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Tateishi Y, Soejima K, Ideguchi Y, Amano T, Torimura D, Otsuka H, Yamashita A, Tomita Y, Hirayama T, Shima T, Yoshimura S, Miyazaki T, Matsunaga Y, Akashi R, Morofuji Y, Maemura K, Tsujino A. Acute heart failure as a predictor of short-term cardiovascular outcomes in patients with acute ischemic stroke. J Neurol Sci 2025; 471:123443. [PMID: 40023936 DOI: 10.1016/j.jns.2025.123443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Revised: 02/03/2025] [Accepted: 02/24/2025] [Indexed: 03/04/2025]
Abstract
BACKGROUND The impact of acute heart failure following acute ischemic stroke on short-term cardiovascular outcomes remains unclear. This study investigated the association between acute heart failure and cardiovascular outcomes within 90 days after acute ischemic stroke. METHOD AND RESULTS We retrospectively analyzed 1658 patients with acute ischemic stroke. In-hospital heart failure was defined as heart failure diagnosed on admission or within seven days of hospitalization. The primary outcome was a composite of major adverse cardiovascular events within 90 days of acute ischemic stroke. Secondary outcomes included a composite of fatal or nonfatal heart failure and all-cause mortality. Logistic regression analyses were used to identify predictors of these outcomes. Eighty-two patients with acute ischemic stroke (4.9 %) developed acute heart failure. Major adverse cardiovascular events occurred in 120 patients (7 %) within 90 days. In-hospital heart failure was an independent predictor of major adverse cardiovascular events (odds ratio [OR] 2.25, 95 % confidence interval [CI] 1.11-4.53, p = 0.023) and fatal or nonfatal heart failure (OR 4.72, 95 % CI 1.96-11.35, p = 0.001) within 90 days. However, it was not a significant predictor of all-cause mortality (OR 1.90, 95 % CI 0.94-3.84, p = 0.075). CONCLUSIONS In-hospital heart failure was a significant predictor of major adverse cardiovascular events and fatal or nonfatal heart failure within 90 days after acute ischemic stroke.
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Affiliation(s)
- Yohei Tateishi
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan; Department of Clinical Neuroscience, Unit of Clinical Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Kosuke Soejima
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan.
| | - Yu Ideguchi
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan.
| | - Takanori Amano
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan.
| | - Daiji Torimura
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan.
| | - Hiroaki Otsuka
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan.
| | - Aya Yamashita
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan.
| | - Yuki Tomita
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan.
| | - Takuro Hirayama
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan.
| | - Tomoaki Shima
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan; Department of Clinical Neuroscience, Unit of Clinical Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Shunsuke Yoshimura
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan; Department of Clinical Neuroscience, Unit of Clinical Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Teiichiro Miyazaki
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan; Department of Clinical Neuroscience, Unit of Clinical Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Yuki Matsunaga
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Ryohei Akashi
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Yoichi Morofuji
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Koji Maemura
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Akira Tsujino
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan; Department of Clinical Neuroscience, Unit of Clinical Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
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Oh MS, Yu KH, Lee BC, Kim JY, Kim BJ, Kang J, Han MK, Kim SE, Park JM, Kang K, Lee SJ, Kim JG, Cha JK, Kim DH, Park TH, Lee K, Park HK, Cho YJ, Hong KS, Choi KH, Kim JT, Kim DE, Choi JC, Park KY, Lee KJ, Lee JS, Jang S, Chae JE, Lee J, Gorelick PB, Bae HJ. Temporal patterns of occult cancer incidence following acute ischemic stroke: A comparative study by stroke etiology. Int J Stroke 2025:17474930251335615. [PMID: 40205731 DOI: 10.1177/17474930251335615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2025]
Abstract
BACKGROUNDS AND AIMS This study investigates the temporal patterns of occult cancer incidence among survivors of acute ischemic stroke (AIS), with a focus on variations by underlying stroke etiology. PATIENTS AND METHODS We analyzed data from a prospective, multicenter stroke registry and a national claims database, identifying AIS patients hospitalized between 2011 and 2013. Patients were categorized by stroke etiology into two groups: unidentified stroke etiology (USE) and identified stroke etiology (ISE). We estimated the occult cancer incidence rates within both groups and the overall AIS cohort. Using Poisson regression, we evaluated variations in cancer incidence over time and by stroke etiology, adjusting for age, sex, and smoking status. We also compared the first-year cancer incidence rate in our cohort to the age-standardized incidence rate (ASIR) in the general Korean population. RESULTS Among 9759 AIS patients (median follow-up: 4.4 years), 976 occult cancers were diagnosed in 569 patients (5.8%). The first month post-stroke exhibited the highest cancer incidence rates across all groups: 8.3 (overall AIS), 14.3 (USE), and 7.6 (ISE) per 1000 person-months, with rates decreasing rapidly thereafter and stabilizing after 12 months. Compared to beyond 36 months, the adjusted incidence rate ratios within 1 month were 7.1 for overall AIS, 17.6 for USE, and 6.8 for ISE. The heightened risk in the USE group, compared to the ISE group, was significant within 1 month but diminished thereafter. Relative to the general population, the ASIR in this cohort was 1.6 times higher, particularly among men and those in the USE category. CONCLUSION Occult cancer incidence is notably high in the early period following AIS, especially among patients with USE. These findings underscore the importance of vigilant cancer screening immediately after a stroke, especially for patients without a clear stroke etiology.Data access statement:Access to the linked data utilized in this research was restricted to authorized researchers and limited to a pre-defined period only. Therefore, it is not possible to guarantee access to the data after the completion of this study, even upon reasonable request.
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Affiliation(s)
- Mi Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Republic of Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Republic of Korea
| | - Byung-Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Republic of Korea
| | - Jun Yup Kim
- Department of Neurology, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, Republic of Korea
| | - Beom Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, Republic of Korea
| | - Jihoon Kang
- Department of Neurology, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, Republic of Korea
| | - Moon-Ku Han
- Department of Neurology, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, Republic of Korea
| | - Seong-Eun Kim
- Department of Neurology, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, Republic of Korea
| | - Jong-Moo Park
- Department of Neurology, Uijeongbu Eulji Medical Center, School of Medicine, Eulji University, Uijenongbu, Republic of Korea
| | - Kyusik Kang
- Department of Neurology, Nowon Eulji Medical Center, School of Medicine, Eulji University, Seoul, Republic of Korea
| | - Soo Joo Lee
- Department of Neurology, Daejeon Eulji Medical Center, School of Medicine, Eulji University, Daejeon, Republic of Korea
| | - Jae Guk Kim
- Department of Neurology, Daejeon Eulji Medical Center, School of Medicine, Eulji University, Daejeon, Republic of Korea
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University Hospital, College of Medicine, Dong-A University, Busan, Republic of Korea
| | - Dae-Hyun Kim
- Department of Neurology, Dong-A University Hospital, College of Medicine, Dong-A University, Busan, Republic of Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, Republic of Korea
| | - Kyungbok Lee
- Department of Neurology, Soonchunhyang University Seoul Hospital, College of Medicine, Soonchunhyang University, Seoul, Republic of Korea
| | - Hong-Kyun Park
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Yong-Jin Cho
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Keun-Sik Hong
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, College of Medicine, Chonnam National University, Gwangju, Republic of Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, College of Medicine, Chonnam National University, Gwangju, Republic of Korea
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, School of Medicine, Jeju National University, Jeju, Republic of Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Keon-Joo Lee
- Department of Neurology, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Sujung Jang
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Jae Eun Chae
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Juneyoung Lee
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Philip B Gorelick
- Division of Stroke and Neurocritical Care, Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, Republic of Korea
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Ryan D, Bou Dargham T, Ikramuddin S, Shekhar S, Sengupta S, Feng W. Epidemiology, Pathophysiology, and Management of Cancer-Associated Ischemic Stroke. Cancers (Basel) 2024; 16:4016. [PMID: 39682202 DOI: 10.3390/cancers16234016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Revised: 11/25/2024] [Accepted: 11/26/2024] [Indexed: 12/18/2024] Open
Abstract
Cancer and stroke are leading causes of global disability and mortality. With improvements in cancer-associated mortality and advancements in treatment of active malignancy, it is more common to encounter patients with ischemic stroke and active malignancy. Evidence suggests that cancer-associated ischemic stroke is a unique subtype of stroke; however, there is limited guidance when considering diagnostic workup, secondary prevention, rehabilitation, and future directions within this population. In this narrative review, we aim to describe the epidemiology, pathophysiological mechanisms, management, and future directions regarding understanding of cancer-associated ischemic stroke.
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Affiliation(s)
- Dylan Ryan
- Department of Neurology, Duke University School of Medicine, Durham, NC 27704, USA
| | - Tarek Bou Dargham
- Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC 27710, USA
| | - Salman Ikramuddin
- Department of Neurology, University of Texas Health Sciences Houston, Houston, TX 77030, USA
| | - Shashank Shekhar
- Department of Neurology, Duke University School of Medicine, Durham, NC 27704, USA
| | - Soma Sengupta
- Department of Neurology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Wuwei Feng
- Department of Neurology, Duke University School of Medicine, Durham, NC 27704, USA
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4
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Navi BB, Zhang C, Miller BR, Pawar A, Cushman M, Kasner SE, Tirschwell D, Longstreth WT, Kronmal R, Elm J, Zweifler RM, Tarsia J, Broderick JP, Gladstone DJ, Beyeler M, Kamel H, Elkind MSV, Streib C. Diagnosis of Incident Cancer After Cryptogenic Stroke: An Exploratory Analysis of the ARCADIA Randomized Trial. Neurology 2024; 103:e210027. [PMID: 39481070 PMCID: PMC11527484 DOI: 10.1212/wnl.0000000000210027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 09/05/2024] [Indexed: 11/02/2024] Open
Abstract
OBJECTIVES The objective of this study was to estimate the incidence, timing, and type of new cancer diagnosis among patients with cryptogenic stroke. METHODS We used data from the ARCADIA trial, which enrolled patients with cryptogenic stroke and atrial cardiopathy. Participants were prospectively followed, and serious adverse events were assessed every 3 months or sooner if investigators were alerted between visits to an event. Kaplan-Meier statistics were used to estimate the cumulative incidence of a cancer diagnosis within the first year after randomization. RESULTS Among 878 participants without baseline history of cancer, 13 (1.5%) were diagnosed with incident cancer in the year after randomization, comprising 12 solid cancers (3 prostate, 2 breast, 2 gastrointestinal, and 5 other primary sites) and 1 hematologic cancer (non-Hodgkin lymphoma). The cumulative incidences of a cancer diagnosis were 0% at 3 months, 0.6% (95% CI 0.2%-1.5%) at 6 months, and 2.0% (95 CI 1.1%-3.4%) at 1 year. The median time from index stroke to cancer diagnosis was 261 days (interquartile range 183-358). DISCUSSION In a multicenter cryptogenic stroke cohort with prospective follow-up, the 1-year cumulative incidence of a cancer diagnosis was 2%. This rate may be an underestimation because of the clinical trial population and exclusion of cancers diagnosed immediately after stroke. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov Identifier: NCT03192215. Registered June 20, 2017. First patient enrolled February 1, 2018.
