - N Oyama
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Y Terasaki
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - T Sasaki
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - H Mochizuki
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
158
|
Lee MJ, Chung JW, Ahn MJ, Kim S, Seok JM, Jang HM, Kim GM, Chung CS, Lee KH, Bang OY. Hypercoagulability and Mortality of Patients with Stroke and Active Cancer: The OASIS-CANCER Study. J Stroke 2016; 19:77-87. [PMID: 28030894 PMCID: PMC5307941 DOI: 10.5853/jos.2016.00570] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/25/2016] [Accepted: 10/04/2016] [Indexed: 12/28/2022] Open
Abstract
Background and Purpose Patients with active cancer are at an increased risk for stroke. Hypercoagulability plays an important role in cancer-related stroke. We aimed to test whether 1) hypercoagulability is a predictor of survival, and 2) correction of the hypercoagulable state leads to better survival in patients with stroke and active cancer. Methods We recruited consecutive patients with acute ischemic stroke and active systemic cancer between January 2006 and July 2015. Hypercoagulability was assessed using plasma D-dimer levels before and after 7 days of anticoagulation treatment. The study outcomes included overall and 1-year survival. Plasma D-dimer levels before and after treatment were tested in univariate and multivariate Cox regression models. We controlled for systemic metastasis, stroke mechanism, age, stroke severity, primary cancer type, histology, and atrial fibrillation using the forward stepwise method. Results A total of 268 patients were included in the analysis. Patients with high (3rd–4th quartiles) pre-treatment plasma D-dimer levels showed decreased overall and 1-year survival (adjusted HR, 2.19 [95% CI, 1.46–3.31] and 2.70 [1.68–4.35], respectively). After anticoagulation treatment, post-treatment D-dimer level was significantly reduced and independently associated with poor 1-year survival (adjusted HR, 1.03 [95% CI, 1.01–1.05] per 1 μg/mL increase, P=0.015). The successful correction of hypercoagulability was a protective factor for 1-year survival (adjusted HR 0.26 [CI 0.10–0.68], P=0.006). Conclusions Hypercoagulability is associated with poor survival after stroke in patients with active cancer. Effective correction of hypercoagulability may play a protective role for survival in these patients.
Collapse
Affiliation(s)
- Mi Ji Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myung-Ju Ahn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seonwoo Kim
- Biostatistics Team, Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Korea
| | - Jin Myoung Seok
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Min Jang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chin-Sang Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang Ho Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
159
|
Hinduja A, Limaye K, Ravilla R, Sasapu A, Papanikolaou X, Wei L, Torbey M, Waheed S. Spectrum of Cerebrovascular Disease in Patients with Multiple Myeloma Undergoing Chemotherapy-Results of a Case Control Study. PLoS One 2016; 11:e0166627. [PMID: 27902730 PMCID: PMC5130211 DOI: 10.1371/journal.pone.0166627] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 11/01/2016] [Indexed: 12/21/2022] Open
Abstract
Objectives Patients with multiple myeloma (MM) are at increased risk of arterial thrombosis. Our aim was to determine the risk factors, mechanisms and outcome of strokes in these patients. Methods We conducted a retrospective matched case–control study from our database of MM patients enrolled in Total Therapy (TT) 2, TT3a and TT3b protocols who developed a vascular event (transient ischemic attack, ischemic stroke, or intracerebral hemorrhage) from October 1998 to January 2014. Cases were matched for age-matched selected controls. Baseline demographics, risk factors, MM characteristics, laboratory values, and mortality of cases were compared to those of controls. Multivariate logistic regression analysis identified risk factors associated with stroke. Ischemic strokes (IS) were classified with modified Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Results Of 1,148 patients, 46 developed a vascular event (ischemic stroke, 33; transient ischemic attack, 11; hypertensive intracerebral hemorrhage, 2). Multivariate logistic regression analysis determined renal insufficiency (odds Ratio, 3.528; 95% CI, 1.36–9.14; P = 0.0094) and MM Stages I and II (odds Ratio, 2.770, 95% CI, 1.31–5.81; p = 0.0073) were independent predictors of stroke. In our study, strokes attributable to hypercoagulability, atrial fibrillation and small-vessel occlusion were common mechanisms. After a stroke, 78% of patients were discharged to home or a rehabilitation facility and 4% to a long-term nursing facility; in-hospital mortality was 15%. Despite suffering a stroke no significant differences in survival were observed. Conclusion In our cohort of multiple myeloma patients, renal failure and MM Stages I and II had increased risk of stroke.
Collapse
Affiliation(s)
- Archana Hinduja
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
- Department of Neurology, Ohio State University Wexner Medical Center, Columbus, OH, United States of America
- * E-mail:
| | - Kaustubh Limaye
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Rahul Ravilla
- Department of Hematology and Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Appalnaidu Sasapu
- Department of Hematology and Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Xenofon Papanikolaou
- Multiple Myeloma for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Lai Wei
- Department of Neurology, Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Michel Torbey
- Department of Neurology, Ohio State University Wexner Medical Center, Columbus, OH, United States of America
- Department of Neurosurgery, Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Sarah Waheed
- Multiple Myeloma for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| |
Collapse
|
160
|
Xie X, Chen L, Zeng J, Qin C, Cheng D, Wei X, Liang Z. Clinical features and biological markers of lung cancer-associated stroke. J Int Med Res 2016; 44:1483-1491. [PMID: 28322105 PMCID: PMC5536770 DOI: 10.1177/0300060516666398] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective To identify the unique clinical features and biological markers of lung cancer-associated stroke. Methods We recruited 102 patients with lung cancer plus stroke, 102 with lung cancer, and 102 with stroke. Detailed information was analysed and compared among groups. Results The groups were age-matched. Patients with lung cancer plus stroke showed multiple lesions involving multiple cerebral artery territories on magnetic resonance imaging, compared with stroke-alone patients. These patients also had a poorer modified Rankin Scale score at 30 days, and high mortality (18.6%). Patients with lung cancer plus stroke had a higher incidence of metastasis, and higher blood levels of D-dimer, CA125 and CA199 compared with patients with lung cancer alone. Multivariate logistic regression analysis showed that levels of D-dimer, CA125 and CA199 were independently related to lung cancer-associated stroke. Conclusion Elevated plasma D-dimer, CA125 and CA199 may be independent risk factors for and biomarkers of lung cancer-associated stroke.
Collapse
Affiliation(s)
- Xingrui Xie
- 1 Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Li Chen
- 1 Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jinsheng Zeng
- 2 Department of Neurology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chao Qin
- 1 Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Daobin Cheng
- 1 Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xinxian Wei
- 1 Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhijian Liang
- 1 Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| |
Collapse
|
161
|
Corraini P, Ording AG, Henderson VW, Szépligeti S, Horváth-Puhó E, Sørensen HT. Cancer, other comorbidity, and risk of venous thromboembolism after stroke: a population-based cohort study. Thromb Res 2016; 147:88-93. [DOI: 10.1016/j.thromres.2016.09.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/22/2016] [Accepted: 09/27/2016] [Indexed: 11/25/2022]
|
162
|
Finelli PF, Nouh A. Three-Territory DWI Acute Infarcts: Diagnostic Value in Cancer-Associated Hypercoagulation Stroke (Trousseau Syndrome). AJNR Am J Neuroradiol 2016; 37:2033-2036. [PMID: 27365322 DOI: 10.3174/ajnr.a4846] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 04/28/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE DWI infarcts involving the bilateral anterior and posterior circulation suggest an embolic etiology. In the absence of an identifiable embolic source, we analyzed DWI lesions involving these 3 cerebral territories to determine the diagnostic value for ischemic infarction caused by cancer-associated hypercoagulation. MATERIALS AND METHODS A retrospective analysis of all brain MR imaging studies at our institution from July 2014 to June 2015 was conducted, yielding 4075 studies. Of those, 17% (n = 709) contained the terms "restricted-diffusion" plus either "numerous," "innumerable," "multiple," or "bilateral." Of these 709 reports, 6% (n = 41) of DWI lesions involving 3 or more vascular territories of the bilateral anterior and posterior circulation were analyzed. RESULTS Of the 41 patients, 19 separate etiologies were identified, the most frequent being malignancy-related infarctions (22% [n = 9]) and hypoxic-ischemic injury (12% [n = 5]). Only 2 patients had an indeterminate etiology. The most frequent etiology of infarctions not suspected clinically or radiographically was malignancy (P < .001). Infarctions of malignancy had a characteristic appearance, being nonenhancing, nonring-appearing clusters or single areas of restricted diffusion of 0.5-2 cm with a peripheral location or larger vascular territories, uncommonly in a watershed distribution, and with absence of diffuse cortical ribbon or deep gray nuclei involvement. CONCLUSIONS Approximately 1 in 5 ischemic infarcts in patients with DWI lesions involving 3 vessel territories are malignancy related. In the absence of an identifiable embolic source, ischemic infarction with cancer-associated hypercoagulation accounts for 75% of cases. Cancer-associated hypercoagulation infarction should be considered, particularly when no other cause is apparent.