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Affiliation(s)
- Babak B Navi
- From the Clinical and Translational Neuroscience Unit (B.B.N., C.Z., A.P., M.B., H.K.), Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York; Department of Neurology (B.B.N.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Neurology (B.R.M., C.S.), University of Minnesota, Minneapolis; Division of Hematology and Oncology (M.C.), Department of Medicine, University of Vermont Larner College of Medicine, Burlington; Department of Neurology (S.E.K.), University of Pennsylvania School of Medicine, Philadelphia; Department of Neurology (D.T., W.L.), Department of Epidemiology (W.L.), and Department of Biostatistics (R.K.), University of Washington, Seattle; Department of Biostatistics (J.E.), Medical University of South Carolina, Charleston; Ochsner Neuroscience Institute (R.M.Z., J.T.), Ochsner Health, New Orleans, LA; Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati College of Medicine, OH; Sunnybrook Research Institute (D.J.G.), Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, and Division of Neurology (D.J.G.), Department of Medicine, University of Toronto, Ontario, Canada; Department of Neurology (M.B.), Inselspital, Bern University Hospital and University of Bern, Switzerland; and Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Cenai Zhang
- From the Clinical and Translational Neuroscience Unit (B.B.N., C.Z., A.P., M.B., H.K.), Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York; Department of Neurology (B.B.N.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Neurology (B.R.M., C.S.), University of Minnesota, Minneapolis; Division of Hematology and Oncology (M.C.), Department of Medicine, University of Vermont Larner College of Medicine, Burlington; Department of Neurology (S.E.K.), University of Pennsylvania School of Medicine, Philadelphia; Department of Neurology (D.T., W.L.), Department of Epidemiology (W.L.), and Department of Biostatistics (R.K.), University of Washington, Seattle; Department of Biostatistics (J.E.), Medical University of South Carolina, Charleston; Ochsner Neuroscience Institute (R.M.Z., J.T.), Ochsner Health, New Orleans, LA; Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati College of Medicine, OH; Sunnybrook Research Institute (D.J.G.), Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, and Division of Neurology (D.J.G.), Department of Medicine, University of Toronto, Ontario, Canada; Department of Neurology (M.B.), Inselspital, Bern University Hospital and University of Bern, Switzerland; and Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Benjamin R Miller
- From the Clinical and Translational Neuroscience Unit (B.B.N., C.Z., A.P., M.B., H.K.), Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York; Department of Neurology (B.B.N.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Neurology (B.R.M., C.S.), University of Minnesota, Minneapolis; Division of Hematology and Oncology (M.C.), Department of Medicine, University of Vermont Larner College of Medicine, Burlington; Department of Neurology (S.E.K.), University of Pennsylvania School of Medicine, Philadelphia; Department of Neurology (D.T., W.L.), Department of Epidemiology (W.L.), and Department of Biostatistics (R.K.), University of Washington, Seattle; Department of Biostatistics (J.E.), Medical University of South Carolina, Charleston; Ochsner Neuroscience Institute (R.M.Z., J.T.), Ochsner Health, New Orleans, LA; Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati College of Medicine, OH; Sunnybrook Research Institute (D.J.G.), Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, and Division of Neurology (D.J.G.), Department of Medicine, University of Toronto, Ontario, Canada; Department of Neurology (M.B.), Inselspital, Bern University Hospital and University of Bern, Switzerland; and Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Anokhi Pawar
- From the Clinical and Translational Neuroscience Unit (B.B.N., C.Z., A.P., M.B., H.K.), Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York; Department of Neurology (B.B.N.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Neurology (B.R.M., C.S.), University of Minnesota, Minneapolis; Division of Hematology and Oncology (M.C.), Department of Medicine, University of Vermont Larner College of Medicine, Burlington; Department of Neurology (S.E.K.), University of Pennsylvania School of Medicine, Philadelphia; Department of Neurology (D.T., W.L.), Department of Epidemiology (W.L.), and Department of Biostatistics (R.K.), University of Washington, Seattle; Department of Biostatistics (J.E.), Medical University of South Carolina, Charleston; Ochsner Neuroscience Institute (R.M.Z., J.T.), Ochsner Health, New Orleans, LA; Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati College of Medicine, OH; Sunnybrook Research Institute (D.J.G.), Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, and Division of Neurology (D.J.G.), Department of Medicine, University of Toronto, Ontario, Canada; Department of Neurology (M.B.), Inselspital, Bern University Hospital and University of Bern, Switzerland; and Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Mary Cushman
- From the Clinical and Translational Neuroscience Unit (B.B.N., C.Z., A.P., M.B., H.K.), Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York; Department of Neurology (B.B.N.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Neurology (B.R.M., C.S.), University of Minnesota, Minneapolis; Division of Hematology and Oncology (M.C.), Department of Medicine, University of Vermont Larner College of Medicine, Burlington; Department of Neurology (S.E.K.), University of Pennsylvania School of Medicine, Philadelphia; Department of Neurology (D.T., W.L.), Department of Epidemiology (W.L.), and Department of Biostatistics (R.K.), University of Washington, Seattle; Department of Biostatistics (J.E.), Medical University of South Carolina, Charleston; Ochsner Neuroscience Institute (R.M.Z., J.T.), Ochsner Health, New Orleans, LA; Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati College of Medicine, OH; Sunnybrook Research Institute (D.J.G.), Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, and Division of Neurology (D.J.G.), Department of Medicine, University of Toronto, Ontario, Canada; Department of Neurology (M.B.), Inselspital, Bern University Hospital and University of Bern, Switzerland; and Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Scott E Kasner
- From the Clinical and Translational Neuroscience Unit (B.B.N., C.Z., A.P., M.B., H.K.), Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York; Department of Neurology (B.B.N.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Neurology (B.R.M., C.S.), University of Minnesota, Minneapolis; Division of Hematology and Oncology (M.C.), Department of Medicine, University of Vermont Larner College of Medicine, Burlington; Department of Neurology (S.E.K.), University of Pennsylvania School of Medicine, Philadelphia; Department of Neurology (D.T., W.L.), Department of Epidemiology (W.L.), and Department of Biostatistics (R.K.), University of Washington, Seattle; Department of Biostatistics (J.E.), Medical University of South Carolina, Charleston; Ochsner Neuroscience Institute (R.M.Z., J.T.), Ochsner Health, New Orleans, LA; Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati College of Medicine, OH; Sunnybrook Research Institute (D.J.G.), Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, and Division of Neurology (D.J.G.), Department of Medicine, University of Toronto, Ontario, Canada; Department of Neurology (M.B.), Inselspital, Bern University Hospital and University of Bern, Switzerland; and Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - David Tirschwell
- From the Clinical and Translational Neuroscience Unit (B.B.N., C.Z., A.P., M.B., H.K.), Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York; Department of Neurology (B.B.N.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Neurology (B.R.M., C.S.), University of Minnesota, Minneapolis; Division of Hematology and Oncology (M.C.), Department of Medicine, University of Vermont Larner College of Medicine, Burlington; Department of Neurology (S.E.K.), University of Pennsylvania School of Medicine, Philadelphia; Department of Neurology (D.T., W.L.), Department of Epidemiology (W.L.), and Department of Biostatistics (R.K.), University of Washington, Seattle; Department of Biostatistics (J.E.), Medical University of South Carolina, Charleston; Ochsner Neuroscience Institute (R.M.Z., J.T.), Ochsner Health, New Orleans, LA; Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati College of Medicine, OH; Sunnybrook Research Institute (D.J.G.), Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, and Division of Neurology (D.J.G.), Department of Medicine, University of Toronto, Ontario, Canada; Department of Neurology (M.B.), Inselspital, Bern University Hospital and University of Bern, Switzerland; and Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - W T Longstreth
- From the Clinical and Translational Neuroscience Unit (B.B.N., C.Z., A.P., M.B., H.K.), Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York; Department of Neurology (B.B.N.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Neurology (B.R.M., C.S.), University of Minnesota, Minneapolis; Division of Hematology and Oncology (M.C.), Department of Medicine, University of Vermont Larner College of Medicine, Burlington; Department of Neurology (S.E.K.), University of Pennsylvania School of Medicine, Philadelphia; Department of Neurology (D.T., W.L.), Department of Epidemiology (W.L.), and Department of Biostatistics (R.K.), University of Washington, Seattle; Department of Biostatistics (J.E.), Medical University of South Carolina, Charleston; Ochsner Neuroscience Institute (R.M.Z., J.T.), Ochsner Health, New Orleans, LA; Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati College of Medicine, OH; Sunnybrook Research Institute (D.J.G.), Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, and Division of Neurology (D.J.G.), Department of Medicine, University of Toronto, Ontario, Canada; Department of Neurology (M.B.), Inselspital, Bern University Hospital and University of Bern, Switzerland; and Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Richard Kronmal
- From the Clinical and Translational Neuroscience Unit (B.B.N., C.Z., A.P., M.B., H.K.), Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York; Department of Neurology (B.B.N.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Neurology (B.R.M., C.S.), University of Minnesota, Minneapolis; Division of Hematology and Oncology (M.C.), Department of Medicine, University of Vermont Larner College of Medicine, Burlington; Department of Neurology (S.E.K.), University of Pennsylvania School of Medicine, Philadelphia; Department of Neurology (D.T., W.L.), Department of Epidemiology (W.L.), and Department of Biostatistics (R.K.), University of Washington, Seattle; Department of Biostatistics (J.E.), Medical University of South Carolina, Charleston; Ochsner Neuroscience Institute (R.M.Z., J.T.), Ochsner Health, New Orleans, LA; Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati College of Medicine, OH; Sunnybrook Research Institute (D.J.G.), Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, and Division of Neurology (D.J.G.), Department of Medicine, University of Toronto, Ontario, Canada; Department of Neurology (M.B.), Inselspital, Bern University Hospital and University of Bern, Switzerland; and Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Jordan Elm
- From the Clinical and Translational Neuroscience Unit (B.B.N., C.Z., A.P., M.B., H.K.), Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York; Department of Neurology (B.B.N.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Neurology (B.R.M., C.S.), University of Minnesota, Minneapolis; Division of Hematology and Oncology (M.C.), Department of Medicine, University of Vermont Larner College of Medicine, Burlington; Department of Neurology (S.E.K.), University of Pennsylvania School of Medicine, Philadelphia; Department of Neurology (D.T., W.L.), Department of Epidemiology (W.L.), and Department of Biostatistics (R.K.), University of Washington, Seattle; Department of Biostatistics (J.E.), Medical University of South Carolina, Charleston; Ochsner Neuroscience Institute (R.M.Z., J.T.), Ochsner Health, New Orleans, LA; Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati College of Medicine, OH; Sunnybrook Research Institute (D.J.G.), Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, and Division of Neurology (D.J.G.), Department of Medicine, University of Toronto, Ontario, Canada; Department of Neurology (M.B.), Inselspital, Bern University Hospital and University of Bern, Switzerland; and Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Richard M Zweifler
- From the Clinical and Translational Neuroscience Unit (B.B.N., C.Z., A.P., M.B., H.K.), Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York; Department of Neurology (B.B.N.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Neurology (B.R.M., C.S.), University of Minnesota, Minneapolis; Division of Hematology and Oncology (M.C.), Department of Medicine, University of Vermont Larner College of Medicine, Burlington; Department of Neurology (S.E.K.), University of Pennsylvania School of Medicine, Philadelphia; Department of Neurology (D.T., W.L.), Department of Epidemiology (W.L.), and Department of Biostatistics (R.K.), University of Washington, Seattle; Department of Biostatistics (J.E.), Medical University of South Carolina, Charleston; Ochsner Neuroscience Institute (R.M.Z., J.T.), Ochsner Health, New Orleans, LA; Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati College of Medicine, OH; Sunnybrook Research Institute (D.J.G.), Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, and Division of Neurology (D.J.G.), Department of Medicine, University of Toronto, Ontario, Canada; Department of Neurology (M.B.), Inselspital, Bern University Hospital and University of Bern, Switzerland; and Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Joseph Tarsia
- From the Clinical and Translational Neuroscience Unit (B.B.N., C.Z., A.P., M.B., H.K.), Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York; Department of Neurology (B.B.N.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Neurology (B.R.M., C.S.), University of Minnesota, Minneapolis; Division of Hematology and Oncology (M.C.), Department of Medicine, University of Vermont Larner College of Medicine, Burlington; Department of Neurology (S.E.K.), University of Pennsylvania School of Medicine, Philadelphia; Department of Neurology (D.T., W.L.), Department of Epidemiology (W.L.), and Department of Biostatistics (R.K.), University of Washington, Seattle; Department of Biostatistics (J.E.), Medical University of South Carolina, Charleston; Ochsner Neuroscience Institute (R.M.Z., J.T.), Ochsner Health, New Orleans, LA; Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati College of Medicine, OH; Sunnybrook Research Institute (D.J.G.), Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, and Division of Neurology (D.J.G.), Department of Medicine, University of Toronto, Ontario, Canada; Department of Neurology (M.B.), Inselspital, Bern University Hospital and University of Bern, Switzerland; and Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Joseph P Broderick
- From the Clinical and Translational Neuroscience Unit (B.B.N., C.Z., A.P., M.B., H.K.), Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York; Department of Neurology (B.B.N.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Neurology (B.R.M., C.S.), University of Minnesota, Minneapolis; Division of Hematology and Oncology (M.C.), Department of Medicine, University of Vermont Larner College of Medicine, Burlington; Department of Neurology (S.E.K.), University of Pennsylvania School of Medicine, Philadelphia; Department of Neurology (D.T., W.L.), Department of Epidemiology (W.L.), and Department of Biostatistics (R.K.), University of Washington, Seattle; Department of Biostatistics (J.E.), Medical University of South Carolina, Charleston; Ochsner Neuroscience Institute (R.M.Z., J.T.), Ochsner Health, New Orleans, LA; Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati College of Medicine, OH; Sunnybrook Research Institute (D.J.G.), Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, and Division of Neurology (D.J.G.), Department of Medicine, University of Toronto, Ontario, Canada; Department of Neurology (M.B.), Inselspital, Bern University Hospital and University of Bern, Switzerland; and Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - David J Gladstone
- From the Clinical and Translational Neuroscience Unit (B.B.N., C.Z., A.P., M.B., H.K.), Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York; Department of Neurology (B.B.N.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Neurology (B.R.M., C.S.), University of Minnesota, Minneapolis; Division of Hematology and Oncology (M.C.), Department of Medicine, University of Vermont Larner College of Medicine, Burlington; Department of Neurology (S.E.K.), University of Pennsylvania School of Medicine, Philadelphia; Department of Neurology (D.T., W.L.), Department of Epidemiology (W.L.), and Department of Biostatistics (R.K.), University of Washington, Seattle; Department of Biostatistics (J.E.), Medical University of South Carolina, Charleston; Ochsner Neuroscience Institute (R.M.Z., J.T.), Ochsner Health, New Orleans, LA; Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati College of Medicine, OH; Sunnybrook Research Institute (D.J.G.), Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, and Division of Neurology (D.J.G.), Department of Medicine, University of Toronto, Ontario, Canada; Department of Neurology (M.B.), Inselspital, Bern University Hospital and University of Bern, Switzerland; and Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Morin Beyeler
- From the Clinical and Translational Neuroscience Unit (B.B.N., C.Z., A.P., M.B., H.K.), Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York; Department of Neurology (B.B.N.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Neurology (B.R.M., C.S.), University of Minnesota, Minneapolis; Division of Hematology and Oncology (M.C.), Department of Medicine, University of Vermont Larner College of Medicine, Burlington; Department of Neurology (S.E.K.), University of Pennsylvania School of Medicine, Philadelphia; Department of Neurology (D.T., W.L.), Department of Epidemiology (W.L.), and Department of Biostatistics (R.K.), University of Washington, Seattle; Department of Biostatistics (J.E.), Medical University of South Carolina, Charleston; Ochsner Neuroscience Institute (R.M.Z., J.T.), Ochsner Health, New Orleans, LA; Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati College of Medicine, OH; Sunnybrook Research Institute (D.J.G.), Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, and Division of Neurology (D.J.G.), Department of Medicine, University of Toronto, Ontario, Canada; Department of Neurology (M.B.), Inselspital, Bern University Hospital and University of Bern, Switzerland; and Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Hooman Kamel
- From the Clinical and Translational Neuroscience Unit (B.B.N., C.Z., A.P., M.B., H.K.), Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York; Department of Neurology (B.B.N.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Neurology (B.R.M., C.S.), University of Minnesota, Minneapolis; Division of Hematology and Oncology (M.C.), Department of Medicine, University of Vermont Larner College of Medicine, Burlington; Department of Neurology (S.E.K.), University of Pennsylvania School of Medicine, Philadelphia; Department of Neurology (D.T., W.L.), Department of Epidemiology (W.L.), and Department of Biostatistics (R.K.), University of Washington, Seattle; Department of Biostatistics (J.E.), Medical University of South Carolina, Charleston; Ochsner Neuroscience Institute (R.M.Z., J.T.), Ochsner Health, New Orleans, LA; Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati College of Medicine, OH; Sunnybrook Research Institute (D.J.G.), Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, and Division of Neurology (D.J.G.), Department of Medicine, University of Toronto, Ontario, Canada; Department of Neurology (M.B.), Inselspital, Bern University Hospital and University of Bern, Switzerland; and Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Mitchell S V Elkind
- From the Clinical and Translational Neuroscience Unit (B.B.N., C.Z., A.P., M.B., H.K.), Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York; Department of Neurology (B.B.N.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Neurology (B.R.M., C.S.), University of Minnesota, Minneapolis; Division of Hematology and Oncology (M.C.), Department of Medicine, University of Vermont Larner College of Medicine, Burlington; Department of Neurology (S.E.K.), University of Pennsylvania School of Medicine, Philadelphia; Department of Neurology (D.T., W.L.), Department of Epidemiology (W.L.), and Department of Biostatistics (R.K.), University of Washington, Seattle; Department of Biostatistics (J.E.), Medical University of South Carolina, Charleston; Ochsner Neuroscience Institute (R.M.Z., J.T.), Ochsner Health, New Orleans, LA; Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati College of Medicine, OH; Sunnybrook Research Institute (D.J.G.), Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, and Division of Neurology (D.J.G.), Department of Medicine, University of Toronto, Ontario, Canada; Department of Neurology (M.B.), Inselspital, Bern University Hospital and University of Bern, Switzerland; and Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Christopher Streib
- From the Clinical and Translational Neuroscience Unit (B.B.N., C.Z., A.P., M.B., H.K.), Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York; Department of Neurology (B.B.N.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Neurology (B.R.M., C.S.), University of Minnesota, Minneapolis; Division of Hematology and Oncology (M.C.), Department of Medicine, University of Vermont Larner College of Medicine, Burlington; Department of Neurology (S.E.K.), University of Pennsylvania School of Medicine, Philadelphia; Department of Neurology (D.T., W.L.), Department of Epidemiology (W.L.), and Department of Biostatistics (R.K.), University of Washington, Seattle; Department of Biostatistics (J.E.), Medical University of South Carolina, Charleston; Ochsner Neuroscience Institute (R.M.Z., J.T.), Ochsner Health, New Orleans, LA; Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati College of Medicine, OH; Sunnybrook Research Institute (D.J.G.), Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, and Division of Neurology (D.J.G.), Department of Medicine, University of Toronto, Ontario, Canada; Department of Neurology (M.B.), Inselspital, Bern University Hospital and University of Bern, Switzerland; and Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
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5
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Göcmen J, Steinauer F, Kielkopf M, Branca M, Kurmann CC, Mujanovic A, Clénin L, Silimon N, Boronylo A, Scutelnic A, Meinel T, Kaesmacher J, Bücke P, Seiffge D, Costamagna G, Michel P, Fischer U, Arnold M, Navi BB, Pabst T, Berger MD, Jung S, Beyeler M. Mortality in acute ischemic stroke patients with new cancer diagnosed during the index hospitalization versus after discharge. J Stroke Cerebrovasc Dis 2024; 33:107899. [PMID: 39106923 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/14/2024] [Accepted: 07/26/2024] [Indexed: 08/09/2024] Open
Abstract
BACKGROUND Early diagnosis of previously unknown cancer (i.e., occult cancer) after an acute ischemic stroke (AIS) could result in faster initiation of cancer therapy and potentially improve clinical outcomes. Our study aimed to compare mortality rates between AIS patients with occult cancer diagnosed during the index stroke hospitalization versus those diagnosed after hospital discharge. METHODS Among consecutive AIS patients treated at our stroke center from 2015 through 2020, we identified new cancer diagnoses made within the year after the AIS. We used multivariable Cox regression analyses to evaluate the association between the timing of occult cancer diagnosis (during the AIS hospitalization versus after discharge) and long-term survival. RESULTS Of 3894 AIS patients with available long-term follow-up data, 59 (1.5 %) were diagnosed with a new cancer within one year after index stroke. Of these, 27 (46 %) were diagnosed during the index hospitalization and 32 (54 %) were diagnosed after discharge. During a median follow-up of 406 days (interquartile range, 89-1073), 70 % (n = 19) of patients whose cancer was diagnosed during hospitalization had died, compared to 63 % (n = 20) of patients whose cancer was diagnosed after discharge (p= 0.58). In our main multivariable model, there was no difference in long-term mortality between patient groups (adjusted hazard ratio, 1.16; 95 % confidence interval, 0.53-2.52; p= 0.71). CONCLUSIONS In this analysis, timing of a new cancer diagnosis after AIS did not seem to influence patients' long-term survival. Given the fairly small number of included patients with previously occult cancer, larger multicenter studies are needed to confirm our results.
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Affiliation(s)
- Jayan Göcmen
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Fabienne Steinauer
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Moritz Kielkopf
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Mattia Branca
- CTU Bern, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Christoph C Kurmann
- Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Switzerland; Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Adnan Mujanovic
- Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Leander Clénin
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Norbert Silimon
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Anna Boronylo
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Adrian Scutelnic
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Thomas Meinel
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Johannes Kaesmacher
- Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Philipp Bücke
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - David Seiffge
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Gianluca Costamagna
- Stroke Unit, Neurology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Patrik Michel
- Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Urs Fischer
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Babak B Navi
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Thomas Pabst
- Department of Medical Oncology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Martin D Berger
- Department of Medical Oncology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Simon Jung
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Morin Beyeler
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Switzerland; Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York, USA.
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6
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Erritzøe-Jervild M, Wenstrup J, Hougaard BH, Kruuse C. Diagnosing cancer-associated ischemic stroke: A systematic review of hematological biomarkers. Int J Stroke 2024; 19:622-634. [PMID: 38192106 DOI: 10.1177/17474930241227385] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
BACKGROUND AND AIM Patients suffering from cancer are reported to have an increased risk of ischemic stroke (IS). We aimed to identify cancer-associated biomarkers found to differentiate between IS associated with cancer from those not associated with cancer. SUMMARY OF REVIEW We performed a systematic search of PubMed and EMBASE databases according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The study is reported in PROSPERO (#CRD42022355129). In total, 5563 papers were screened, of which 49 papers were included. Seven biomarkers were identified which had the potential to differentiate between patients who had cancer or stroke or both conditions. D-dimer was the most frequently monitored biomarker, and high levels were significantly associated with cancer-related strokes in (42/44) studies. Fibrinogen was significantly associated with cancer-related strokes in 11/27 studies. A higher level of C-reactive protein, investigated in 19 studies, was associated with cancer-related strokes, but conclusive multivariate analysis was not performed. Finally, the four cancer-associated antigens CA125, CA153, CA199, and carcinoembryonic antigen were only reported on in three to six studies, respectively. These studies all originated from the Guangxi province in China. CA125 was associated with an increased risk of IS in four of six studies. CONCLUSION Increased D-dimer seems associated with cancer-related IS. CRP may also be a candidate as a cancer-associated stroke biomarker, but this requires further verification. Fibrinogen and the more specific cancer biomarkers have not yet been proven helpful for detecting cancer-related strokes.
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Affiliation(s)
- Mai Erritzøe-Jervild
- Department of Neurology, Neurovascular Research Unit, Copenhagen University Hospital-Herlev Gentofte, Copenhagen, Denmark
- Department of Brain and Spinal Cord Injury, Neuroscience Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jonathan Wenstrup
- Department of Neurology, Neurovascular Research Unit, Copenhagen University Hospital-Herlev Gentofte, Copenhagen, Denmark
- Emergency Medical Services, Copenhagen, Denmark
- Emergency Medical Services, Region Zealand, Denmark
| | | | - Christina Kruuse
- Department of Neurology, Neurovascular Research Unit, Copenhagen University Hospital-Herlev Gentofte, Copenhagen, Denmark
- Department of Brain and Spinal Cord Injury, Neuroscience Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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7
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Ntaios G, Baumgartner H, Doehner W, Donal E, Edvardsen T, Healey JS, Iung B, Kamel H, Kasner SE, Korompoki E, Navi BB, Pristipino C, Saba L, Schnabel RB, Svennberg E, Lip GYH. Embolic strokes of undetermined source: a clinical consensus statement of the ESC Council on Stroke, the European Association of Cardiovascular Imaging and the European Heart Rhythm Association of the ESC. Eur Heart J 2024; 45:1701-1715. [PMID: 38685132 PMCID: PMC11107123 DOI: 10.1093/eurheartj/ehae150] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
One in six ischaemic stroke patients has an embolic stroke of undetermined source (ESUS), defined as a stroke with unclear aetiology despite recommended diagnostic evaluation. The overall cardiovascular risk of ESUS is high and it is important to optimize strategies to prevent recurrent stroke and other cardiovascular events. The aim of clinicians when confronted with a patient not only with ESUS but also with any other medical condition of unclear aetiology is to identify the actual cause amongst a list of potential differential diagnoses, in order to optimize secondary prevention. However, specifically in ESUS, this may be challenging as multiple potential thromboembolic sources frequently coexist. Also, it can be delusively reassuring because despite the implementation of specific treatments for the individual pathology presumed to be the actual thromboembolic source, patients can still be vulnerable to stroke and other cardiovascular events caused by other pathologies already identified during the index diagnostic evaluation but whose thromboembolic potential was underestimated. Therefore, rather than trying to presume which particular mechanism is the actual embolic source in an ESUS patient, it is important to assess the overall thromboembolic risk of the patient through synthesis of the individual risks linked to all pathologies present, regardless if presumed causally associated or not. In this paper, a multi-disciplinary panel of clinicians/researchers from various backgrounds of expertise and specialties (cardiology, internal medicine, neurology, radiology and vascular surgery) proposes a comprehensive multi-dimensional assessment of the overall thromboembolic risk in ESUS patients through the composition of individual risks associated with all prevalent pathologies.
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Affiliation(s)
- George Ntaios
- Department of Internal Medicine, School of Health Sciences, University of Thessaly, Larissa University Hospital, Larissa 41132, Greece
| | - Helmut Baumgartner
- Department of Cardiology III: Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany
| | - Wolfram Doehner
- Department of Cardiology (Campus Virchow), Center of Stroke Research Berlin, German Centre for Cardiovascular Research (DZHK) partner site Berlin, Berlin Institute of Health-Center for Regenerative Therapies, Deutsches Herzzentrum der Charité, Charité, Berlin, Germany
| | - Erwan Donal
- Service de Cardiologie et CIC-IT 1414, CHU Rennes, Rennes, France
| | - Thor Edvardsen
- Department of Cardiology, Faculty of Medicine, Oslo University Hospital, Rikshospitalet, University of Oslo, Oslo, Norway
| | - Jeff S Healey
- Cardiology Division, McMaster University, Hamilton, Canada
| | - Bernard Iung
- Bichat Hospital, APHP and Université Paris-Cité, INSERM LVTS U1148, Paris, France
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Scott E Kasner
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Eleni Korompoki
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Babak B Navi
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Department of Neurology, Weill Cornell Medicine, New York, NY, USA
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christian Pristipino
- Interventional and Intensive Cardiology Unit, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari—Polo di Monserrato, Cagliari, Italy
| | - Renate B Schnabel
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany
| | - Emma Svennberg
- Department of Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, Liverpool Heart & Chest Hospital, Liverpool, UK
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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8
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Xiao J, Poblete RA, Lerner A, Nguyen PL, Song JW, Sanossian N, Wilcox AG, Song SS, Lyden PD, Saver JL, Wasserman BA, Fan Z. MRI in the Evaluation of Cryptogenic Stroke and Embolic Stroke of Undetermined Source. Radiology 2024; 311:e231934. [PMID: 38652031 PMCID: PMC11070612 DOI: 10.1148/radiol.231934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 04/25/2024]
Abstract
Cryptogenic stroke refers to a stroke of undetermined etiology. It accounts for approximately one-fifth of ischemic strokes and has a higher prevalence in younger patients. Embolic stroke of undetermined source (ESUS) refers to a subgroup of patients with nonlacunar cryptogenic strokes in whom embolism is the suspected stroke mechanism. Under the classifications of cryptogenic stroke or ESUS, there is wide heterogeneity in possible stroke mechanisms. In the absence of a confirmed stroke etiology, there is no established treatment for secondary prevention of stroke in patients experiencing cryptogenic stroke or ESUS, despite several clinical trials, leaving physicians with a clinical dilemma. Both conventional and advanced MRI techniques are available in clinical practice to identify differentiating features and stroke patterns and to determine or infer the underlying etiologic cause, such as atherosclerotic plaques and cardiogenic or paradoxical embolism due to occult pelvic venous thrombi. The aim of this review is to highlight the diagnostic utility of various MRI techniques in patients with cryptogenic stroke or ESUS. Future trends in technological advancement for promoting the adoption of MRI in such a special clinical application are also discussed.
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Affiliation(s)
- Jiayu Xiao
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.),
Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.),
Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of
Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033;
Department of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center,
Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of
Neurology, David Geffen School of Medicine, University of California–Los
Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and
Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md
(B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins
University, Baltimore, Md (B.A.W.)
| | - Roy A. Poblete
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.),
Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.),
Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of
Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033;
Department of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center,
Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of
Neurology, David Geffen School of Medicine, University of California–Los
Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and
Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md
(B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins
University, Baltimore, Md (B.A.W.)
| | - Alexander Lerner
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.),
Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.),
Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of
Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033;
Department of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center,
Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of
Neurology, David Geffen School of Medicine, University of California–Los
Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and
Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md
(B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins
University, Baltimore, Md (B.A.W.)
| | - Peggy L. Nguyen
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.),
Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.),
Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of
Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033;
Department of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center,
Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of
Neurology, David Geffen School of Medicine, University of California–Los
Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and
Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md
(B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins
University, Baltimore, Md (B.A.W.)
| | - Jae W. Song
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.),
Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.),
Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of
Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033;
Department of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center,
Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of
Neurology, David Geffen School of Medicine, University of California–Los
Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and
Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md
(B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins
University, Baltimore, Md (B.A.W.)
| | - Nerses Sanossian
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.),
Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.),
Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of
Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033;
Department of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center,
Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of
Neurology, David Geffen School of Medicine, University of California–Los
Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and
Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md
(B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins
University, Baltimore, Md (B.A.W.)
| | - Alison G. Wilcox
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.),
Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.),
Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of
Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033;
Department of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center,
Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of
Neurology, David Geffen School of Medicine, University of California–Los
Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and
Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md
(B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins
University, Baltimore, Md (B.A.W.)
| | - Shlee S. Song
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.),
Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.),
Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of
Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033;
Department of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center,
Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of
Neurology, David Geffen School of Medicine, University of California–Los
Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and
Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md
(B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins
University, Baltimore, Md (B.A.W.)
| | - Patrick D. Lyden
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.),
Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.),
Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of
Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033;
Department of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center,
Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of
Neurology, David Geffen School of Medicine, University of California–Los
Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and
Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md
(B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins
University, Baltimore, Md (B.A.W.)
| | - Jeffrey L. Saver
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.),
Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.),
Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of
Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033;
Department of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center,
Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of
Neurology, David Geffen School of Medicine, University of California–Los
Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and
Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md
(B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins
University, Baltimore, Md (B.A.W.)
| | - Bruce A. Wasserman
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.),
Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.),
Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of
Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033;
Department of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center,
Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of
Neurology, David Geffen School of Medicine, University of California–Los
Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and
Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md
(B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins
University, Baltimore, Md (B.A.W.)
| | - Zhaoyang Fan
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.),
Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.),
Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of
Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033;
Department of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center,
Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of
Neurology, David Geffen School of Medicine, University of California–Los
Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and
Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md
(B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins
University, Baltimore, Md (B.A.W.)
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9
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Zhao B, Jia W, Yuan Y, Li Z. Clinical analysis of twenty-one cases of acute ischemic stroke related to Trousseau syndrome. Neurol Sci 2024; 45:1537-1547. [PMID: 37957481 DOI: 10.1007/s10072-023-07180-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Trousseau syndrome (TS) is relatively rare and easily overlooked by clinicians, causing misdiagnosis and affecting subsequent treatment. OBJECTIVE In this study, clinical features, laboratory examination, imaging features, treatment, and prognosis of patients with TS were discussed. METHODS AND MATERIAL From February 2018 to April 2022, cases of 21 patients with malignant tumors complicated by acute ischemic stroke (AIS) were admitted to the Neurology Department of the hospital, and were retrospectively analyzed and discussed based on the literature. RESULTS Twenty-one cases were included in the study. Of these, 95.23% (20/21) developed AIS 6-21 months after the onset of malignant tumors, 9.52% (2/21) had ischemic stroke as the first symptom, 4.76% (1/21) had recurrent ischemic stroke, and 14.29% (3/21) subsequently experienced venous and arterial thrombosis events; 80.95% (17/21) were pathologically confirmed to have adenocarcinoma; and 90.47% (19/21) of infarction cases involved multiple blood vessel feeding sites. MRI showed multiregional, multifocal patchy infarcts. D-dimer concentration was higher than normal in all patients. In addition, 61.90% (13/21) of the patients had poor outcomes according to mRS. CONCLUSION TS is a rare clinical type. It is often associated with adenocarcinoma, and the treatment is different from that of conventional cerebral infarction and the prognosis is very poor. In clinical practice, for AIS of unknown cause, if MRI shows multiple small lesions accompanied by a significant increase in D-dimer, routine screening for latent malignant tumors is recommended.