Collapse
Affiliation(s)
- P F Finelli
- From the Department of Neurology, Hartford Hospital and University of Connecticut School of Medicine, Hartford, Connecticut.
| | - A Nouh
- From the Department of Neurology, Hartford Hospital and University of Connecticut School of Medicine, Hartford, Connecticut
| |
Collapse
|
163
|
Nam KW, Kim CK, Kim TJ, An SJ, Demchuk AM, Kim Y, Jung S, Han MK, Ko SB, Yoon BW. D-dimer as a predictor of early neurologic deterioration in cryptogenic stroke with active cancer. Eur J Neurol 2016; 24:205-211. [PMID: 27766716 DOI: 10.1111/ene.13184] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 09/16/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND PURPOSE The occurrence of stroke in cancer patients is caused by conventional vascular risk factors and cancer-specific mechanisms. However, cryptogenic stroke in patients with cancer was considered to be more related to cancer-specific hypercoagulability. In this study, we investigated the potential of the D-dimer level to serve as a predictor of early neurologic deterioration (END) in cryptogenic stroke patients with active cancer. METHODS We recruited 109 cryptogenic stroke patients with active cancer within 72 h of symptom onset. We defined END as an increase of ≥1 point in the motor National Institutes of Health Stroke Scale (NIHSS) score or ≥2 points in the total NIHSS score within 72 h of admission. After adjusting for potential confounding factors in the multivariate analysis, we calculated the odds ratios (ORs) and confidence intervals (CIs) of D-dimer in the prediction of END. RESULTS Among 109 patients, END events were identified in 34 (31%) patients within 72 h. END was significantly associated with systemic metastasis, multiple vascular territory lesions on the initial magnetic resonance imaging (MRI), initial NIHSS score and D-dimer levels. In the multivariate analysis, the D-dimer level (adjusted OR, 1.11; 95% CI, 1.04-1.17; P < 0.01) and initial NIHSS score (adjusted OR, 1.08; 95% CI, 1.01-1.15; P = 0.03) predicted END after adjusting for potential confounding factors. In the subgroup analysis of 72 follow-up MRIs, D-dimer level was also correlated with new territory lesions on the follow-up MRI in a dose-dependent manner. CONCLUSION Ischemic stroke patients with active cancer and elevated D-dimer levels appear to be at increased risk for END recurrent thromboembolic stroke.
Collapse
Affiliation(s)
- K-W Nam
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - C K Kim
- Department of Neurology, Korea University Guro Hospital, Seoul, Korea.,Calgary Stroke Program, Department of Clinical Neuroscience and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - T J Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - S J An
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - A M Demchuk
- Calgary Stroke Program, Department of Clinical Neuroscience and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Y Kim
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - S Jung
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - M-K Han
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - S-B Ko
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - B-W Yoon
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
164
|
The Role of Pulmonary Veins in Cancer Progression from a Computed Tomography Viewpoint. JOURNAL OF ONCOLOGY 2016; 2016:1872627. [PMID: 27746816 PMCID: PMC5055964 DOI: 10.1155/2016/1872627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 08/25/2016] [Indexed: 12/21/2022]
Abstract
Background. We studied the role of pulmonary veins in cancer progression using computed tomography (CT) scans. Methods. We obtained data from 260 patients with pulmonary vein obstruction syndrome (PVOS). We used CT scans to investigate pulmonary lesions in relation to pulmonary veins. We divided the lesions into central and peripheral lesions by their anatomical location: in the lung parenchymal tissue or pulmonary vein; in the superior or inferior pulmonary vein; and by unilateral or bilateral presence in the lungs. Results. Of the 260 PVOS patients, 226 (87%) had central lesions, 231 (89%) had peripheral lesions, and 190 (75%) had mixed central and peripheral lesions. Among the 226 central lesions, 93% had lesions within the superior pulmonary vein, either bilaterally or unilaterally. Among the 231 peripheral lesions, 65% involved bilateral lungs, 70% involved lesions within the inferior pulmonary veins, and 23% had obvious metastatic extensions into the left atrium. All patients exhibited nodules within their pulmonary veins. The predeath status included respiratory failure (40%) and loss of consciousness (60%). Conclusion. CT scans play an important role in following tumor progression within pulmonary veins. Besides respiratory distress, PVOS cancer cells entering centrally can result in cardiac and cerebral events and loss of consciousness or can metastasize peripherally from the pulmonary veins to the lungs.
Collapse
|
165
|
Differentiation of cancer from atrial fibrillation in patients with acute multifocal stroke. J Neurol Sci 2016; 368:344-8. [DOI: 10.1016/j.jns.2016.07.054] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 07/21/2016] [Accepted: 07/22/2016] [Indexed: 11/18/2022]
|
166
|
Liao TY, Hsu HC, Wen MS, Juan YH, Hung YH, Liaw CC. Iliofemoral Venous Thrombosis Mainly Related to Iliofemoral Venous Obstruction by External Tumor Compression in Cancer Patients. Case Rep Oncol 2016; 9:760-771. [PMID: 27990113 PMCID: PMC5156891 DOI: 10.1159/000452943] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 10/27/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND To study iliofemoral venous thrombosis related to iliofemoral venous obstruction in cancer patients. METHODS In this case series study, 829 cancer patients were surveyed for iliofemoral obstruction/thrombosis within 10 years. The criteria for inclusion were: (1) presence of unilateral lower-extremity swelling; (2) computed tomography (CT) scans showing a tumor with external compression of the iliac or femoral vein, and (3) duplex ultrasound scans showing venous thrombosis or venous flow insufficiency over a femoral vein or saphenous vein. RESULTS Sixty-three patients (8%) developed an iliofemoral venous obstruction. The presence of iliofemoral venous thrombosis was detected in 21 of these patients (33%). The rate of iliofemoral venous thrombosis was significantly higher in patients with an invasion of the inguinal region, D-dimer levels >3,000 ng/ml, gastrointestinal cancer, or invasion of the inguinal lymph nodes. However, none of our patients with iliofemoral venous thrombosis had a detection of iliofemoral venous obstruction. Improved lower-extremity swelling was reported in 84% of the patients following combination therapy involving low-molecular-weight heparin (LMWH) and systemic therapy. CONCLUSION Patients with an iliofemoral venous thrombosis mainly had iliofemoral venous obstruction by external tumor compression. Combination therapy with LMWH and systemic therapy were mandatory for these patients.
Collapse
Affiliation(s)
- Tzu-Yao Liao
- Division of Hemato-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hui-Ching Hsu
- Division of Chinese Acupuncture and Traumatology, Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Min-Sheng Wen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Hsiang Juan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Hsin Hung
- Division of Hemato-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chuang-Chi Liaw
- Division of Hemato-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
167
|
D-Dimer versus International Normalized Ratio of Prothrombin Time in Ischemic Stroke Patients Treated with Sufficient Warfarin. J Stroke Cerebrovasc Dis 2016; 25:1781-1785. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.03.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 03/11/2016] [Accepted: 03/17/2016] [Indexed: 11/18/2022] Open
|
168
|
Yigit M, Sogut O, Yigit E, Turkdogan KA, Kaplan O, Dur A, Sonmez E, Demirel B. The relationship between anemia and recurrence of ischemic stroke in patients with Trousseau's syndrome: A retrospective cross-sectional study. Turk J Emerg Med 2016; 16:65-68. [PMID: 27896324 PMCID: PMC5121256 DOI: 10.1016/j.tjem.2015.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 11/09/2015] [Accepted: 11/27/2015] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES The relationship between cancer and thrombosis was first recognized by the French internist Armand Trousseau in 1865. Trousseau's syndrome is a spectrum of symptoms that result from recurrent thromboembolism associated with cancer or malignancy-related hypercoagulability. In this study, we investigated whether demographics, clinical features, or laboratory findings were able to predict recurrent stroke episodes in patients with Trousseau's syndrome. METHODS In total, 178 adult patients were enrolled in this retrospective cross-sectional study. All patients had been admitted to the emergency room of our hospital between January 2011 and September 2014 and were diagnosed with acute ischemic stroke. Patients were divided into two groups: patients with malignancy (Trousseau's syndrome), and patients without malignancy. RESULTS There were several significant differences between the laboratory results of the two patient groups. For patients with Trousseau's, the hemoglobin levels for those with one stroke was 12.29 ± 1.81, while those in patients who had experienced more than one stroke was 10.94 ± 2.14 (p = 0.004). CONCLUSIONS Trousseau's syndrome is a cancer-associated coagulopathy associated with high morbidity and mortality rates. In this study, anemia was associated with increased stroke recurrence in patients with malignancy (Trousseau's syndrome).