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Affiliation(s)
- Bingqing Zhao
- Department of Neurology, Beijing Shijingshan Hospital, Shijingshan Teaching Hospital of Capital Medical University, No. 24, Shijingshan Road, Beijing, 100043, China.
| | - Weihua Jia
- Department of Neurology, Beijing Shijingshan Hospital, Shijingshan Teaching Hospital of Capital Medical University, No. 24, Shijingshan Road, Beijing, 100043, China
| | - Ye Yuan
- Department of Neurology, Beijing Shijingshan Hospital, Shijingshan Teaching Hospital of Capital Medical University, No. 24, Shijingshan Road, Beijing, 100043, China
| | - Zheng Li
- Department of Neurology, Beijing Shijingshan Hospital, Shijingshan Teaching Hospital of Capital Medical University, No. 24, Shijingshan Road, Beijing, 100043, China
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10
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Costamagna G, Navi BB, Beyeler M, Hottinger AF, Alberio L, Michel P. Ischemic Stroke in Cancer: Mechanisms, Biomarkers, and Implications for Treatment. Semin Thromb Hemost 2024; 50:342-359. [PMID: 37506734 DOI: 10.1055/s-0043-1771270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
Ischemic stroke is an important cause of morbidity and mortality in cancer patients. The underlying mechanisms linking cancer and stroke are not completely understood. Long-standing and more recent evidence suggests that cancer-associated prothrombotic states, along with treatment-related vascular toxicity, such as with chemotherapy and immunotherapy, contribute to an increased risk of ischemic stroke in cancer patients. Novel biomarkers, including coagulation, platelet and endothelial markers, cell-free DNA, and extracellular vesicles are being investigated for their potential to improve risk stratification and patient selection for clinical trials and to help guide personalized antithrombotic strategies. Treatment of cancer-related stroke poses unique challenges, including the need to balance the risk of recurrent stroke and other thromboembolic events with that of bleeding associated with antithrombotic therapy. In addition, how and when to restart cancer treatment after stroke remains unclear. In this review, we summarize current knowledge on the mechanisms underlying ischemic stroke in cancer, propose an etiological classification system unique to cancer-related stroke to help guide patient characterization, provide an overview of promising biomarkers and their clinical utility, and discuss the current state of evidence-based management strategies for cancer-related stroke. Ultimately, a personalized approach to stroke prevention and treatment is required in cancer patients, considering both the underlying cancer biology and the individual patient's risk profile.
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Affiliation(s)
- Gianluca Costamagna
- Stroke Unit, Neurology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Babak B Navi
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Department of Neurology, Weill Cornell Medicine, New York, New York
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Morin Beyeler
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas F Hottinger
- Services of Neurology and Oncology, Lundin Family Brain Tumor Research Center, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Lorenzo Alberio
- Division of Hematology and Hematology Central Laboratory, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Patrik Michel
- Department of Clinical Neurosciences, Stroke Center, Neurology Service, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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11
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Xie W, Hsu S, Lin Y, Xie L, Jin X, Zhu Z, Guo Y, Chen C, Huang D, Boltze J, Li P. Malignancy-associated ischemic stroke: Implications for diagnostic and therapeutic workup. CNS Neurosci Ther 2024; 30:e14619. [PMID: 38532275 PMCID: PMC10965754 DOI: 10.1111/cns.14619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/02/2024] [Accepted: 01/08/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Patients with malignancies have an increased risk of suffering ischemic stroke via several mechanisms such as coagulation dysfunction and other malignancy-related effects as well as iatrogenic causes. Moreover, stroke can be the first sign of an occult malignancy, termed as malignancy-associated ischemic stroke (MAS). Therefore, timely diagnostic assessment and targeted management of this complex clinical situation are critical. FINDINGS Patients with both stroke and malignancy have atypical ages, risk factors, and often exhibit malignancy-related symptoms and multiple lesions on neuroimaging. New biomarkers such as eicosapentaenoic acid and blood mRNA profiles may help in distinguishing MAS from other strokes. In terms of treatment, malignancy should not be considered a contraindication, given comparable rates of recanalization and complications between stroke patients with or without malignancies. CONCLUSION In this review, we summarize the latest developments in diagnosing and managing MAS, especially stroke with occult malignancies, and provide new recommendations from recently emerged clinical evidence for diagnostic and therapeutic workup strategies.
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Affiliation(s)
- Wanqing Xie
- Department of Anesthesiology, Renji HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Szuyao Hsu
- Department of Anesthesiology, Renji HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yuxuan Lin
- Department of Anesthesiology, Renji HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Lv Xie
- Department of Anesthesiology, Renji HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Xia Jin
- Department of Anesthesiology, Renji HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Ziyu Zhu
- Department of Anesthesiology, Renji HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yunlu Guo
- Department of Anesthesiology, Renji HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Caiyang Chen
- Department of Anesthesiology, Renji HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Dan Huang
- Department of Anesthesiology, Renji HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | | | - Peiying Li
- Department of Anesthesiology, Renji HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Clinical Research Center, Renji HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Outcomes Research ConsortiumClevelandOhioUSA
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12
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Lun R, Siegal D, Ramsay T, Stotts G, Dowlatshahi D. Synthetic data in cancer and cerebrovascular disease research: A novel approach to big data. PLoS One 2024; 19:e0295921. [PMID: 38324588 PMCID: PMC10849264 DOI: 10.1371/journal.pone.0295921] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 12/01/2023] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVES Synthetic datasets are artificially manufactured based on real health systems data but do not contain real patient information. We sought to validate the use of synthetic data in stroke and cancer research by conducting a comparison study of cancer patients with ischemic stroke to non-cancer patients with ischemic stroke. DESIGN retrospective cohort study. SETTING We used synthetic data generated by MDClone and compared it to its original source data (i.e. real patient data from the Ottawa Hospital Data Warehouse). OUTCOME MEASURES We compared key differences in demographics, treatment characteristics, length of stay, and costs between cancer patients with ischemic stroke and non-cancer patients with ischemic stroke. We used a binary, multivariable logistic regression model to identify risk factors for recurrent stroke in the cancer population. RESULTS Using synthetic data, we found cancer patients with ischemic stroke had a lower prevalence of hypertension (52.0% in the cancer cohort vs 57.7% in the non-cancer cohort, p<0.0001), and a higher prevalence of chronic obstructive pulmonary disease (COPD: 8.5% vs 4.7%, p<0.0001), prior ischemic stroke (1.7% vs 0.1%, p<0.001), and prior venous thromboembolism (VTE: 8.2% vs 1.5%, p<0.0001). They also had a longer length of stay (8 days [IQR 3-16] vs 6 days [IQR 3-13], p = 0.011), and higher costs associated with their stroke encounters: $11,498 (IQR $4,440 -$20,668) in the cancer cohort vs $8,084 (IQR $3,947 -$16,706) in the non-cancer cohort (p = 0.0061). A multivariable logistic regression model identified 5 predictors for recurrent ischemic stroke in the cancer cohort using synthetic data; 3 of the same predictors identified using real patient data with similar effect measures. Summary statistics between synthetic and original datasets did not significantly differ, other than slight differences in the distributions of frequencies for numeric data. CONCLUSION We demonstrated the utility of synthetic data in stroke and cancer research and provided key differences between cancer and non-cancer patients with ischemic stroke. Synthetic data is a powerful tool that can allow researchers to easily explore hypothesis generation, enable data sharing without privacy breaches, and ensure broad access to big data in a rapid, safe, and reliable fashion.
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Affiliation(s)
- Ronda Lun
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, Canada
| | - Deborah Siegal
- School of Epidemiology, University of Ottawa, Ottawa, Canada
- Division of Hematology, Department of Medicine, The Ottawa Hospital, Ottawa, Canada
| | - Tim Ramsay
- School of Epidemiology, University of Ottawa, Ottawa, Canada
| | - Grant Stotts
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, Canada
| | - Dar Dowlatshahi
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, Canada
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13
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Mishra RK, Chavda VK, Moscote-Salazar LR, Atallah O, Das S, Janjua T, Maurya VP, Agrawal A. Systematic review and meta-analysis of studies comparing baseline D-dimer level in stroke patients with or without cancer: Strength of current evidence. J Neurosci Rural Pract 2024; 15:16-28. [PMID: 38476438 PMCID: PMC10927037 DOI: 10.25259/jnrp_379_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/06/2023] [Indexed: 03/14/2024] Open
Abstract
Objectives D-dimer levels are increased in stroke and cancer. Cancer patients are at a higher risk of stroke. However, the evidence is unclear if high D-dimer in stroke patients can suggest the diagnosis of concomitant cancer or the development of stroke in a cancer patient. The objective is to assess the evidence available on the baseline D-dimer level in stroke patients with and without cancer. Materials and Methods We conducted the systematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. We searched PUBMED, Cochrane, ScienceDirect, and Scopus for potentially eligible articles published till June 2023. All the review steps were iterative and done independently by two reviewers. The Newcastle-Ottawa scale tool was used to assess the quality of included studies for case control and cohort studies and the Agency for Healthcare Research and Quality tool for cross-sectional studies. The qualitative synthesis is presented narratively, and quantitative synthesis is shown in the forest plot using the random effects model. I2 of more than 60% was considered as high heterogeneity. Results The searches from all the databases yielded 495 articles. After the study selection process, six papers were found eligible for inclusion in the qualitative and quantitative synthesis. In the present systematic review, 2651 patients with ischemic infarcts are included of which 404 (13.97%) patients had active cancer while 2247 (86.02%) did not. The studies included were of high quality and low risk of bias. There were significantly higher baseline D-dimer levels in stroke patients with cancer than in non-cancer patients with a mean difference of 4.84 (3.07-6.60) P < 0.00001. Conclusion D-dimer is a simple and relatively non-expensive biomarker that is increased to significant levels in stroke patients, who have cancer and therefore may be a tool to predict through screening for active or occult cancer in stroke patients.
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Affiliation(s)
- Rakesh Kumar Mishra
- Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Vishal K. Chavda
- Department of Pathology, Stanford University School of Medicine, Stanford University Medical Center, CA-USA
| | | | - Oday Atallah
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Saikat Das
- Department of Radiation Oncology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Tariq Janjua
- Department of Neurology, Regions Hospital, Saint Paul, Minnesota, United States
| | - Ved Prakash Maurya
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Amit Agrawal
- Department of Radiation Oncology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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14
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Tan ESJ, de Leon J, Boey E, Chin HK, Ho KH, Aguirre S, Sim MG, Seow SC, Sharma VK, Kojodjojo P. Stroke Recurrence in Embolic Stroke of Undetermined Source Without Atrial Fibrillation on Invasive Cardiac Monitoring. Heart Lung Circ 2023; 32:1000-1009. [PMID: 37291002 DOI: 10.1016/j.hlc.2023.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/04/2023] [Accepted: 05/02/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND More than half of patients with embolic stroke of undetermined source (ESUS) suffer from recurrent ischaemic stroke, despite the absence of atrial fibrillation (AF) on invasive cardiac monitoring (ICM). This study investigated the predictors and prognosis of recurrent stroke in ESUS without AF on ICM. METHOD This prospective study included patients with ESUS at two tertiary hospitals from 2015 to 2021 who underwent comprehensive neurological imaging, transthoracic echocardiography, and inpatient continuous electrographic monitoring for ≥48 hours prior to ICM for definitive exclusion of AF. Recurrent ischaemic stroke, all-cause mortality, and functional outcome by the modified Rankin scale (mRS) at 3 months were evaluated in patients without AF. RESULTS Of 185 consecutive patients with ESUS, AF was not detected in 163 (88%) patients (age 62±12 years, 76% men, 25% prior stroke, median time to ICM insertion 26 [7, 123] days), and stroke recurred in 24 (15%) patients. Stroke recurrences were predominantly ESUS (88%), within the first 2 years (75%), and involved a different vascular territory from qualifying ESUS (58%). Pre-existing cancer was the only independent predictor of recurrent stroke (adjusted hazard ratio [AHR] 5.43, 95% CI 1.43-20.64), recurrent ESUS (AHR 5.67, 95% CI 1.15-21.21), and higher mRS score at 3 months (ß 1.27, 95% CI 0.23-2.42). All-cause mortality occurred in 17 (10%) patients. Adjusting for age, cancer, and mRS category (≥3 vs <3), recurrent ESUS was independently associated with more than four times greater hazard of death (AHR 4.66, 95% CI 1.76-12.34). CONCLUSIONS Patients with recurrent ESUS are a high-risk subgroup. Studies elucidating optimal diagnostic and treatment strategies in non-AF-related ESUS are urgently required.
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Affiliation(s)
- Eugene S J Tan
- Department of Cardiology, National University Heart Centre, Singapore; Yong Loo Lin School of Medicine, National University Singapore, Singapore.
| | - Jhobeleen de Leon
- Department of Cardiology, National University Heart Centre, Singapore
| | - Elaine Boey
- Division of Cardiology, Ng Teng Fong General Hospital, Singapore
| | - Howe-Keat Chin
- Department of Neurology, National University Health System, Singapore
| | - Kian-Hui Ho
- Department of Cardiology, National University Heart Centre, Singapore
| | - Shana Aguirre
- Department of Cardiology, National University Heart Centre, Singapore
| | - Ming-Gin Sim
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | - Swee-Chong Seow
- Department of Cardiology, National University Heart Centre, Singapore; Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | - Vijay K Sharma
- Yong Loo Lin School of Medicine, National University Singapore, Singapore; Department of Neurology, National University Health System, Singapore
| | - Pipin Kojodjojo
- Department of Cardiology, National University Heart Centre, Singapore; Yong Loo Lin School of Medicine, National University Singapore, Singapore; Division of Cardiology, Ng Teng Fong General Hospital, Singapore
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15
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Cen G, Song Y, Chen S, Liu L, Wang J, Zhang J, Li J, Li G, Li H, Liang H, Liang Z. The investigation on the hypercoagulability of hepatocellular carcinoma-related cerebral infarction with thromboelastography. Brain Behav 2023; 13:e2961. [PMID: 36929158 PMCID: PMC10097062 DOI: 10.1002/brb3.2961] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 01/21/2023] [Accepted: 02/28/2023] [Indexed: 03/18/2023] Open
Abstract
AIM To investigate the hypercoagulability of hepatocellular carcinoma (HCC)-related cerebral infarction (HCRCI) with thromboelastography (TEG). METHODS A multicenter prospective study was conducted in HCRCI patients, HCC patients without cerebral infarction, and acute cerebral infarction (ACI) patients without HCC between January 2016 and December 2019. TEG parameters and laboratory and clinical data were collected and compared among the three groups. To confirm the independent risk factors of HCRCI, multivariate analyses were conducted. Receiver operating characteristic (ROC) curves were utilized to evaluate the area under the curve (AUC) plotted by each independent risk factor. RESULTS There were 38 patients recruited in the HCRCI group, and 152 patients were recruited to the HCC group and the ACI group. The levels of plasma neutrophil count, D-dimer, α-fetoprotein (AFP), carcinoembryonic antigen, and maximum amplitude (MA)-a parameter of TEG-were significantly higher in the HCRCI group than HCC and ACI groups. Multivariate logistic regression analysis showed that increased neutrophile count, D-dimer, AFP, and MA were independently associated with HCRCI. ROC curve analysis showed first that AUC of MA for HCRCI was .875, which was larger than the other risk factors, and second that the optimal cutoff value for MA was 61.35, with a sensitivity of 89.50% and specificity of 66.40%. CONCLUSION It was suggested that TEG disclosed that the pathogenesis of HCRIC is exactly related to the hypercoagulability. And with a cutoff value of MA equaling to 61.35, TEG facilitates clinicians to identify HCC patients at high risk of HCRIC.
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Affiliation(s)
- Gengyu Cen
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yiting Song
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Shijian Chen
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Liuyu Liu
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jun Wang
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jian Zhang
- Department of Neurology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jing Li
- Department of Neurology, The Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Guohui Li
- Department of Neurology, Wuzhou Red Cross Hospital, Wuzhou, China
| | - Haihua Li
- Department of Neurology, Fusui County People's Hospital, Chongzuo, China
| | - Hongbin Liang
- Department of Neurology, Cenxi People's Hospital, Cenxi, China
| | - Zhijian Liang
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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16
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Seystahl K, Gramatzki D, Wanner M, Weber SJ, Hug A, Luft AR, Rohrmann S, Wegener S, Weller M. A risk model for prediction of diagnosis of cancer after ischemic stroke. Sci Rep 2023; 13:111. [PMID: 36596831 PMCID: PMC9810715 DOI: 10.1038/s41598-022-26790-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 12/20/2022] [Indexed: 01/05/2023] Open
Abstract
It remains controversial which characteristics may predict occult cancer in stroke patients. Characteristics of patients with ischemic stroke registered in the Zurich Swiss Stroke Registry (2014 to 2016) were tested for associations with cancer diagnosis after stroke with consideration of death as competing risk for cancer diagnosis. Among 1157 patients, 34 (3%) and 55 patients (5%) were diagnosed with cancer within 1 and 3 years after stroke. Levels of white blood cells (WBC) > 9,600/µl (subdistribution hazard ratio (SHR) 3.68, p = 0.014), platelets > 400,000/µl (SHR 7.71, p = 0.001), and d-dimers ≥ 3 mg/l (SHR 3.67, p = 0.007) were independently associated with cancer diagnosis within 1 year after stroke. Occurrence of ischemic lesions in ≥ 2 vascular territories not attributed to cardioembolic etiology was associated with cancer diagnosed within 1 year after stroke in univariable analysis (SHR 3.69, p = 0.001). The area under the curve of a score from these parameters (score sum 0-4) was 0.73. A score of ≥ 2 had a sensitivity of 43% and specificity of 92% for prediction of cancer diagnosis within 1 year after stroke. We suggest further validation of a score of WBC, platelets, d-dimers and multiple ischemic lesions without cardioembolic stroke etiology for prediction of cancer diagnosis after stroke.
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Affiliation(s)
- Katharina Seystahl
- Department of Neurology, University Hospital and University of Zurich, CH-8091, Zurich, Switzerland.
| | - Dorothee Gramatzki
- Department of Neurology, University Hospital and University of Zurich, CH-8091, Zurich, Switzerland
| | - Miriam Wanner
- Cancer Registry of the Cantons of Zurich, Zug, Schaffhausen and Schwyz, University Hospital and University of Zurich, Zurich, Switzerland
| | - Sung Ju Weber
- Department of Neurology, University Hospital and University of Zurich, CH-8091, Zurich, Switzerland
| | - Alessia Hug
- Department of Neurology, University Hospital and University of Zurich, CH-8091, Zurich, Switzerland
| | - Andreas R Luft
- Department of Neurology, University Hospital and University of Zurich, CH-8091, Zurich, Switzerland
- Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Sabine Rohrmann
- Cancer Registry of the Cantons of Zurich, Zug, Schaffhausen and Schwyz, University Hospital and University of Zurich, Zurich, Switzerland
| | - Susanne Wegener
- Department of Neurology, University Hospital and University of Zurich, CH-8091, Zurich, Switzerland
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, CH-8091, Zurich, Switzerland
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17
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Zamora C, Castillo M, Puac-Polanco P, Torres C. Oncologic Emergencies in the Head and Neck. Radiol Clin North Am 2023; 61:71-90. [DOI: 10.1016/j.rcl.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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18
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Beyeler M, Grunder L, Göcmen J, Steinauer F, Belachew NF, Kielkopf M, Clénin L, Mueller M, Silimon N, Kurmann C, Meinel T, Bücke P, Seiffge D, Dobrocky T, Piechowiak EI, Pilgram-Pastor S, Mattle HP, Navi BB, Arnold M, Fischer U, Pabst T, Gralla J, Berger MD, Jung S, Kaesmacher J. Absence of susceptibility vessel sign and hyperdense vessel sign in patients with cancer-related stroke. Front Neurol 2023; 14:1148152. [PMID: 37021282 PMCID: PMC10067593 DOI: 10.3389/fneur.2023.1148152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/02/2023] [Indexed: 04/07/2023] Open
Abstract
Background and aim Identification of paraneoplastic hypercoagulability in stroke patients helps to guide investigations and prevent stroke recurrence. A previous study demonstrated an association between the absence of the susceptibility vessel sign (SVS) on brain MRI and active cancer in patients treated with mechanical thrombectomy. The present study aimed to confirm this finding and assess an association between the absence of the hyperdense vessel sign (HVS) on head CT and active cancer in all stroke patients. Methods SVS and HVS status on baseline imaging were retrospectively assessed in all consecutive stroke patients treated at a comprehensive stroke center between 2015 and 2020. Active cancer, known at the time of stroke or diagnosed within 1 year after stroke (occult cancer), was identified. Adjusted odds ratios (aOR) and their 95% confidence interval (CI) for the association between the thrombus imaging characteristics and cancer were calculated using multivariable logistic regression. Results Of the 2,256 patients with thrombus imaging characteristics available at baseline, 161 had an active cancer (7.1%), of which 36 were occult at the time of index stroke (1.6% of the total). The absence of SVS was associated with active cancer (aOR 3.14, 95% CI 1.45-6.80). No significance was reached for the subgroup of occult cancer (aOR 3.20, 95% CI 0.73-13.94). No association was found between the absence of HVS and active cancer (aOR 1.07, 95% CI 0.54-2.11). Conclusion The absence of SVS but not HVS could help to identify paraneoplastic hypercoagulability in stroke patients with active cancer and guide patient care.
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Affiliation(s)
- Morin Beyeler
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
- *Correspondence: Morin Beyeler,
| | - Lorenz Grunder
- Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Jayan Göcmen
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Fabienne Steinauer
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | | | - Moritz Kielkopf
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Leander Clénin
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Madlaine Mueller
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Norbert Silimon
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Christoph Kurmann
- Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Thomas Meinel
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Philipp Bücke
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - David Seiffge
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Tomas Dobrocky
- Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Eike I. Piechowiak
- Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Sara Pilgram-Pastor
- Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Heinrich P. Mattle
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Babak B. Navi
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
- Neurology Department, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Thomas Pabst
- Department of Medical Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Jan Gralla
- Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Martin D. Berger
- Department of Medical Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Simon Jung
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Johannes Kaesmacher
- Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
- Johannes Kaesmacher,
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19
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Xu Y, Wu Z, Xu H. Cancer-related cryptogenic stroke involving the bilateral anterior and the posterior circulations: Diagnostic value of clinical and imaging characteristics. Front Neurol 2022; 13:1032984. [PMID: 36578305 PMCID: PMC9790910 DOI: 10.3389/fneur.2022.1032984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022] Open
Abstract
Objectives This study analyzed the clinical and imaging characteristics of patients with cancer-related cryptogenic stroke (CCS) involving the bilateral anterior and the posterior circulations (three circulations) and evaluate the diagnostic value of clinical and imaging features for patients with cryptogenic stroke involving three circulations (CST). Methods Of the 12,580 patients with acute ischemic stroke, 148 patients with CST from May 2017 to November 2021 were divided into the cancer group (n = 81) and the non-cancer group (n = 67). Cardiovascular risk factors, diffusion-weighted imaging patterns of cryptogenic stroke, blood routine, coagulation routine, and biochemical routine were compared between the two groups. Multivariable logistic regression and receiver operating characteristic (ROC) curve analysis were used to determine associations between the two groups. Results Compared with the non-cancer group, the cancer group exhibited higher D-dimer levels (P < 0.001), fibrin degradation product (FDP, P < 0.001), international normalized ratio (INR, P = 0.014), neutrophil to lymphocyte ratio (NLR, P < 0.001), platelets to lymphocyte ratio (PLR, P = 0.001), activated partial thromboplastin time (APTT, P = 0.039), more frequent multiple lesions in three circulations (P < 0.001) and lower lymphocytes (P < 0.001), red blood cells (P < 0.001), and thrombin time (TT, P = 0.034). Furthermore, D-dimer [area under the curve (AUC) = 0.915, P < 0.001)], FDP (AUC = 0.923, P < 0.001), INR (AUC = 0.617, P = 0.014), NLR (AUC = 0.700, P < 0.001), PLR (AUC = 0.658, P = 0.001), and multiple lesions in three circulations (AUC = 0.786, P < 0.001) had potential diagnostic value in cryptogenic stroke. When combining these 6 parameters, the predictive power was improved (AUC = 0.949, P < 0.001). Conclusion Cryptogenic stroke involving three circulations with cancer has unique clinical features, and these potential diagnostic indicators could help patients identify CCS earlier.
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Affiliation(s)
- Yifan Xu
- Department of Radiology, Affiliated Hospital 4 of Nantong University, Yancheng, China,Department of Radiology, Yancheng First People's Hospital, Yancheng, China
| | - Zhuang Wu
- Neurotoxin Research Center of Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China,Zhuang Wu
| | - Hang Xu
- Department of Neurology, Jiangsu University Affiliated People's Hospital, Zhenjiang, China,Department of Neurology, Zhenjiang First People's Hospital, Zhenjiang, China,*Correspondence: Hang Xu
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20
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Tandi R, Bansal S, Sahu S, Dinesh Eshwar M, Raghavan P, Kulkarni OV, Natarajan B, Dodda S, Banur A. Stroke as a Paraneoplastic Manifestation of Ovarian Cancer: A Case Report. Cureus 2022; 14:e29835. [PMID: 36337801 PMCID: PMC9625077 DOI: 10.7759/cureus.29835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2022] [Indexed: 11/05/2022] Open
Abstract
People with gynecologic neoplasms have the highest risk of having an ischemic stroke. A 76-year-old woman came into the stroke unit of our hospital complaining of anosmia and acutely developing dysarthria. She was ultimately determined to have ovarian cancer after extensive testing. Ovarian carcinoma is one of the neoplasms that cause ischemic stroke and is most commonly documented in case studies. Identifying the underlying neoplastic condition in female ischemic stroke patients who are otherwise "healthy" is crucial as an early surgical intervention on cancer offers therapeutic treatment for both malignancy and thromboembolism.
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21
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Cancer and stroke: What do we know and where do we go? Thromb Res 2022; 219:133-140. [PMID: 36179651 DOI: 10.1016/j.thromres.2022.09.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 11/23/2022]
Abstract
Cancer is an increasingly recognized cause for ischemic stroke, with recent acknowledgement of cancer-related stroke as an emerging stroke subtype with unique pathophysiologic mechanisms. In addition, cancer-related stroke may differ from stroke in the general population as cancer patients may not receive guideline-recommended stroke care, and the occurrence of stroke may also preclude patients from receiving optimal cancer treatments. Due to the high degree of morbidity and mortality associated with both conditions, understanding the relationship between stroke and cancer is crucial. In this narrative review, we discuss the association between cancer and stroke, the unique pathophysiologic mechanisms underlying this phenomenon, treatment options including acute reperfusion therapies and secondary prevention strategies, compare outcomes between cancer-related stroke and stroke in the general population, and review new and emerging evidence in this field.
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22
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Kong Y, Xu XC, Hong L. Arteriovenous thrombotic events in a patient with advanced lung cancer following bevacizumab plus chemotherapy: A case report. World J Clin Cases 2022; 10:6507-6513. [PMID: 35979297 PMCID: PMC9294919 DOI: 10.12998/wjcc.v10.i19.6507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 11/15/2021] [Accepted: 05/07/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In driver gene-negative non-small cell lung cancer patients who relapse following radical resection, combination chemotherapy using bevacizumab and platinum-based dual drugs is known to increase both progression-free and overall survival. Treatment initially includes bevacizumab, and if patients are able to tolerate it, bevacizumab can continue to be utilized until disease progression. Bevacizumab is a recombinant humanized monoclonal neutralizing antibody that acts against vascular endothelial growth factor (VEGF). Various anti-VEGF monoclonal antibodies, such as bevacizumab, can increase the risk of arterial thromboembolism. Current data indicate that VEGF-targeted treatment does not significantly increase the risk of venous thromboembolism events, except for bevacizumab.
CASE SUMMARY A 55-year-old man underwent radical resection for cancer of the right lung. Six months following surgery, multiple metastases were observed in his left lung. Subsequently, six cycles of bevacizumab combined with pemetrexed/carboplatin chemotherapy was given. Efficacy evaluation continued to be partial relief according to RECIST 1.1 standards, and no noticeable adverse reactions were noted. After three cycles of maintenance therapy using a combination of bevacizumab and pemetrexed, the patient developed dizziness and dyspnea. The patient was diagnosed with acute cerebral infarction and pulmonary embolism following head magnetic resonance imaging, computed tomography (CT) angiography, and chest enhanced CT. Although the patient received low-molecular-weight heparin anticoagulation and other treatment, the patient eventually died of respiratory failure 1 mo later. This case report may offer some insight into fatal arteriovenous embolism, which has not been previously reported.
CONCLUSION Bevacizumab combined with chemotherapy may also increase the risk of arteriovenous thromboembolism. Accordingly, patients who receive angiogenesis inhibitor therapy should be carefully selected. Furthermore, close monitoring and timely intervention are necessary in order to reduce the risk of such toxicities.