Collapse
Affiliation(s)
- Mehmet Yigit
- Department of Emergency Medicine, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Ozgur Sogut
- Department of Emergency Medicine, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Eda Yigit
- Department of Emergency Medicine, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | | | - Onur Kaplan
- Department of Emergency Medicine, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Ali Dur
- Department of Emergency Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ertan Sonmez
- Department of Emergency Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Bulut Demirel
- Department of Emergency Medicine, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
169
|
Bonnerot M, Humbertjean L, Mione G, Lacour JC, Derelle AL, Sanchez JC, Riou-Comte N, Richard S. Cerebral ischemic events in patients with pancreatic cancer: A retrospective cohort study of 17 patients and a literature review. Medicine (Baltimore) 2016; 95:e4009. [PMID: 27368015 PMCID: PMC4937929 DOI: 10.1097/md.0000000000004009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Stroke is a dramatic complication of pancreatic cancer with mechanisms related to oncological disease. A better description of the characteristics of cerebrovascular events would help better understand the pathogeny and protect vulnerable patients. We thus conducted a descriptive analysis of clinical, biological, and radiological features of patients from our centers and literature.We reviewed consecutive cases of patients who presented cerebrovascular events and pancreatic cancer in 4 stroke units in Lorrain (France) between January 1, 2009 and March 31, 2015, and all reported cases of literature. We identified 17 cases in our centers and 18 reported cases. Fifty-seven per cent of patients were male. Median age was 63 ± 14 years and ranged from 23 to 81 years. All cerebral events were ischemic. At the onset of stroke, pancreatic cancer had already been diagnosed in 59% of the patients in our centers for a mean time of 5.4 months. Five of them (29%) were being treated with gemcitabine and 2 (12%) with folfirinox. Adenocarcinoma at metastatic stage was reported in 82% of cases overall. Brain imaging revealed disseminated infarctions in 64%. High median levels of D-dimer (7600 ± 5 × 10 μg/L), C-reactive protein (63 ± 43 mg/L), and elevated prothrombin time (19 ± 6 seconds) were found. Thirty-six per cent of patients explored with echocardiography were diagnosed with nonbacterial thrombotic endocarditis. Ten of our patients received anticoagulant therapy as secondary stroke prevention without any documented recurrence. Nevertheless, outcome was poor with a median survival time of 28 ± 14 days after stroke onset. Cerebral ischemic events occur at advanced stages of pancreatic cancer, most likely by a thromboembolic mechanism. Disseminated infarctions and high D-dimer, C-reactive protein levels, and a high prothrombin time are the most constant characteristics found in this context. All patients should be screened for nonbacterial thrombotic endocarditis as this etiology supports the use of anticoagulant therapy.
Collapse
Affiliation(s)
| | | | | | | | - Anne-Laure Derelle
- Department of Neuroradiology, University Hospital of Nancy, Nancy, France
| | - Jean-Charles Sanchez
- Department of Human Protein Sciences, University Medical Center, Geneva, Switzerland
| | | | - Sébastien Richard
- Department of Neurology, Stroke Unit
- Department of Human Protein Sciences, University Medical Center, Geneva, Switzerland
- Centre d’Investigation Clinique Plurithématique Pierre Drouin, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
- Correspondence: Sébastien Richard, Service de Neurologie – Unité Neurovasculaire, Hôpital Central, 29 avenue Maréchal de Lattre de Tassigny, CO n°34, 54035 Nancy, Cedex, France (e-mail: )
| |
Collapse
|
170
|
Tzounos C, Davies ES. Intracranial infarcts in two cats with suspected thoracic limb and pulmonary neoplasia. VETERINARY RECORD CASE REPORTS 2016. [DOI: 10.1136/vetreccr-2015-000283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Emma Sian Davies
- Department Clinical ServicesCornell Veterinary CollegeIthacaNYUSA
| |
Collapse
|
171
|
Shin YW, Lee ST, Jung KH, Kim DY, Park CK, Kim TM, Choi SH, Chu K, Lee SK. Predictors of survival for patients with cancer after cryptogenic stroke. J Neurooncol 2016; 128:277-84. [PMID: 26968716 DOI: 10.1007/s11060-016-2106-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 03/06/2016] [Indexed: 12/11/2022]
Abstract
Patients with active cancer experience ischemic stroke via cryptogenic mechanisms, with cancer-associated hypercoagulability being considered a major contributor to such strokes. Despite the remarkably shortened survival of these patients, the clinical predictors of survival are poorly understood. We determined the clinical factors including D-dimer levels serving as the predictors of overall survival in these patients. Retrospective study was conducted on cancer patients who visited our hospital for acute ischemic stroke with cryptogenic mechanisms from April 2012 through November 2014. Demographics, clinical characteristics, imaging and laboratory results including coagulation markers were collected, and overall survival was calculated from the patient medical records and a governmental national database. A high D-dimer level was defined as a D-dimer level exceeding the median value from the study population (>5.50 μg/ml). A total of 93 patients were identified, with a median survival of 62 days (interquartile range 32-223 days). A high D-dimer level (p = 0.004; hazard ratio [HR] 2.01, 95 % confidence interval [CI] 1.26-3.21), systemic metastases (p = 0.02; HR 2.08, 95 % CI 1.11-3.90), and diabetes mellitus (p = 0.03; HR 1.78, 95 % CI 1.03-3.10) were identified as independent predictors of poor overall survival using multivariate Cox proportional hazard analysis. Most of the patients (87 %) were primarily treated with low-molecular-weight heparin (dalteparin, n = 49; enoxaparin, n = 32). The type of low-molecular-weight heparin had no association with survival. A high D-dimer level, systemic metastases, and diabetes are independent predictors of poor survival in cancer patients with cryptogenic stroke.
Collapse
Affiliation(s)
- Yong-Won Shin
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Nohwa Branch of Public Health Center, Seoul, Jeollanam-do, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea. .,Integrated Cancer Care Center, Seoul National University Cancer Hospital, Seoul, South Korea.
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Do-Yong Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
| | - Tae Min Kim
- Department of Internal Medicine, Cancer Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| |
Collapse
|
172
|
Abstract
Despite many advances in our understanding of ischemic stroke, cryptogenic strokes (those that do not have a determined etiology) remain a diagnostic and therapeutic challenge. Previous classification approaches to cryptogenic stroke have led to inconsistent definitions, and evidence to determine optimal treatment is scarce. These limitations have prompted international efforts to redefine cryptogenic strokes, leading to more rigorous diagnostic criteria, outcome studies, and new clinical trials. Improvement in our ability to detect paroxysmal atrial fibrillation in patients with cryptogenic stroke has strengthened the idea that these strokes are embolic in nature. Further, better understanding of acute biomarkers has helped to identify otherwise occult mechanisms. Together, these strategies will inform long-term outcomes and shape management.