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Affiliation(s)
- Ying Kong
- Department of Oncology, The First People’s Hospital of Xiaoshan District, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou 311200, Zhejiang Province, China
| | - Xiao-Cheng Xu
- Department of Oncology, The First People’s Hospital of Xiaoshan District, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou 311200, Zhejiang Province, China
| | - Liang Hong
- Department of Oncology, The First People’s Hospital of Xiaoshan District, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou 311200, Zhejiang Province, China
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23
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Wei Y, Tang S, Xie Z, He Y, Zhang Y, Xie Y, Chen S, Liu L, Liu Y, Liang Z. Pulmonary Tuberculosis-Related Ischemic Stroke: A Retrospective Case Control Study. J Inflamm Res 2022; 15:4239-4249. [PMID: 35923909 PMCID: PMC9341260 DOI: 10.2147/jir.s368183] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/01/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Yunfei Wei
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Key Laboratory of Precision Medicine in Cardio-cerebrovascular Diseases Control and Prevention & Guangxi Clinical Research Center for Cardio-cerebrovascular Diseases, Nanning, People’s Republic of China
- Department of Neurology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Shiting Tang
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Key Laboratory of Precision Medicine in Cardio-cerebrovascular Diseases Control and Prevention & Guangxi Clinical Research Center for Cardio-cerebrovascular Diseases, Nanning, People’s Republic of China
| | - Zhouhua Xie
- Department of Tuberculosis, The Fourth People’s Hospital of Nanning City, Nanning, People’s Republic of China
| | - Yaoqin He
- Department of Tuberculosis, The Fourth People’s Hospital of Nanning City, Nanning, People’s Republic of China
| | - Yunli Zhang
- Department of Neurology, People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, People’s Republic of China
| | - Yiju Xie
- Department of Neurology, Wuming hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Shijian Chen
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Key Laboratory of Precision Medicine in Cardio-cerebrovascular Diseases Control and Prevention & Guangxi Clinical Research Center for Cardio-cerebrovascular Diseases, Nanning, People’s Republic of China
| | - Liuyu Liu
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Key Laboratory of Precision Medicine in Cardio-cerebrovascular Diseases Control and Prevention & Guangxi Clinical Research Center for Cardio-cerebrovascular Diseases, Nanning, People’s Republic of China
| | - Yayuan Liu
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Key Laboratory of Precision Medicine in Cardio-cerebrovascular Diseases Control and Prevention & Guangxi Clinical Research Center for Cardio-cerebrovascular Diseases, Nanning, People’s Republic of China
| | - Zhijian Liang
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Key Laboratory of Precision Medicine in Cardio-cerebrovascular Diseases Control and Prevention & Guangxi Clinical Research Center for Cardio-cerebrovascular Diseases, Nanning, People’s Republic of China
- Correspondence: Zhijian Liang, Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Key Laboratory of Precision Medicine in Cardio-cerebrovascular Diseases Control and Prevention & Guangxi Clinical Research Center for Cardio-cerebrovascular Diseases, Nanning, People’s Republic of China, Tel +86-771-5330705, Fax +86-771-5352627, Email
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24
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Nakajima S, Kawano H, Yamashiro K, Tanaka R, Kameda T, Kurita N, Hira K, Miyamoto N, Ueno Y, Watanabe M, Hirano T, Fujimoto S, Urabe T, Hattori N. Post-Treatment Plasma D-Dimer Levels Are Associated With Short-Term Outcomes in Patients With Cancer-Associated Stroke. Front Neurol 2022; 13:868137. [PMID: 35444612 PMCID: PMC9015657 DOI: 10.3389/fneur.2022.868137] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/17/2022] [Indexed: 12/21/2022] Open
Abstract
Background and Objective Hypercoagulability is associated with increased risks of ischemic stroke and subsequent mortality in patients with active cancer. This study investigated the relationships between plasma D-dimer levels after stroke treatment and short-term outcomes in patients with cancer-associated stroke. Methods This retrospective, observational, multicenter study analyzed consecutive patients with cancer-associated ischemic stroke. Hypercoagulability was assessed by plasma D-dimer levels before and after stroke treatment. Short-term outcomes were assessed in terms of poor outcomes (a modified Rankin Scale score >3), cumulative rates of recurrent ischemic stroke, and mortality at 30 days after admission. Results Of 282 patients, 135 (47.9%) showed poor outcomes. Recurrent ischemic stroke was observed in 28 patients (9.9%), and the cumulative mortality rate was 12.4%. Multivariate analysis showed that post-treatment plasma D-dimer levels ≥10 μg/ml were independently associated with both poor outcomes (adjusted odds ratio [OR], 9.61; 95% confidence interval [CI], 3.60–25.70; P < 0.001) and mortality (adjusted OR, 9.38; 95% CI, 3.32–26.44; P < 0.001). Pre-treatment plasma D-dimer levels ≥10 μg/ml were not associated with these outcomes. Patients who received heparin had higher pre-treatment plasma D-dimer levels than those treated with other anticoagulants. Heparin produced a significant reduction in D-dimer levels from pre- to post-treatment without increasing the incidence of hemorrhagic events. Conclusion A high plasma D-dimer level after stroke treatment was associated with poor short-term outcomes in patients with cancer-associated stroke. Using anticoagulants to reduce D-dimer levels may improve short-term outcomes in these patients.
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Affiliation(s)
- Sho Nakajima
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan.,Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Hiroyuki Kawano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University, Tokyo, Japan
| | - Kazuo Yamashiro
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan.,Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Ryota Tanaka
- Division of Neurology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Tomoaki Kameda
- Department of Neurology, Shin-Oyama City Hospital, Tochigi, Japan
| | - Naohide Kurita
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan.,Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kenichiro Hira
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Nobukazu Miyamoto
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yuji Ueno
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Masao Watanabe
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Teruyuki Hirano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University, Tokyo, Japan
| | - Shigeru Fujimoto
- Division of Neurology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Takao Urabe
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
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25
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Nezu T, Hosomi N, Naito H, Aoki S, Torii T, Kurashige T, Sugiura T, Kuzume D, Morimoto Y, Yoshida T, Yagita Y, Oyama N, Shiga Y, Kinoshita N, Kamimura T, Ueno H, Ohshita T, Maruyama H. Clinical characteristics and tumor markers in ischemic stroke patients with active cancer. Intern Emerg Med 2022; 17:735-741. [PMID: 34596824 DOI: 10.1007/s11739-021-02862-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/26/2021] [Indexed: 10/20/2022]
Abstract
Cancer-associated ischemic stroke (CAS) refers to a hypercoagulation disorder related to malignant tumors, especially adenocarcinoma. Carbohydrate antigen (CA) 125 is a mucinous serum marker that might reflect hypercoagulation status, but the association between CA 125 and CAS is unclear across various types of cancer. The aim of this study was to investigate the associations among tumor markers, coagulation markers, and clinical factors in acute ischemic stroke (AIS) patients with active cancer. Consecutive AIS patients with active cancer (a diagnosis or ongoing active therapy for cancer within 6 months) were prospectively enrolled at four hospitals. D-dimer, C-reactive protein (CRP), carcinoembryonic antigen (CEA), CA19-9, and CA 125 levels were measured. Of 120 AIS patients with active cancer, 47 were diagnosed with CAS. CA 125 had the strongest correlations with D-dimer and CRP (ρ = 0.543, p < 0.001 and ρ = 0.452, p < 0.001, respectively). The areas under the receiver-operating characteristic curves for the diagnosis of CAS were 0.812 (95% CI 0.718-0.878) for CA 125, 0.714 (95% CI 0.602-0.801) for CEA, and 0.663 (95% CI 0.552-0.759) for CA 19-9. Multivariable analysis revealed that CA 125 levels in the highest quartile (OR 2.91, 95% CI 1.68-5.53), multiple lesions in multiple vascular territories observed on diffusion-weighted imaging, the absence of dyslipidemia, and the absence of atrial fibrillation were independently associated with CAS. Increased CA 125 levels, which indicate hypercoagulability, were useful for diagnosing CAS in AIS patients with active cancer.
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Affiliation(s)
- Tomohisa Nezu
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Naohisa Hosomi
- Department of Neurology, Chikamori Hospital, Kochi, Japan
- Department of Disease Model, Research Institute of Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Hiroyuki Naito
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shiro Aoki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Tsuyoshi Torii
- Department of Neurology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Takashi Kurashige
- Department of Neurology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Tomohito Sugiura
- Department of Neurology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Daisuke Kuzume
- Department of Neurology, Chikamori Hospital, Kochi, Japan
| | - Yuko Morimoto
- Department of Neurology, Chikamori Hospital, Kochi, Japan
| | - Takeshi Yoshida
- Department of Rheumatology, Chikamori Hospital, Kochi, Japan
| | - Yoshiki Yagita
- Department of Stroke Medicine, Kawasaki Medical School, Okayama, Japan
| | - Naoki Oyama
- Department of Stroke Medicine, Kawasaki Medical School, Okayama, Japan
| | - Yuji Shiga
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Naoto Kinoshita
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Teppei Kamimura
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hiroki Ueno
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Tomohiko Ohshita
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Simonetto M, Rutrick S, LeMoss NM, Lansdale KN, Tagawa ST, Kamel H, Parikh N, Navi BB. Adherence to Guideline-Recommended Cancer Screening in Stroke Survivors: A Nationwide Analysis. J Stroke Cerebrovasc Dis 2022; 31:106297. [PMID: 35032754 PMCID: PMC8852296 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/23/2021] [Accepted: 12/25/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES Cancer can present as stroke. Several cancer types have established screening guidelines. We investigated adherence to guideline-recommended cancer screening in stroke survivors versus the general population. MATERIALS AND METHODS We performed a cross-sectional analysis using 2012-2018 data from the CDC's Behavioral Risk Factor Surveillance System (BRFSS) survey. BRFSS is a nationally-representative telephone survey of non-institutionalized Americans that collects data about health conditions and behaviors, including cancer screening. We defined guideline-recommended colorectal, lung, and breast cancer screening based on the U.S. Preventive Services Task Force recommendations. We used survey-specific methods to estimate up-to-date screening rates for those with and without prior stroke. We used logistic regression to estimate the odds of up-to-date screening in stroke survivors compared to those without history of stroke after adjustment for potential confounders. RESULTS Among 1,018,440 respondents eligible for colorectal cancer screening, 66% were up-to-date. Among 6,880 respondents eligible for lung cancer screening, 16% were up-to-date. Among 548,434 women eligible for breast cancer screening, 78% were up-to-date. After adjustment for demographics and confounders, stroke survivors were more likely to have up-to-date colorectal cancer screening (OR, 1.10; 95% CI, 1.05-1.16), equally likely to undergo lung cancer screening (OR, 0.99; 95% CI, 0.62-1.59), and less likely to undergo breast cancer screening (OR, 0.87; 95% CI, 0.80-0.94). CONCLUSIONS In a nationwide analysis, stroke survivors had similar suboptimal adherence to guideline-recommended cancer screening as the general population.
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Affiliation(s)
- Marialaura Simonetto
- Clinical and Translational Neuroscience Unit, Department of Neurology and Feil Brain and Mind Research Institute, Weill Cornell Medicine, New York, United States
| | - Stephanie Rutrick
- Clinical and Translational Neuroscience Unit, Department of Neurology and Feil Brain and Mind Research Institute, Weill Cornell Medicine, New York, United States
| | - Natalie M. LeMoss
- Clinical and Translational Neuroscience Unit, Department of Neurology and Feil Brain and Mind Research Institute, Weill Cornell Medicine, New York, United States
| | - Kelsey N. Lansdale
- Clinical and Translational Neuroscience Unit, Department of Neurology and Feil Brain and Mind Research Institute, Weill Cornell Medicine, New York, United States
| | - Scott T. Tagawa
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, United States
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Department of Neurology and Feil Brain and Mind Research Institute, Weill Cornell Medicine, New York, United States
| | - Neal Parikh
- Clinical and Translational Neuroscience Unit, Department of Neurology and Feil Brain and Mind Research Institute, Weill Cornell Medicine, New York, United States
| | - Babak B. Navi
- Clinical and Translational Neuroscience Unit, Department of Neurology and Feil Brain and Mind Research Institute, Weill Cornell Medicine, New York, United States,Corresponding Author: 420 East 70th Street, Room 411, New York, NY, USA,
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Marchetti M, Falanga A. Hemostatic biomarkers in occult cancer and cancer risk prediction. Thromb Res 2021; 191 Suppl 1:S37-S42. [PMID: 32736777 DOI: 10.1016/s0049-3848(20)30395-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 12/20/2022]
Abstract
Cancer patients present with abnormalities of coagulation tests, reflecting a hypercoagulable state, often asso- ciated with a high incidence of thrombotic complications and poor disease prognosis. Different degrees of blood clotting abnormalities are described in diverse cancers, depending on tumor types and stage. The mechanisms of hemostasis that are critically involved in thrombosis are also implicated in tumor progression, angiogenesis, and metastatic spread. In this review, we summarize the results of published studies and focus on ongoing research and future directions of clotting factors and clotting activation bioproducts as biomarkers for cancer disease diagnosis and in cancer risk prediction.
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Affiliation(s)
- Marina Marchetti
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy.
| | - Anna Falanga
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy; University of Milan Bicocca, School of Medicine, Italy
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Jiang J, Shang X, Zhao J, Cao M, Wang J, Li R, Wang Y, Xu J. Score for Predicting Active Cancer in Patients with Ischemic Stroke: A Retrospective Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5585206. [PMID: 34124248 PMCID: PMC8169246 DOI: 10.1155/2021/5585206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/01/2021] [Accepted: 05/18/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND We aimed to examine the differences of clinical characteristics between patients with ischemic stroke with active cancer and those without cancer to develop a clinical score for predicting the presence of occult cancer in patients with ischemic stroke. METHODS This retrospective study enrolled consecutive adult patients with acute ischemic stroke who were admitted to our department between December 2017 and January 2019. The demographic, clinical, laboratory, and neuroimaging characteristics were compared between patients with ischemic stroke with active cancer and those without cancer. Multivariate analysis was performed to identify independent factors associated with active cancer. Subsequently, a predictive score was developed using the areas under the receiver operating characteristic curves based on these independent factors. Finally, Bayesian decision theory was applied to calculate the posterior probability of active cancer for finding the best scoring system. RESULTS Fifty-three (6.63%) of 799 patients with ischemic stroke had active cancer. The absence of a history of hyperlipidemia (odds ratio (OR) = 0.17, 95% confidence interval (CI): 0.06-0.48, P < 0.01), elevated serum fibrinogen (OR = 1.72, 95% CI: 1.33-2.22, P < 0.01) and D-dimer levels (OR = 1.43, 95% CI: 1.24-1.64, P <0.01), and stroke of undetermined etiology (OR = 22.87, 95% CI: 9.91-52.78, P < 0.01) were independently associated with active cancer. A clinical score based on the absence of hyperlipidemia, serum fibrinogen level of ≥4.00 g/L, and D-dimer level of ≥2.00 μg/mL predicted active cancer with an area under the curve of 0.83 (95% CI: 0.77-0.89, P < 0.01). The probability of active cancer was 59% at a supposed prevalence of 6.63%, if all three independent factors were present in a patient with ischemic stroke. CONCLUSIONS We devised a clinical score to predict active cancer in patients with ischemic stroke based on the absence of a history of hyperlipidemia and elevated serum D-dimer and fibrinogen levels. The use of this score may allow for early intervention. Further research is needed to confirm the implementation of this score in clinical settings.
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Affiliation(s)
- Jiwei Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiuli Shang
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Jinming Zhao
- Department of Pathology, The First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, China
| | - Meihui Cao
- Department of Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, China
| | - Jirui Wang
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Runzhi Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yanli Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jun Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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29
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Rioux B, Keezer MR, Gioia LC. Occult cancer diagnosed following acute ischemic stroke. CMAJ 2021; 192:E1037-E1039. [PMID: 32900764 DOI: 10.1503/cmaj.200725] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Bastien Rioux
- Department of Neurosciences (Rioux, Keezer, Gioia), University of Montreal; Centre hospitalier de l'Universitéde Montréal (Rioux, Keezer, Gioia); Department of Social and Preventive Medicine (Keezer), University of Montreal, Montréal, Que
| | - Mark R Keezer
- Department of Neurosciences (Rioux, Keezer, Gioia), University of Montreal; Centre hospitalier de l'Universitéde Montréal (Rioux, Keezer, Gioia); Department of Social and Preventive Medicine (Keezer), University of Montreal, Montréal, Que
| | - Laura C Gioia
- Department of Neurosciences (Rioux, Keezer, Gioia), University of Montreal; Centre hospitalier de l'Universitéde Montréal (Rioux, Keezer, Gioia); Department of Social and Preventive Medicine (Keezer), University of Montreal, Montréal, Que.
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30
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Choi KH, Kim JH, Kim JM, Kang KW, Lee C, Kim JT, Choi SM, Park MS, Cho KH. d-dimer Level as a Predictor of Recurrent Stroke in Patients With Embolic Stroke of Undetermined Source. Stroke 2021; 52:2292-2301. [PMID: 33971744 DOI: 10.1161/strokeaha.120.033217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Kang-Ho Choi
- Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea (K.-H.C., J.-M.K., K.-W.K., J.-T.K., S.-M.C., M.-S.P., K.-H.C.).,Department of Neurology, Chonnam National University Hwasun Hospital, Republic of Korea (K.-H.C., J.-M.K., K.-W.K.)
| | - Ja-Hae Kim
- Molecular Imaging Center, Department of Nuclear Medicine, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea (J.-H.K.)
| | - Jae-Myung Kim
- Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea (K.-H.C., J.-M.K., K.-W.K., J.-T.K., S.-M.C., M.-S.P., K.-H.C.).,Department of Neurology, Chonnam National University Hwasun Hospital, Republic of Korea (K.-H.C., J.-M.K., K.-W.K.)
| | - Kyung-Wook Kang
- Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea (K.-H.C., J.-M.K., K.-W.K., J.-T.K., S.-M.C., M.-S.P., K.-H.C.).,Department of Neurology, Chonnam National University Hwasun Hospital, Republic of Korea (K.-H.C., J.-M.K., K.-W.K.)
| | - Changho Lee
- Molecular Imaging Center, Department of Nuclear Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Korea (C.L.)
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea (K.-H.C., J.-M.K., K.-W.K., J.-T.K., S.-M.C., M.-S.P., K.-H.C.)
| | - Seong-Min Choi
- Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea (K.-H.C., J.-M.K., K.-W.K., J.-T.K., S.-M.C., M.-S.P., K.-H.C.)
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea (K.-H.C., J.-M.K., K.-W.K., J.-T.K., S.-M.C., M.-S.P., K.-H.C.)
| | - Ki-Hyun Cho
- Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea (K.-H.C., J.-M.K., K.-W.K., J.-T.K., S.-M.C., M.-S.P., K.-H.C.)
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31
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Ramos-Pachón A, López-Cancio E, Bustamante A, Pérez de la Ossa N, Millán M, Hernández-Pérez M, Garcia-Berrocoso T, Cardona P, Rubiera M, Serena J, Ustrell X, Garcés M, Terceño M, Dávalos A, Montaner J. D-Dimer as Predictor of Large Vessel Occlusion in Acute Ischemic Stroke. Stroke 2021; 52:852-858. [PMID: 33563016 DOI: 10.1161/strokeaha.120.031657] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Improving prehospital triage of large vessel occlusion (LVO) would reduce time to reperfusion therapies. We aimed to study early predictors of LVO in acute ischemic stroke to identify candidates for endovascular treatment. METHODS The Stroke-Chip was a prospective observational study conducted at 6 Stroke Centers in Catalonia. Blood samples were obtained in the first 6 hours from symptom onset of consecutive patients. Stroke severity was evaluated with National Institutes of Health Stroke Scale (NIHSS) and LVO was assessed. Independent association of multiple blood biomarkers with LVO was evaluated using logistic regression models adjusted by covariates. Sensitivity, specificity, and predictive values were assessed for NIHSS and the combination of NIHSS and selected serum biomarkers levels. RESULTS One thousand three hundred eight suspected strokes were enrolled for a 17-month period. LVO was not assessed in 131 patients. One thousand one hundred seventy-seven patients were selected for analysis (mean age 69.3 years, 56% men, median baseline NIHSS of 6, and median time to blood collection 2.5 hours). LVO was detected in 262 patients. LVO patients were older, had higher baseline NIHSS, history of atrial fibrillation, and lower time from stroke onset to admission. After logistic regression analysis, D-dimer remained an independent predictor of LVO (odds ratio, 1.59 [1.31-1.92]). Specificity and positive predictive value to exclude or detect LVO were higher when using combined D-dimer levels and NIHSS score assessment rather than NIHSS alone. CONCLUSIONS Early D-dimer levels are an independent predictor of LVO and may be useful to better optimize prehospital patient transport to the appropriate stroke center.
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Affiliation(s)
- Anna Ramos-Pachón
- Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (A.R.-P., A.B., N.P.d.l.O., M.M., M.H.-P., A.D.)
| | - Elena López-Cancio
- Neurology Department, Hospital Universitario Central de Asturias, Oviedo, Spain (E.L.-C.)
| | - Alejandro Bustamante
- Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (A.R.-P., A.B., N.P.d.l.O., M.M., M.H.-P., A.D.)
| | - Natàlia Pérez de la Ossa
- Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (A.R.-P., A.B., N.P.d.l.O., M.M., M.H.-P., A.D.)
| | - Mònica Millán
- Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (A.R.-P., A.B., N.P.d.l.O., M.M., M.H.-P., A.D.)
| | - Maria Hernández-Pérez
- Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (A.R.-P., A.B., N.P.d.l.O., M.M., M.H.-P., A.D.)
| | - Teresa Garcia-Berrocoso
- Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Spain (T.G.-B., J.M.)
| | - Pere Cardona
- Neurology Department, Hospital Universitari Bellvitge, L'Hospitalet de Llobregat, Spain (P.C.)
| | - Marta Rubiera
- Neurology Department, Hospital Universitari Vall D'Hebron-VHIR, Barcelona, Spain (M.R.)
| | - Joaquín Serena
- Neurology Department, Hospital Universitari Josep Trueta, Girona, Spain (J.S., M.T.)
| | - Xavier Ustrell
- Neurology Department, Hospital Universitari Joan XXIII, Tarragona, Spain (X.U.)
| | - Moisés Garcés
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain (M.G.)
| | - Mikel Terceño
- Neurology Department, Hospital Universitari Josep Trueta, Girona, Spain (J.S., M.T.)
| | - Antoni Dávalos
- Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (A.R.-P., A.B., N.P.d.l.O., M.M., M.H.-P., A.D.)
| | - Joan Montaner
- Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (A.R.-P., A.B., N.P.d.l.O., M.M., M.H.-P., A.D.).,Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Spain (T.G.-B., J.M.)
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32
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Navi BB, Kasner SE, Elkind MSV, Cushman M, Bang OY, DeAngelis LM. Cancer and Embolic Stroke of Undetermined Source. Stroke 2021; 52:1121-1130. [PMID: 33504187 DOI: 10.1161/strokeaha.120.032002] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
One-quarter to one-third of ischemic strokes have no established mechanism after standard diagnostic evaluation and are classified as embolic stroke of undetermined source (ESUS). Failure of randomized trials to demonstrate a benefit of direct oral anticoagulants over aspirin for the treatment of ESUS as a single homogeneous entity has led to renewed interest by stroke experts to divide ESUS into subgroups. Emerging data suggest that active cancer, which is present in 5% to 10% of patients with ESUS, is a distinct and important subgroup of ESUS with unique clinical characteristics, underlying pathophysiologies, and treatment and prognostic considerations. Furthermore, the prevalence of cancer-related ESUS is expected to increase as patients with cancer, even those with distant metastases, survive longer due to improvements in cancer treatments. In this topical review, we examine the epidemiological link between ESUS and cancer, the clinical features and potential mechanistic underpinnings of ESUS with cancer (with a focus on novel biomarkers and their relationship to recurrent stroke and other thromboembolic events), and the potential treatment strategies for cancer-related ESUS. We include a critical appraisal of existing data and ongoing or planned clinical trials of different antithrombotic approaches. As cancer-related ESUS is a dynamic disease with variable course, we recommend close collaboration between neurologists and oncologists to develop individualized management plans.
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Affiliation(s)
- Babak B Navi
- Clinical and Translational Neuroscience Unit, Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY (B.B.N.).,Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY (B.B.N., L.M.D.)
| | - Scott E Kasner
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia (S.E.K.)
| | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.)
| | - Mary Cushman
- Division of Hematology and Oncology, Department of Medicine, University of Vermont Larner College of Medicine, Burlington (M.C.)
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (O.Y.B.)
| | - Lisa M DeAngelis
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY (B.B.N., L.M.D.)
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33
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Rioux B, Touma L, Nehme A, Gore G, Keezer MR, Gioia LC. Frequency and predictors of occult cancer in ischemic stroke: A systematic review and meta-analysis. Int J Stroke 2020; 16:12-19. [PMID: 33197367 DOI: 10.1177/1747493020971104] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The optimal approach for cancer screening after an ischemic stroke remains unclear. AIMS We sought to summarize the existing evidence regarding the frequency and predictors of cancer after an ischemic stroke. SUMMARY OF REVIEW We searched seven databases from January 1980 to September 2019 for articles reporting malignant tumors and myeloproliferative neoplasms diagnosed after an ischemic stroke (PROSPERO protocol: CRD42019132455). We screened 15,400 records and included 51 articles. The pooled cumulative incidence of cancer within one year after an ischemic stroke was 13.6 per thousand (95% confidence interval [CI], 5.6-24.8), higher in studies focusing on cryptogenic stroke (62.0 per thousand; 95% CI, 13.6-139.3 vs 9.6 per thousand; 95% CI, 4.0-17.3; p = 0.02) and those reporting cancer screening (39.2 per thousand; 95% CI, 16.4-70.6 vs 7.2 per thousand; 95% CI, 2.5-14.1; p = 0.003). Incidence of cancer after stroke was generally higher compared to people without stroke. Most cases were diagnosed within the first few months after stroke. Several predictors of cancer were identified, namely older age, smoking, and involvement of multiple vascular territories as well as elevated C-reactive protein and d-dimers. CONCLUSIONS The frequency of incident cancer after an ischemic stroke is low, but higher in cryptogenic stroke and after cancer screening. Several predictors may increase the yield of cancer screening after an ischemic stroke. The pooled incidence of post-stroke cancer is likely underestimated, and larger studies with systematic assessment of cancer after stroke are needed to produce more precise and valid estimates.
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Affiliation(s)
- Bastien Rioux
- Department of Neurosciences, 5622University of Montreal, Montreal, Canada.,Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | - Lahoud Touma
- Department of Neurosciences, 5622University of Montreal, Montreal, Canada.,Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | - Ahmad Nehme
- Department of Neurosciences, 5622University of Montreal, Montreal, Canada.,Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | - Genevieve Gore
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, 5620McGill University, Montreal, Canada
| | - Mark R Keezer
- Department of Neurosciences, 5622University of Montreal, Montreal, Canada.,Centre hospitalier de l'Université de Montréal, Montreal, Canada.,Department of Social and Preventive Medicine, School of Public Health, 5622University of Montreal, Montreal, Canada
| | - Laura C Gioia
- Department of Neurosciences, 5622University of Montreal, Montreal, Canada.,Centre hospitalier de l'Université de Montréal, Montreal, Canada
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Gon Y, Kabata D, Kawano T, Kanki H, Todo K, Sasaki T, Shintani A, Mochizuki H. Hematological Abnormalities and Malnutrition Mediate Pathway between Cancer and Outcomes in Ischemic Stroke Patients. J Stroke Cerebrovasc Dis 2020; 29:104943. [PMID: 32689614 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104943] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/16/2020] [Accepted: 05/05/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The present study aimed to examine whether variables including D-dimer, high-sensitivity C-reactive protein (hsCRP), hemoglobin, platelet count, and nutritional status mediate the pathway between cancer and ischemic stroke outcomes. METHODS We reviewed data from consecutive patients with ischemic stroke admitted to Osaka University Hospital between January 1, 2006, and December 31, 2016. Patients with ischemic stroke were grouped according to the presence of cancer. Nutritional status was assessed using Controlling Nutritional Status (CONUT) scores. Mediation analyses were utilized to address the study aims. RESULTS Among 1,570 patients with ischemic stroke, 185 (12%) had active cancer. Relative to patients with ischemic stroke in the non-cancer group, those in the cancer group exhibited higher National Institutes of Health Stroke Scale scores on admission, higher D-dimer and hsCRP levels, lower hemoglobin levels and platelet counts, higher CONUT scores, and poorer modified Rankin Scale scores at discharge. Mediation analysis revealed that D-dimer, hsCRP, hemoglobin, platelet count, and CONUT scores acted as mediators of poor prognosis in the cancer group. The association between the exposure and outcome variables was no longer significant in the models containing D-dimer and CONUT scores as mediator variables, suggesting that they were strong mediators. Regarding the association between the mediator and outcome variables, hemoglobin, platelet count, and CONUT exhibited non-linearity (p for non-linearity < 0.001). CONCLUSIONS D-dimer, hsCRP, hemoglobin, platelet count, and CONUT score act as mediators of poor prognosis in patients with ischemic stroke with comorbid cancer. Such abnormalities can help to predict ischemic stroke outcomes.
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Affiliation(s)
- Yasufumi Gon
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan.
| | - Daijiro Kabata
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan.
| | - Tomohiro Kawano
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hideaki Kanki
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Kenichi Todo
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Tsutomu Sasaki
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Ayumi Shintani
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hideki Mochizuki
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan.
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Guo L, Wang L, Liu W. Ability of the number of territories involved on DWI-MRI to predict occult systemic malignancy in cryptogenic stroke patients. J Stroke Cerebrovasc Dis 2020; 29:104823. [PMID: 32362555 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104823] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/01/2020] [Accepted: 03/19/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Lesions in multiple arterial territories is one of the typical features of malignancy patients with cryptogenic stroke. Hence, if patients with cryptogenic stroke display such feature, occult cancer could be predicted. The study aimed to analyze the predictive ability of the number of territories involved on DWI-MRI for occult systemic malignancy (OSM) in patients with cryptogenic stroke. METHODS We enrolled patients with cryptogenic stroke without a diagnosis of malignancy at stroke onset between January 2013 and November 2018. Clinical variables were analyzed between cryptogenic stroke patients with and without OSM through univariate and multiple logistic regression analyses. Points for OSM were generated by β-coefficients. The sensitivity and specificity of the risk score were assessed by the area under the receiver operating characteristic curve (AUROC). The cutoff value for predicting OSM was determined by the maximum Youden index. RESULTS Among 108 cyptogenic stroke patients, compared to patients without OSM (n = 96), patients with OSM (n = 12) had a lower nutrition status (P = 0.031), higher plasma D-dimer levels (P < 0.001) and more territories involved on DWI-MRI (P < 0.001). Multiple logistic regression analysis revealed that plasma D-dimer levels (OR, 3.54; 95% Cl, 1.62-7.76; P = 0.002) and the number of territories involved (OR, 4.45; 95% CI, 1.25-15.80; P = 0.021) independently predicted OSM. The predictive score system built upon the number of territories showed good discrimination with an AUROC of 0.84 (95% CI, 0.71-0.96). The cutoff value was 2 with a maximum Youden's index of 0.56, which means that patients with more than one territory involved on DWI-MRI may need extensive screening for OSM. CONCLUSIONS The number of territories involved on DWI-MRI was a valid predictor for OSM in cryptogenic stroke patients who need to undergo further evaluations .
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Affiliation(s)
- Linjia Guo
- Department of Neurology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
| | - Lili Wang
- Department of Neurology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Wenhong Liu
- Department of Neurology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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Wei Y, Yang Q, Qin Q, Chen Y, Quan X, Wei J, Zhou L, Wang D, Li H, Li G, Li S, Liang Z. Profiling of the Risk Factors and Designing of a Model to Identify Ischemic Stroke in Patients with Non-Hodgkin Lymphoma: A Multicenter Retrospective Study. Eur Neurol 2020; 83:41-48. [PMID: 32344398 DOI: 10.1159/000506046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 01/18/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The occurrence of ischemic stroke in patients with non-Hodgkin lymphoma (NHL) is not well understood. This study aimed to determine independent risk factors to identity ischemic stroke in non-Hodgkin lymphoma-associated ischemic stroke (NHLAIS) patients. METHODS This retrospective study was conducted on NHLAIS patients and age- and gender-matched NHL patients. We collected clinical data of patients in both groups and used multiple logistic regression analysis to identify independent risk factors for NHLAIS. A receiver operating characteristic (ROC) analysis was used to establish an identification model based on potential risk factors of NHLAIS. RESULTS Sixty-three NHLAIS patients and 63 NHL patients were enrolled. Stage III/IV (58/63, 92.1%) and multiple arterial infarcts (44/63, 69.8%) were common among NHLAIS patients. Notably, NHLAIS patients had higher levels of serum fibrinogen (FIB), D-dimer, and ferritin (SF) and prolonged thromboplastin time and prothrombin time (PT) compared with NHL patients (all p < 0.05). Elevated FIB, D-dimer, and SF and prolonged PT were independent risk factors for NHLAIS. The area under the ROC curve of the identification model of NHLAIS patients was largest compared to that of other risk factors (0.838, 95% confidence interval: 0.759-0.899) (p < 0.05). CONCLUSION This study reveals that elevated serum FIB, D-dimer, and SF and prolonged PT are potential independent risk factors of NHLAIS. The identification model established in this study may help monitor NHL patients who are at high risk of developing NHLAIS.