Collapse
Affiliation(s)
- Cen Zhang
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, 19104, USA
| | - Scott Kasner
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, 19104, USA
| |
Collapse
|
173
|
Gon Y, Okazaki S, Terasaki Y, Sasaki T, Yoshimine T, Sakaguchi M, Mochizuki H. Characteristics of cryptogenic stroke in cancer patients. Ann Clin Transl Neurol 2016; 3:280-7. [PMID: 27081658 PMCID: PMC4818743 DOI: 10.1002/acn3.291] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 12/16/2015] [Accepted: 12/31/2015] [Indexed: 12/21/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Yasufumi Gon
- Department of Neurology Osaka University Graduate School of Medicine Osaka Japan
| | - Shuhei Okazaki
- Department of Neurology Osaka University Graduate School of Medicine Osaka Japan
| | - Yasukazu Terasaki
- Department of Neurology Osaka University Graduate School of Medicine Osaka Japan
| | - Tsutomu Sasaki
- Department of Neurology Osaka University Graduate School of Medicine Osaka Japan
| | - Toshiki Yoshimine
- Department of Neurosurgery Osaka University Graduate School of Medicine Osaka Japan
| | - Manabu Sakaguchi
- Department of Neurology Osaka University Graduate School of Medicine Osaka Japan
| | - Hideki Mochizuki
- Department of Neurology Osaka University Graduate School of Medicine Osaka Japan
| |
Collapse
|
174
|
Ando D, Kobayashi J, Kuroda H, Aoki M. Cancer-related Stroke due to Mural Thrombus in the Extracranial Carotid Artery. Intern Med 2016; 55:1497-9. [PMID: 27250060 DOI: 10.2169/internalmedicine.55.6013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 41-year-old man was admitted to our hospital because of a cancer-related stroke (CRS) caused by a thrombus of the extracranial carotid artery. He had undergone neoadjuvant radiochemotherapy for metastatic colorectal adenocarcinoma. The serum D-dimer values were within the normal range. We treated him with intravenous unfractionated heparin followed by warfarin. There were no recurrent stroke events over six months. The leading cause of a CRS is an embolism caused by hypercoagulopathy, mainly represented by non-bacterial thrombotic endocarditis. However, it was unusual that, in the current case, a thrombus of the extracranial carotid artery was formed with no significant residual stenosis, thus resulting in an artery-to-artery embolism.
Collapse
Affiliation(s)
- Daisuke Ando
- Department of Neurology, Tohoku University School of Medicine, Japan
| | | | | | | |
Collapse
|
175
|
Adams HP, Davis PH. Antithrombotic Therapy for Treatment of Acute Ischemic Stroke. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00052-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
176
|
Kneihsl M, Enzinger C, Wünsch G, Khalil M, Culea V, Urbanic-Purkart T, Payer F, Niederkorn K, Fazekas F, Gattringer T. Poor short-term outcome in patients with ischaemic stroke and active cancer. J Neurol 2015; 263:150-6. [DOI: 10.1007/s00415-015-7954-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 10/20/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
|
177
|
Pulmonary Venous Obstruction in Cancer Patients. JOURNAL OF ONCOLOGY 2015; 2015:210916. [PMID: 26425121 PMCID: PMC4575742 DOI: 10.1155/2015/210916] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 01/22/2015] [Accepted: 01/22/2015] [Indexed: 12/21/2022]
Abstract
Background. We study the clinical significance and management of pulmonary venous obstruction in cancer patients. Methods. We conducted a prospective cohort study to characterize the syndrome that we term “pulmonary vein obstruction syndrome” (PVOS) between January 2005 and March 2014. The criteria for inclusion were (1) episodes of shortness of breath; (2) chest X-ray showing abnormal pulmonary hilum shadow with or without presence of pulmonary edema and/or pleural effusion; (3) CT scan demonstrating pulmonary vein thrombosis/tumor with or without tumor around the vein. Results. Two hundred and twenty-two patients developed PVOS. Shortness of breath was the main symptom, which was aggravated by chemotherapy in 28 (13%), and medical/surgical procedures in 21 (9%) and showed diurnal change in intensity in 32 (14%). Chest X-rays all revealed abnormal pulmonary hilum shadows and presence of pulmonary edema in 194 (87%) and pleural effusion in 192 (86%). CT scans all showed pulmonary vein thrombosis/tumor (100%) and surrounding the pulmonary veins by tumor lesions in 140 patients (63%). PVOS was treated with low molecular weight heparin in combination with dexamethasone, and 66% of patients got clinical/image improvement. Conclusion. Physicians should be alert to PVOS when shortness of breath occurs and chest X-ray reveals abnormal pulmonary hilum shadows.
Collapse
|
178
|
Schwarzbach CJ, Fatar M, Eisele P, Ebert AD, Hennerici MG, Szabo K. DWI Lesion Patterns in Cancer-Related Stroke--Specifying the Phenotype. Cerebrovasc Dis Extra 2015; 5:139-45. [PMID: 26648971 PMCID: PMC4662270 DOI: 10.1159/000439549] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 08/14/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Due to the lack of specific diagnostic markers, the diagnosis of cancer-related stroke strongly depends on its phenotype. Distinct DWI lesion patterns with involvement of multiple vascular territories have been reported repeatedly in cancer-related stroke but have not been addressed in detail in a selected cohort of prospectively recruited cancer patients with emphasis on hypercoagulable conditions. PATIENTS AND METHODS Ischemic stroke patients with known malignant cancer activity, laboratory evidence of strong plasmatic hypercoagulation (D-dimer levels > 3 µg/ml) and without competing stroke etiologies according to the recently introduced ASCOD (A - atherosclerosis, S - small vessel disease, C - cardiac pathology, O - other cause, and D - dissection) classification of evidence-rated etiology of stroke subtypes were included in the analysis. Cerebral MRI on admission was reviewed with respect to ischemic lesion patterns. RESULTS Thirty-two patients met the inclusion criteria. The mean D-dimer levels were 15.39 µg/ml (± 10.84). Acute infarction in ≥ 2 vascular territories was present in 27/32 (84%) patients. (Micro-) embolic scattering of infarction was present in 25/32 (78%) patients. Evidence for previous, potentially oligosymptomatic infarction was found in 16 (50%) patients, demonstrated by the additional presence of subacute or chronic ischemic lesions. CONCLUSION When excluding competing embolic and nonembolic stroke etiologies, the pattern of scattered DWI lesions in multiple vascular supply territories strongly dominates the phenotype of cancer-related stroke. Additionally, evidence of recurrent infarction is frequent in this cohort of patients. This is not only important for the diagnosis of cancer-related stroke itself but may prove helpful for the identification of cancer-related stroke patients with unknown malignancy at the time of stroke manifestation and evaluation of strategies for secondary prevention.
Collapse
|
179
|
Comparison of Enoxaparin and Warfarin for Secondary Prevention of Cancer-Associated Stroke. JOURNAL OF ONCOLOGY 2015; 2015:502089. [PMID: 26064116 PMCID: PMC4439482 DOI: 10.1155/2015/502089] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 04/22/2015] [Indexed: 01/29/2023]
Abstract
Background. The aim of this study was to determine which anticoagulant is superior for secondary prevention of cancer-associated stroke, using changes in D-dimer levels as a biomarker for recurrent thromboembolic events. Methods. We conducted a retrospective, single center observational study including patients with cancer-associated stroke who were treated with either enoxaparin or warfarin. Blood samples for measuring the initial and follow-up D-dimer levels were collected at admission and a median of 8 days after admission, respectively. Multiple logistic regression analysis was conducted to evaluate the factors that influenced D-dimer levels after treatment. Results. Although the initial D-dimer levels did not differ between the two groups, the follow-up levels were dramatically decreased in patients treated with enoxaparin, while they did not change with use of warfarin (3.88 μg/mL versus 17.42 μg/mL, p = 0.026). On multiple logistic regression analysis, use of warfarin (OR 12.95; p = 0.001) and the presence of systemic metastasis (OR 18.73; p = 0.017) were independently associated with elevated D-dimer levels (≥10 μg/mL) after treatment. Conclusion. In cancer-associated stroke patients, treatment with enoxaparin may be more effective than treatment with warfarin for lowering the D-dimer levels. Future prospective studies are warranted to show that enoxaparin is better than warfarin for secondary prevention in cancer-associated stroke.
Collapse
|
180
|
Merkler AE, Navi BB, Singer S, Cheng NT, Stone JB, Kamel H, Iadecola C, Elkind MSV, DeAngelis LM. Diagnostic yield of echocardiography in cancer patients with ischemic stroke. J Neurooncol 2015; 123:115-21. [PMID: 25851114 DOI: 10.1007/s11060-015-1768-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 04/02/2015] [Indexed: 12/21/2022]
Abstract
The yield of echocardiography in cancer patients with acute ischemic stroke is unknown. We identified adult patients with active systemic cancer diagnosed with acute ischemic stroke at a tertiary-care cancer center from 2005 through 2009 who underwent transthoracic (TTE) or transesophageal echocardiography (TEE). Two neurologists independently reviewed all clinical data, including TTE and TEE reports, and adjudicated whether echocardiographic studies revealed a definite or possible source of stroke according to pre-defined criteria. Patients were classified as having suspected cardioembolic strokes if imaging showed embolic-appearing infarcts in more than one vascular territory. Among 220 patients with cancer and ischemic stroke who underwent echocardiography, 216 (98%) had TTE and 37 (17%) had TEE. TTE revealed a definite source in 15 (7%, 95% CI 4-10%) patients and a possible source in 42 (19%, 95% CI 14-25%), while TEE revealed a definite source in 10 (27%, 95% CI 12-42%) patients and a possible source in 14 (38%, 95% CI 21-54%). In 92 patients with suspected cardioembolic strokes who underwent TTE, 6 (7%, 95% CI 1-12%) had a definite source, including 4 with marantic endocarditis, and 20 (22%, 95% CI 13-30%) had a possible source. Twenty-one of these patients also underwent TEE, which demonstrated a definite or possible source in 16 (76%, 95% CI 56-96%) patients, including marantic endocarditis in 4 (19%). The yield of TTE for detecting marantic endocarditis and other cardiac sources of stroke in cancer patients is low, but TEE may provide a higher yield in targeted patients.
Collapse
Affiliation(s)
- Alexander E Merkler
- Department of Neurology, Weill Cornell Medical College, 525 East 68th Street, Room F610, New York, NY, 10065, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
181
|
The Activity of Malignancy May Determine Stroke Pattern in Cancer Patients. J Stroke Cerebrovasc Dis 2015; 24:778-83. [DOI: 10.1016/j.jstrokecerebrovasdis.2014.11.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 10/29/2014] [Accepted: 11/09/2014] [Indexed: 11/21/2022] Open
|
182
|
Multiple extra-ischemic hemorrhages following intravenous thrombolysis in a patient with Trousseau syndrome: case study. SPRINGERPLUS 2015; 4:141. [PMID: 25830084 PMCID: PMC4375212 DOI: 10.1186/s40064-015-0920-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 03/09/2015] [Indexed: 12/21/2022]
Abstract
Background Intracerebral hemorrhage is the most feared complication of intravenous thrombolysis for acute ischemic stroke. Such hemorrhage usually occurs within or at the margin of ischemic or manifestly infarcted brain tissue. A patient with Trousseau syndrome who developed multiple extra-ischemic hemorrhages following intravenous thrombolysis is described. Case description An 80-year-old Japanese man with no other underlying disease was diagnosed with unresectable advanced lung cancer (stage IV) without brain metastasis and had not yet been treated. The patient suddenly presented with disturbance of consciousness, right hemiplegia, and total aphasia, and was admitted to our hospital. Magnetic resonance imaging revealed acute cerebral infarction extending from the basal ganglia to the corona radiata of the left cerebrum and multiple small areas of bilateral cerebral cortices. Cardiogenic cerebral embolism was considered among the differential diagnoses, but the brain natriuretic peptide level was within the normal range, and no arrhythmias such as atrial fibrillation were observed. With no other causes, the patient was diagnosed with Trousseau syndrome due to hypercoagulability associated with the advanced lung cancer. The patient received intravenous tissue plasminogen activator (t-PA) at 96 minutes after onset of symptoms. His symptoms partially improved, but they suddenly deteriorated at 84 minutes after the thrombolysis. A computed tomography (CT) scan immediately after the neurological deterioration revealed a subcortical hemorrhage in the left occipital lobe. A repeat CT scan the day after onset showed enlargement of the left occipital hemorrhage and two new subcortical hemorrhages in the right frontal and right temporal lobes. These hemorrhages were located in areas remote from the acute ischemic lesions. Conclusion To the best of our knowledge, this is the first reported case of multiple extra-ischemic hemorrhages following intravenous thrombolysis in a patient with Trousseau syndrome. The course of this case suggests that intravenous t-PA administration for acute ischemic stroke with Trousseau syndrome may be associated with a higher risk of intracranial hemorrhage.
Collapse
|
183
|
Pulmonary Embolism and Stroke as the Initial Manifestation of Advanced Metastatic Pancreatic Adenocarcinoma. J Gastrointest Cancer 2015; 46:182-4. [DOI: 10.1007/s12029-015-9697-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
184
|
A case of Trousseau’s syndrome and pulmonary arteriovenous fistula: a malignant combination for ischemic stroke. Neurol Sci 2015; 36:1035-6. [DOI: 10.1007/s10072-015-2138-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 02/26/2015] [Indexed: 12/21/2022]
|
185
|
Mai H, Xia J, Wu Y, Ke J, Li J, Pan J, Chen W, Shao Y, Yang Z, Luo S, Sun Y, Zhao B, Li L. Clinical presentation and imaging characteristics of occult lung cancer associated ischemic stroke. J Clin Neurosci 2014; 22:296-302. [PMID: 25443087 DOI: 10.1016/j.jocn.2014.05.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 05/18/2014] [Indexed: 10/24/2022]
Abstract
We investigated the clinical and imaging characteristics of initial and recurrent strokes in patients with occult lung cancer associated ischemic stroke (OLCA-stroke). A retrospective review of all ischemic stroke patients with occult lung cancer in the absence of conventional stroke etiologies between 2005 and 2013 was conducted. We compared the initial and recurrent lesion patterns on diffusion-weighted MRI in patients with OLCA-stroke, with respect to vascular territory involved, number and size of lesions, clinical presentation, cancer subtypes, recurrences and fatalities, and outcome of survivors. Thirteen patients with confirmed OLCA-stroke were identified. All had elevated D-dimer levels, six had central lung cancer and seven had peripheral lung cancer. Eight (62%) had adenocarcinoma, and nine (69%) had metastasis. Ten (77%) patients had multiple lesions in multiple vascular territories. Twelve (92%) patients suffered recurrent strokes. Multiple small and large disseminated lesions in multiple vascular territories were more frequent in recurrent strokes in comparison with initial strokes. The middle cerebral artery was most frequently involved in recurrent strokes, followed by the posterior circulation territory and anterior cerebral artery, which were of similar frequency as initial strokes. Overall, 58% of patients had their first recurrent stroke within the first month, and 69% had a poor outcome, especially for those with multiple recurrent strokes and metastases. Occult cancer should be considered in the setting of multiple and recurrent embolic strokes within the short term in the absence of conventional stroke etiologies. The severity of malignancy and cancer treatments and stroke influenced the recurrences and outcome.
Collapse
Affiliation(s)
- Hui Mai
- Department of Neurology, Guangdong Medical College Affiliated Hospital, 57 South Renmin Road, Zhanjiang 524001, Guangdong, PR China
| | - Jun Xia
- Department of Radiology, Guangdong Medical College Affiliated Hospital, Zhanjiang, PR China
| | - Yongjun Wu
- Department of Radiology, Guangdong Medical College Affiliated Hospital, Zhanjiang, PR China
| | - Junlong Ke
- Department of Neurology, Guangdong Medical College Affiliated Hospital, 57 South Renmin Road, Zhanjiang 524001, Guangdong, PR China
| | - Junliang Li
- Department of Neurology, Guangdong Medical College Affiliated Hospital, 57 South Renmin Road, Zhanjiang 524001, Guangdong, PR China
| | - Jiangang Pan
- Department of Neurology, Guangdong Medical College Affiliated Hospital, 57 South Renmin Road, Zhanjiang 524001, Guangdong, PR China
| | - Wubiao Chen
- Department of Radiology, Guangdong Medical College Affiliated Hospital, Zhanjiang, PR China
| | - Yiming Shao
- Department of Critical Care Medicine, Guangdong Medical College Affiliated Hospital, Zhanjiang, PR China
| | - Zhi Yang
- Department of Neurology, Maoming People's Hospital, Maoming, PR China
| | - Saihua Luo
- Department of Neurosurgery, Lianjiang People's Hospital, Lianjiang, PR China
| | - Yonghua Sun
- Department of Radiology, Lianjiang People's Hospital, Lianjiang, PR China
| | - Bin Zhao
- Department of Neurology, Guangdong Medical College Affiliated Hospital, 57 South Renmin Road, Zhanjiang 524001, Guangdong, PR China
| | - Longxuan Li
- Department of Neurology, Guangdong Medical College Affiliated Hospital, 57 South Renmin Road, Zhanjiang 524001, Guangdong, PR China; Department of Neurology, Gongli Hospital, Pudong New Area, Shanghai, PR China.
| |
Collapse
|
186
|
Lee KJ, Jung KH, Byun JI, Kim JM, Roh JK. Infarct Pattern and Clinical Outcome in Acute Ischemic Stroke Following Middle Cerebral Artery Occlusion. Cerebrovasc Dis 2014; 38:31-8. [DOI: 10.1159/000364939] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 05/30/2014] [Indexed: 11/19/2022] Open
|
187
|
Navi BB, Singer S, Merkler AE, Cheng NT, Stone JB, Kamel H, Iadecola C, Elkind MSV, DeAngelis LM. Cryptogenic subtype predicts reduced survival among cancer patients with ischemic stroke. Stroke 2014; 45:2292-7. [PMID: 24994717 DOI: 10.1161/strokeaha.114.005784] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Cryptogenic stroke is common in patients with cancer. Autopsy studies suggest that many of these cases may be because of marantic endocarditis, which is closely linked to cancer activity. We, therefore, hypothesized that among patients with cancer and ischemic stroke, those with cryptogenic stroke would have shorter survival. METHODS We retrospectively analyzed all adult patients with active systemic cancer diagnosed with acute ischemic stroke at a tertiary care cancer center from 2005 through 2009. Two neurologists determined stroke mechanisms by consensus. Patients were diagnosed with cryptogenic stroke if no specific mechanism could be determined. The diagnosis of marantic endocarditis was restricted to patients with cardiac vegetations on echocardiography or autopsy and negative blood cultures. Patients were followed until July 31, 2012, for the primary outcome of death. Kaplan-Meier statistics and the log-rank test were used to compare survival between patients with cryptogenic stroke and patients with known stroke mechanisms. Multivariate Cox proportional hazard analysis evaluated the association between cryptogenic stroke and death after adjusting for potential confounders. RESULTS Among 263 patients with cancer and ischemic stroke, 133 (51%) were cryptogenic. Median survival in patients with cryptogenic stroke was 55 days (interquartile range, 21-240) versus 147 days (interquartile range, 33-735) in patients with known stroke mechanisms (P<0.01). Cryptogenic stroke was independently associated with death (hazard ratio, 1.64; 95% confidence interval, 1.25-2.14) after adjusting for age, systemic metastases, adenocarcinoma histology, and functional status. CONCLUSIONS Cryptogenic stroke is independently associated with reduced survival in patients with active cancer and ischemic stroke.
Collapse
Affiliation(s)
- Babak B Navi
- From the Department of Neurology (B.B.N., A.E.M., N.T.C., H.K., C.I., L.M.D.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K., C.I.), Weill Cornell Medical College, New York, NY; Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY (B.B.N., S.S., J.B.S., L.M.D.); and Department of Neurology, College of Physicians and Surgeons and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.).
| | - Samuel Singer
- From the Department of Neurology (B.B.N., A.E.M., N.T.C., H.K., C.I., L.M.D.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K., C.I.), Weill Cornell Medical College, New York, NY; Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY (B.B.N., S.S., J.B.S., L.M.D.); and Department of Neurology, College of Physicians and Surgeons and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.)
| | - Alexander E Merkler
- From the Department of Neurology (B.B.N., A.E.M., N.T.C., H.K., C.I., L.M.D.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K., C.I.), Weill Cornell Medical College, New York, NY; Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY (B.B.N., S.S., J.B.S., L.M.D.); and Department of Neurology, College of Physicians and Surgeons and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.)
| | - Natalie T Cheng
- From the Department of Neurology (B.B.N., A.E.M., N.T.C., H.K., C.I., L.M.D.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K., C.I.), Weill Cornell Medical College, New York, NY; Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY (B.B.N., S.S., J.B.S., L.M.D.); and Department of Neurology, College of Physicians and Surgeons and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.)
| | - Jacqueline B Stone
- From the Department of Neurology (B.B.N., A.E.M., N.T.C., H.K., C.I., L.M.D.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K., C.I.), Weill Cornell Medical College, New York, NY; Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY (B.B.N., S.S., J.B.S., L.M.D.); and Department of Neurology, College of Physicians and Surgeons and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.)
| | - Hooman Kamel
- From the Department of Neurology (B.B.N., A.E.M., N.T.C., H.K., C.I., L.M.D.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K., C.I.), Weill Cornell Medical College, New York, NY; Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY (B.B.N., S.S., J.B.S., L.M.D.); and Department of Neurology, College of Physicians and Surgeons and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.)
| | - Costantino Iadecola
- From the Department of Neurology (B.B.N., A.E.M., N.T.C., H.K., C.I., L.M.D.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K., C.I.), Weill Cornell Medical College, New York, NY; Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY (B.B.N., S.S., J.B.S., L.M.D.); and Department of Neurology, College of Physicians and Surgeons and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.)
| | - Mitchell S V Elkind
- From the Department of Neurology (B.B.N., A.E.M., N.T.C., H.K., C.I., L.M.D.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K., C.I.), Weill Cornell Medical College, New York, NY; Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY (B.B.N., S.S., J.B.S., L.M.D.); and Department of Neurology, College of Physicians and Surgeons and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.)
| | - Lisa M DeAngelis
- From the Department of Neurology (B.B.N., A.E.M., N.T.C., H.K., C.I., L.M.D.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K., C.I.), Weill Cornell Medical College, New York, NY; Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY (B.B.N., S.S., J.B.S., L.M.D.); and Department of Neurology, College of Physicians and Surgeons and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.)
| |
Collapse
|
188
|
Zhang Y, Frohman MA. Cellular and physiological roles for phospholipase D1 in cancer. J Biol Chem 2014; 289:22567-22574. [PMID: 24990946 DOI: 10.1074/jbc.r114.576876] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Phospholipase D enzymes have long been proposed to play multiple cell biological roles in cancer. With the generation of phospholipase D1 (PLD1)-deficient mice and the development of small molecule PLD-specific inhibitors, in vivo roles for PLD1 in cancer are now being defined, both in the tumor cells and in the tumor environment. We review here tools now used to explore in vivo roles for PLD1 in cancer and summarize recent findings regarding functions in angiogenesis and metastasis.
Collapse
Affiliation(s)
- Yi Zhang
- Center for Developmental Genetics and the Department of Pharmacological Sciences, Stony Brook University, Stony Brook, New York 11794
| | - Michael A Frohman
- Center for Developmental Genetics and the Department of Pharmacological Sciences, Stony Brook University, Stony Brook, New York 11794.
| |
Collapse
|
189
|
Malignancy-related mortality following kidney transplantation is common. Kidney Int 2014; 85:1395-403. [DOI: 10.1038/ki.2013.458] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 08/30/2013] [Accepted: 09/05/2013] [Indexed: 01/09/2023]
|
190
|
Kim K, Lee JH. Risk factors and biomarkers of ischemic stroke in cancer patients. J Stroke 2014; 16:91-6. [PMID: 24949315 PMCID: PMC4060273 DOI: 10.5853/jos.2014.16.2.91] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 11/01/2013] [Accepted: 11/01/2013] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND PURPOSE Stroke is common among cancer patients. However, risk factors and biomarkers of stroke in cancer patients are not well established. This study aimed to investigate risk factors and biomarkers as well as etiology of ischemic stroke in cancer patients. METHODS A retrospective review was conducted in cancer patients with ischemic stroke who were admitted to a general hospital in Busan, Korea, between January 2003 and December 2012. The risk factors and biomarkers for stroke and stroke subtypes in cancer patients were compared with age- and sex-matched noncancer patients with ischemic stroke who were admitted to the same hospital during the same period. RESULTS One hundred fifty-six cancer patients with ischemic stroke were identified. Cancer patients with ischemic stroke were found to have a significantly lower proportion of hypertension, atrial fibrillation, hyperlipidemia, and ischemic heart disease than noncancer patients with ischemic stroke. However, stroke biomarkers, such as erythrocyte sedimentation rate and high-sensitivity C-reactive protein, fibrinogen, pro-brain natriuretic peptide, and D-dimer levels, were significantly increased in cancer patients with ischemic stroke than in noncancer patients. Large-artery atherosclerosis and stroke of undetermined cause were more common in cancer patients with ischemic stroke than in noncancer patients with ischemic stroke. CONCLUSIONS Cancer patients with ischemic stroke showed different risk factors, stroke biomarkers, and stroke etiology compared with noncancer patients with ischemic stroke.
Collapse
Affiliation(s)
- Kwangsoo Kim
- Department of Neurology, Kosin University College of Medicine, Busan, Korea
| | - Ji-Hun Lee
- Department of Neurology, Kosin University College of Medicine, Busan, Korea
| |
Collapse
|
191
|
Navi BB, Singer S, Merkler AE, Cheng NT, Stone JB, Kamel H, Iadecola C, Elkind MSV, DeAngelis LM. Recurrent thromboembolic events after ischemic stroke in patients with cancer. Neurology 2014; 83:26-33. [PMID: 24850486 DOI: 10.1212/wnl.0000000000000539] [Citation(s) in RCA: 137] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To determine the cumulative rate and characteristics of recurrent thromboembolic events after acute ischemic stroke in patients with cancer. METHODS We retrospectively identified consecutive adult patients with active systemic cancer diagnosed with acute ischemic stroke at a tertiary-care cancer center from 2005 through 2009. Two neurologists independently reviewed all electronic records to ascertain the composite outcome of recurrent ischemic stroke, myocardial infarction, systemic embolism, TIA, or venous thromboembolism. Kaplan-Meier statistics were used to determine cumulative outcome rates. In exploratory analyses, Cox proportional hazard analysis was used to evaluate potential independent associations between a priori selected clinical factors and recurrent thromboembolic events. RESULTS Among 263 study patients, complete follow-up until death was available in 230 (87%). Most patients had an adenocarcinoma as their underlying cancer (60%) and had systemic metastases (69%). Despite a median survival of 84 days (interquartile range 24-419 days), 90 patients (34%; 95% confidence interval 28%-40%) had 117 recurrent thromboembolic events, consisting of 57 cases of venous thromboembolism, 36 recurrent ischemic strokes, 13 myocardial infarctions, 10 cases of systemic embolism, and one TIA. Kaplan-Meier rates of recurrent thromboembolism were 21%, 31%, and 37% at 1, 3, and 6 months, respectively; cumulative rates of recurrent ischemic stroke were 7%, 13%, and 16%. Adenocarcinoma histology (hazard ratio 1.65, 95% confidence interval 1.02-2.68) was independently associated with recurrent thromboembolism. CONCLUSIONS Patients with acute ischemic stroke in the setting of active cancer (especially adenocarcinoma) face a substantial short-term risk of recurrent ischemic stroke and other types of thromboembolism.
Collapse
Affiliation(s)
- Babak B Navi
- From the Department of Neurology and the Brain and Mind Research Institute (B.B.N., A.E.M., N.T.C., J.B.S., H.K., C.I., L.M.D.), Weill Cornell Medical College, New York; Department of Neurology (B.B.N., S.S., L.M.D.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (M.S.V.E.), Columbia University, New York, NY.
| | - Samuel Singer
- From the Department of Neurology and the Brain and Mind Research Institute (B.B.N., A.E.M., N.T.C., J.B.S., H.K., C.I., L.M.D.), Weill Cornell Medical College, New York; Department of Neurology (B.B.N., S.S., L.M.D.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (M.S.V.E.), Columbia University, New York, NY
| | - Alexander E Merkler
- From the Department of Neurology and the Brain and Mind Research Institute (B.B.N., A.E.M., N.T.C., J.B.S., H.K., C.I., L.M.D.), Weill Cornell Medical College, New York; Department of Neurology (B.B.N., S.S., L.M.D.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (M.S.V.E.), Columbia University, New York, NY
| | - Natalie T Cheng
- From the Department of Neurology and the Brain and Mind Research Institute (B.B.N., A.E.M., N.T.C., J.B.S., H.K., C.I., L.M.D.), Weill Cornell Medical College, New York; Department of Neurology (B.B.N., S.S., L.M.D.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (M.S.V.E.), Columbia University, New York, NY
| | - Jacqueline B Stone
- From the Department of Neurology and the Brain and Mind Research Institute (B.B.N., A.E.M., N.T.C., J.B.S., H.K., C.I., L.M.D.), Weill Cornell Medical College, New York; Department of Neurology (B.B.N., S.S., L.M.D.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (M.S.V.E.), Columbia University, New York, NY
| | - Hooman Kamel
- From the Department of Neurology and the Brain and Mind Research Institute (B.B.N., A.E.M., N.T.C., J.B.S., H.K., C.I., L.M.D.), Weill Cornell Medical College, New York; Department of Neurology (B.B.N., S.S., L.M.D.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (M.S.V.E.), Columbia University, New York, NY
| | - Costantino Iadecola
- From the Department of Neurology and the Brain and Mind Research Institute (B.B.N., A.E.M., N.T.C., J.B.S., H.K., C.I., L.M.D.), Weill Cornell Medical College, New York; Department of Neurology (B.B.N., S.S., L.M.D.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (M.S.V.E.), Columbia University, New York, NY
| | - Mitchell S V Elkind
- From the Department of Neurology and the Brain and Mind Research Institute (B.B.N., A.E.M., N.T.C., J.B.S., H.K., C.I., L.M.D.), Weill Cornell Medical College, New York; Department of Neurology (B.B.N., S.S., L.M.D.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (M.S.V.E.), Columbia University, New York, NY
| | - Lisa M DeAngelis
- From the Department of Neurology and the Brain and Mind Research Institute (B.B.N., A.E.M., N.T.C., J.B.S., H.K., C.I., L.M.D.), Weill Cornell Medical College, New York; Department of Neurology (B.B.N., S.S., L.M.D.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (M.S.V.E.), Columbia University, New York, NY
| |
Collapse
|
192
|
Goedee S, Naber A, Rovers JMP, Roks G. Ischaemic stroke as initial presentation of systemic malignancy. BMJ Case Rep 2014; 2014:bcr-2013-202122. [PMID: 24591382 DOI: 10.1136/bcr-2013-202122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Ischaemic stroke as the initial presentation of systemic malignancy is reported infrequently and is characterised by ischaemic lesions that exceed the vascular territory of a single vessel. There is also a high rate of early stroke recurrence. Several pathophysiological mechanisms are known to cause cerebrovascular complications in malignancies, as a direct effect of the tumour, paraneoplastic or even of the tumour treatment itself. Prognosis is reportedly poor, treatment is symptomatic and at best anecdotal. We present a case report and available literature.
Collapse
Affiliation(s)
- Stephan Goedee
- Department of Neurology, UMC Utrecht, Utrecht, The Netherlands
| | | | | | | |
Collapse
|
193
|
Tseng WS. Halitosis: Could it be a predictor of stroke? Med Hypotheses 2014; 82:335-7. [DOI: 10.1016/j.mehy.2013.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 12/27/2013] [Indexed: 12/21/2022]
|
194
|
Lau KK, Wong YK, Teo KC, Chang RSK, Hon SFK, Chan KH, Cheung RTF, Li LSW, Tse HF, Ho SL, Siu CW. Stroke patients with a past history of cancer are at increased risk of recurrent stroke and cardiovascular mortality. PLoS One 2014; 9:e88283. [PMID: 24523883 PMCID: PMC3921146 DOI: 10.1371/journal.pone.0088283] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 01/07/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND PURPOSE Cancer patients are at increased risk of cardiovascular and cerebrovascular events. It is unclear whether cancer confers any additional risk for recurrent stroke or cardiovascular mortality after stroke. METHODS This was a single center, observational study of 1,105 consecutive Chinese ischemic stroke patients recruited from a large stroke rehabilitation unit based in Hong Kong. We sought to determine whether patients with cancer are at higher risk of recurrent stroke and cardiovascular mortality. RESULTS Amongst 1,105 patients, 58 patients (5.2%) had cancer, of whom 74% were in remission. After a mean follow-up of 76 ± 18 months, 241 patients developed a recurrent stroke: 22 in patients with cancer (38%, annual incidence 13.94%/year), substantially more than those without cancer (21%, 4.65%/year) (p<0.01). In a Cox regression model, cancer, age and atrial fibrillation were the 3 independent predictors of recurrent stroke with a hazard ratio (HR) of 2.42 (95% confidence interval (CI): 1.54-3.80), 1.01 (1.00-1.03) and 1.35 (1.01-1.82) respectively. Likewise, patients with cancer had a higher cardiovascular mortality compared with those without cancer (4.30%/year vs. 2.35%/year, p = 0.08). In Cox regression analysis, cancer (HR: 2.08, 95% CI: 1.08-4.02), age (HR: 1.04, 95% CI 1.02-1.06), heart failure (HR: 3.06, 95% CI 1.72-5.47) and significant carotid atherosclerosis (HR: 1.55, 95% CI 1.02-2.36) were independent predictors for cardiovascular mortality. CONCLUSIONS Stroke patients with a past history of cancer are at increased risk of recurrent stroke and cardiovascular mortality.
Collapse
Affiliation(s)
- Kui-Kai Lau
- Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
- Research Center of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Yuen-Kwun Wong
- Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Kay-Cheong Teo
- Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Richard Shek-Kwan Chang
- Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Sonny Fong-Kwong Hon
- Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Koon-Ho Chan
- Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
- Research Center of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Raymond Tak-Fai Cheung
- Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
- Research Center of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Leonard Sheung-Wai Li
- Division of Rehabilitation Medicine, Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Hung-Fat Tse
- Research Center of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Shu-Leong Ho
- Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
- Research Center of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- * E-mail: (CWS); (SLH)
| | - Chung-Wah Siu
- Research Center of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
- * E-mail: (CWS); (SLH)
| |
Collapse
|
195
|
Villemur B, Payraud E, Seetha V, De Angelis MP, Magne J, Perennou D, Carpentier P, Pernod G. Thromboses itératives de pontages artériels et cancer : à propos de trois cas. ACTA ACUST UNITED AC 2014; 39:14-7. [DOI: 10.1016/j.jmv.2013.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 08/22/2013] [Indexed: 12/24/2022]
|
196
|
Predictive value of plasma (D)-dimer levels for cancer-related stroke: a 3-year retrospective study. J Stroke Cerebrovasc Dis 2013; 23:e249-54. [PMID: 24295603 DOI: 10.1016/j.jstrokecerebrovasdis.2013.10.022] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 10/23/2013] [Accepted: 10/24/2013] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Cerebrovascular disease is the second leading cause of central nervous system pathology in cancer patients. Cancer-associated hypercoagulation plays an important role in cancer-related stroke. The present study aims to test whether plasma d-dimer levels could predict comorbid malignancy in patients with ischemic stroke. METHODS Five hundred sixteen stroke patients with measured d-dimer levels and who were consecutively admitted to our stroke center from 2009 to 2012 were included. Cancer status was determined by medical chart, and 59 patients were identified to have active cancer. An additional 48 cancer patients with stroke were identified from the hospital database. Several d-dimer cutoff levels were used to predict cancer-related stroke. RESULTS Stroke patients with active cancer had significantly higher d-dimer levels than those without cancer (P < .001). The average d-dimer level in stroke patients without cancer was .66 ± 1.83 mg/L, whereas the levels for active cancer patients from the stroke center and hospital database were 5.70 ± 9.63 mg/L and 10.47 ± 12.31 mg/L, respectively. When using d-dimer of .55 mg/L or more and multiple territory infarctions as criteria, the specificity and positive predictive value (PPV) for cancer-related stroke were 99.7% and 92.9%, respectively. When using d-dimer of 5.5 mg/L or more as the cutoff value, the test had a high specificity and PPV regardless the brain magnetic resonance imaging (MRI) findings. Six stroke patients fitting our criteria were confirmed to have occult malignancy after comprehensive cancer survey. CONCLUSIONS Extraordinary high d-dimer levels or combining d-dimer and MRI findings may be used as a screening tool to detect malignancy in stroke patients.
Collapse
|
197
|
Zis P, Assi A, Kravaritis D, Sevastianos VA. Ischemic stroke as the first manifestation of hepatic epithelioid hemangioendothelioma. J Stroke Cerebrovasc Dis 2013; 23:e237-40. [PMID: 24231139 DOI: 10.1016/j.jstrokecerebrovasdis.2013.09.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 09/30/2013] [Indexed: 10/26/2022] Open
Abstract
A 38-year-old obese woman, with a past medical history of cholecystectomy and dyslipidaemia, presented with acute occipital headache, vomiting and rotational vertigo which lasted 8 hours. On admission neurological examination was unremarkable, however general physical examination revealed hepatomegaly. Routine blood tests showed abnormal liver function tests. MRI scan indicated an acute ischemic infarct in the right cerebellum. Extensive investigation was negative. However, liver MRI revealed multiple lesions in both liver lobes. Ultrasound guided liver biopsy and histopathological analysis confirmed the diagnosis of hepatic hemangioendothelioma. In conclusion, hypercoaguable state related to hepatic epithelioid hemangioendothelioma can lead to an ischemic stroke, as a rare first manifestation of the disease.
Collapse
Affiliation(s)
- Panagiotis Zis
- Department of Neurology, Evangelismos General Hospital, Athens, Greece.
| | - Avraam Assi
- Fourth Department of Internal Medicine, Evangelismos General Hospital, Athens, Greece
| | | | | |
Collapse
|
198
|
Tadokoro Y, Sakaguchi M, Yagita Y, Furukado S, Okazaki S, Fujinaka T, Kimura T, Yoshimine T, Mochizuki H, Kitagawa K. Ischemic stroke in patients with solid gynecologic tract tumors and coagulopathy. Eur Neurol 2013; 70:304-7. [PMID: 24080953 DOI: 10.1159/000353799] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 06/16/2013] [Indexed: 11/19/2022]
Abstract
AIM Patients with gynecological neoplasms often suffer ischemic stroke. This study aimed to clarify the underlying mechanisms of ischemic stroke in patients with gynecological tract tumors. METHODS We retrospectively reviewed 6 patients with gynecologic tumors and hypercoagulability who were being treated for acute ischemic stroke between 2006 and 2012. Diffusion-weighted magnetic resonance imaging (DW-MRI), cardiovascular risk factors including plasma D-dimer levels, and histologic examination of the patients' solid tumors were performed. All 6 patients underwent transesophageal echocardiography (TEE) for nonbacterial thrombotic endocarditis (NBTE) and paradoxical embolism. RESULTS All 6 patients showed elevated plasma D-dimer levels. In 1 patient, paradoxical embolism was diagnosed. In the remaining 5 patients, DW-MRI scans showed numerous lesions in multiple vascular territories, and in 4 of these 5 patients, TEE demonstrated vegetations on the mitral valve, leading to the diagnosis of NBTE. Interestingly, 2 of these 4 patients had benign uterine tumors, whereas the other 2 had ovarian cancer. CONCLUSIONS NBTE was the main etiology for ischemic stroke in patients with gynecologic tract tumors and coagulopathy. Both malignant and benign tumors of the gynecologic tract can cause NBTE.
Collapse
Affiliation(s)
- Yasuhiro Tadokoro
- Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
199
|
Abstract
Background Thromboembolic events are important causes of morbidity and mortality in cancer patients. Clinical presentation in a community-based setting has not been fully clarified. The purpose of this study was to evaluate the incidence, risk factors, role of thrombophilia, and subsequent survival following thrombosis in cancer patients. Methods A retrospective review was undertaken of clinical data for all consecutive patients with histologically confirmed cancer seen by the author at a regional cancer center, with emphasis on cancer-related thrombosis. Results Between 2005 and 2012, of 1874 cancer patients, 307 (16.4%) developed thrombosis during their lifetime. Of these patients, 37 (2%) had a history of thrombosis, while the remaining 270 (14.4%) patients developed thrombosis 3 months before or any time after diagnosis of cancer, which was considered to be cancer-related. These patients included 230 (12.3%) with venous thrombosis, 28 (1.5%) cases with arterial occlusion, and 12 (0.6%) with combined venous and arterial thrombosis. Patients of Caucasian ancestry were more prone to develop thrombosis, with a higher frequency of multiple genetic thrombophilia compared with other ethnic groups. In regression analysis, only advanced stages of cancer and the presence of atherosclerosis were predictive of thrombosis. There were no significant differences between venous and arterial thrombosis. The worst survival was noted in patients who developed thrombosis 3 months prior to or shortly after their diagnosis of cancer. There has been a recent improved survival outcome following therapy. Conclusion In addition to venous thrombosis, arterial occlusion with stroke and anginal symptoms is relatively common among cancer patients, especially those of Caucasian ancestry, and is possibly related to genetic predisposition.
Collapse
Affiliation(s)
- Magid H Amer
- Department of Medicine, St Rita's Medical Center, Lima, OH, USA
| |
Collapse
|