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Affiliation(s)
- Yunfei Wei
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.,Department of Neurology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qingqing Yang
- Department of Neurology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qixiong Qin
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ya Chen
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xuemei Quan
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jing Wei
- Department of Neurology, The Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Liyuan Zhou
- Department of Neurology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Dacheng Wang
- Department of Neurology, The Ninth Affiliated Hospital of Guangxi Medical University, Beihai, China
| | - Haihong Li
- Department of Neurology, Fusui County People's Hospital, Chongzuo, China
| | - Guohui Li
- Department of Neurology, Wuzhou Red Cross Hospital, Wuzhou, China
| | - Shengyu Li
- Department of Neurology, Wuming County People's Hospital, Nanning, China
| | - Zhijian Liang
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China,
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Quan X, Qin Q, Chen Y, Wei Y, Xie X, Wang D, Li H, Li S, Cheng D, Liang Z. Independent risk factors and the potential predictors of bladder cancer-related ischemic stroke. J Int Med Res 2020; 48:300060520919227. [PMID: 32338169 PMCID: PMC7218468 DOI: 10.1177/0300060520919227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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 investigate the independent risk factors and potential predictors of bladder cancer-related ischemic stroke (BCRIS). Methods This was a multi-center retrospective study including patients with active bladder cancer and acute ischemic stroke without traditional stroke risk factors (BCRIS group), and sex- and age-matched patients with active bladder cancer alone (control group). Data were collected between January 2006 and December 2018. Uni- and multivariate analyses were performed to identify independent risk factors for BCRIS. The predictive performance of these risk factors was assessed using receiver operating characteristic (ROC) curves. Results Records were retrospectively reviewed from 60 BCRIS patients and 120 bladder cancer controls. Univariate analysis revealed that serum D-dimer and carcinoembryonic antigen (CEA) levels and the platelet and neutrophil counts were significantly higher in BCRIS patients compared with controls. Multivariate analysis identified the three above-mentioned variables as independent risk factors for BCRIS. The product of all three factors gave the largest area under the ROC curve. Conclusions Elevated serum D-dimer and CEA levels and increased platelet count were independent risk factors for BCRIS, and the cut-off value based on the product of the three independent risk factors (≥2,640,745.29) could serve as a potential predictor of BCRIS.
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Affiliation(s)
- Xuemei Quan
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University & Guangxi Key Laboratory of Precision Medicine in Cardio-cerebrovascular Diseases Control and Prevention & Guangxi Clinical Research Center for Cardio-cerebrovascular Diseases, Nanning, Guangxi Province, China
| | - Qixiong Qin
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University & Guangxi Key Laboratory of Precision Medicine in Cardio-cerebrovascular Diseases Control and Prevention & Guangxi Clinical Research Center for Cardio-cerebrovascular Diseases, Nanning, Guangxi Province, China
| | - Ya Chen
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University & Guangxi Key Laboratory of Precision Medicine in Cardio-cerebrovascular Diseases Control and Prevention & Guangxi Clinical Research Center for Cardio-cerebrovascular Diseases, Nanning, Guangxi Province, China
| | - Yunfei Wei
- Department of Neurology, Guangxi Medical University Second Affiliated Hospital, Nanning, Guangxi Province, China
| | - Xianlong Xie
- Intensive Care Unit, Guangxi Cancer Hospital and Guangxi Medical University Affiliated Cancer Hospital, Nanning, Guangxi Province, China
| | - Dacheng Wang
- Department of Neurology, Guangxi Medical University Ninth Affiliated Hospital, Beihai, Guangxi Province, China
| | - Haihua Li
- Department of Neurology, Fusui County People's Hospital, Chongzuo, Guangxi Province, China
| | - Shengyu Li
- Department of Neurology, Wuming Hospital of Guangxi Medical University, Nanning, Guangxi Province, China
| | - Daobin Cheng
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University & Guangxi Key Laboratory of Precision Medicine in Cardio-cerebrovascular Diseases Control and Prevention & Guangxi Clinical Research Center for Cardio-cerebrovascular Diseases, Nanning, Guangxi Province, China
| | - Zhijian Liang
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University & Guangxi Key Laboratory of Precision Medicine in Cardio-cerebrovascular Diseases Control and Prevention & Guangxi Clinical Research Center for Cardio-cerebrovascular Diseases, Nanning, Guangxi Province, China
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Cheng X, Qin Q, Lu L, Chen C, Wei Y, Wang D, Li H, Li G, Liang H, Li S, Cheng D, Liang Z. The independent risks and specific biomarker of breast cancer-related ischemic stroke. Int J Neurosci 2020; 131:135-143. [PMID: 32083954 DOI: 10.1080/00207454.2020.1733562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIM This retrospective study was designed to investigate the independent risks and specific biomarker for breast cancer-related ischemic stroke (BCRS). METHODS Clinical features and laboratory findings were compared between BCRS group and breast cancer group without stroke, and further multivariate analyses were performed to predict independent risks factors for BCRS patients. A receiver operator characteristic (ROC) curve analysis was configured to estimate the diagnostic efficacy of each independent risk and the product of these risks and to obtain the optimal cut-off value of diagnosis, which was termed the BCRS Index. RESULTS BCRS patients had elevated plasma D-dimer and CA153 levels and platelet-to-lymphocyte ratio (PLR), as well as more patients received endocrine therapy (all p < 0.05). Moreover, multivariate analysis revealed that D-dimer levels (odds ratio [OR]: 1.002; 95% confidence interval [CI]: 1.001-1.003; p = 0.000), CA153 levels (OR: 1.005; 95% CI: 1.001-1.008; p = 0.007), PLR (OR: 1.010; 95% CI: 1.004-1.015; p = 0.001), and endocrine therapy (OR: 1.268; 95% CI: 1.087-1.479; p = 0.003) were identified as independent risks of BCRS. Furthermore, ROC analysis displayed that the product of risks had the best diagnostic efficacy, of which the area under the curve was 0.846 ± 0.28. The optimum cut-off point was 2.37 × 106/mL, which was termed the BCRS Index with higher diagnostic accuracy and validity. CONCLUSIONS Endocrine therapy, as well as elevated plasma D-dimer and CA153 levels and PLR values may be independent risks for BCRS. Furthermore, BCRS Index should be served as a novel specific biomarker for BCRS, which is useful to distinguish BCRS for clinicians.
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Affiliation(s)
- Xuemin Cheng
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University & Guangxi Key Laboratory of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention & Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning, Guangxi, China
| | - Qixiong Qin
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University & Guangxi Key Laboratory of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention & Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning, Guangxi, China
| | - Lizhi Lu
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University & Guangxi Key Laboratory of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention & Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning, Guangxi, China
| | - Chunyong Chen
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University & Guangxi Key Laboratory of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention & Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning, Guangxi, China
| | - Yunfei Wei
- Department of Neurology, The Second Affliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Dacheng Wang
- Department of Neurology, The Ninth Affiliated Hospital of Guangxi Medical University, Beihai, Guangxi, China
| | - Haihua Li
- Department of Neurology, Fusui County People's Hospital, Chongzuo, Guangxi, China
| | - Guohui Li
- Department of Neurology, Wuzhou Red Cross Hospital, Wuzhou, Guangxi, China
| | - Hongbin Liang
- Department of Neurology, Cenxi People's Hospital, Cenxi, Guangxi, China
| | - Shengyu Li
- Department of Neurology, Wuming County People's Hospital, Nanning, Guangxi, China
| | - Daobin Cheng
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University & Guangxi Key Laboratory of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention & Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning, Guangxi, China
| | - Zhijian Liang
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University & Guangxi Key Laboratory of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention & Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning, Guangxi, China
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Amiral J. Measurement of blood activation markers applied to the early diagnosis of cardiovascular alterations. Expert Rev Mol Diagn 2019; 20:85-98. [DOI: 10.1080/14737159.2020.1704258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Jean Amiral
- Scientific-Hemostasis-Consulting, Scientific Director and Consultant in Thrombosis-Hemostasis, Andrésy, France
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Potugari BR, Priyanka P, Komanapalli SD, Mercier RJ. Ovarian Cancer Presenting as Cryptogenic Stroke from Patent Foramen Ovale. Clin Med Res 2019; 17:97-101. [PMID: 31324738 PMCID: PMC6886892 DOI: 10.3121/cmr.2019.1444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 04/15/2019] [Accepted: 05/13/2019] [Indexed: 12/21/2022]
Abstract
A woman, aged 52 years, experienced severe headache, confusion, nausea, dizziness, and diplopia for three days. Magnetic resonance imaging of the brain showed multiple acute and subacute infarcts suggestive of embolic events. Dermatological examination was notable for splinter hemorrhages and macular patches on the fingernails and feet, respectively. Further diagnostic imaging of the chest and abdomen revealed pulmonary emboli and an ovarian mass with omental deposits and splenic infarcts. Fine-needle aspiration cytology and surgery confirmed a diagnosis of high-grade serous adenocarcinoma of the ovary with clear cell features. Extensive evaluation for malignancy should be considered on a case-by-case basis for patients with thromboembolic disease and an initial negative diagnostic evaluation for stroke. Consideration of patent foramen ovale closure is reasonable in patients with malignancy who are at risk for recurrent strokes.
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Affiliation(s)
- Bindu R Potugari
- Department of Internal Medicine, Marshfield Clinic, Marshfield, Wisconsin; Current affiliation: Oncology Fellow, St. Joseph Mercy Ann Arbor, Ypsilanti, Michigan
| | - Priyanka Priyanka
- Department of Internal Medicine, Marshfield Medical Center, Marshfield, Wisconsin; Current affiliation: Department of Internal Medicine, University of West Virginia, Morgantown, West Virginia
| | - Sarah D Komanapalli
- Department of Hospital Medicine, Marshfield Medical Center, Marshfield, Wisconsin
| | - Richard J Mercier
- Department of Oncology, Marshfield Medical Center, Marshfield, Wisconsin
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Navi BB, Mathias R, Sherman CP, Wolfe J, Kamel H, Tagawa ST, Saxena A, Ocean AJ, Iadecola C, DeAngelis LM, Elkind MSV, Hull H, Jickling GC, Sharp FR, Ander BP, Stamova B. Cancer-Related Ischemic Stroke Has a Distinct Blood mRNA Expression Profile. Stroke 2019; 50:3259-3264. [PMID: 31510897 PMCID: PMC6817410 DOI: 10.1161/strokeaha.119.026143] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/26/2019] [Indexed: 12/21/2022]
Abstract
Background and Purpose- Comorbid cancer is common in patients with acute ischemic stroke (AIS). As blood mRNA profiles can distinguish AIS mechanisms, we hypothesized that cancer-related AIS would have a distinctive gene expression profile. Methods- We evaluated 4 groups of 10 subjects prospectively enrolled at 3 centers from 2009 to 2018. This included the group of interest with active solid tumor cancer and AIS and 3 control groups with active cancer only, AIS only, or vascular risk factors only. Subjects in the AIS-only and cancer-only groups were matched to subjects in the cancer-stroke group by age, sex, and cancer type (if applicable). Subjects in the vascular risk factor group were matched to subjects in the cancer-stroke and stroke-only groups by age, sex, and vascular risk factors. Blood was drawn 72 to 120 hours after stroke. Total RNA was processed using 3' mRNA sequencing. ANOVA and Fisher least significant difference contrast methods were used to estimate differential gene expression between groups. Results- In the cancer-stroke group, 50% of strokes were cryptogenic. All groups had differentially expressed genes that could distinguish among them. Comparing the cancer-stroke group to the stroke-only group and after accounting for cancer-only genes, 438 genes were differentially expressed, including upregulation of multiple genes/pathways implicated in autophagy signaling, immunity/inflammation, and gene regulation, including IL (interleukin)-1, interferon, relaxin, mammalian target of rapamycin signaling, SQSTMI1 (sequestosome-1), and CREB1 (cAMP response element binding protein-1). Conclusions- This study provides evidence for a distinctive molecular signature in blood mRNA expression profiles of patients with cancer-related AIS. Future studies should evaluate whether blood mRNA can predict detection of occult cancer in patients with AIS. Clinical Trial Registration- URL: https://clinicaltrials.gov. Unique identifier: NCT02604667.
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Affiliation(s)
- Babak B Navi
- From the Department of Neurology and Feil Family Brain and Mind Research Institute (B.B.N, R.M., C.P.S., H.K., C.I., L.M.D.), Weill Cornell Medicine, New York, NY
- Department of Neurology, Memorial Sloan Kettering, New York, NY (B.B.N, J.W., L.M.D.)
| | - Ryna Mathias
- From the Department of Neurology and Feil Family Brain and Mind Research Institute (B.B.N, R.M., C.P.S., H.K., C.I., L.M.D.), Weill Cornell Medicine, New York, NY
| | - Carla P Sherman
- From the Department of Neurology and Feil Family Brain and Mind Research Institute (B.B.N, R.M., C.P.S., H.K., C.I., L.M.D.), Weill Cornell Medicine, New York, NY
| | - Julia Wolfe
- Department of Neurology, Memorial Sloan Kettering, New York, NY (B.B.N, J.W., L.M.D.)
| | - Hooman Kamel
- From the Department of Neurology and Feil Family Brain and Mind Research Institute (B.B.N, R.M., C.P.S., H.K., C.I., L.M.D.), Weill Cornell Medicine, New York, NY
| | - Scott T Tagawa
- Department of Medicine (S.T.T., A.S., A.J.O.), Weill Cornell Medicine, New York, NY
| | - Ashish Saxena
- Department of Medicine (S.T.T., A.S., A.J.O.), Weill Cornell Medicine, New York, NY
| | - Allyson J Ocean
- Department of Medicine (S.T.T., A.S., A.J.O.), Weill Cornell Medicine, New York, NY
| | - Costantino Iadecola
- From the Department of Neurology and Feil Family Brain and Mind Research Institute (B.B.N, R.M., C.P.S., H.K., C.I., L.M.D.), Weill Cornell Medicine, New York, NY
| | - Lisa M DeAngelis
- From the Department of Neurology and Feil Family Brain and Mind Research Institute (B.B.N, R.M., C.P.S., H.K., C.I., L.M.D.), Weill Cornell Medicine, New York, NY
- Department of Neurology, Memorial Sloan Kettering, New York, NY (B.B.N, J.W., L.M.D.)
| | - Mitchell S V Elkind
- Departments of Neurology (M.S.V.E.), Columbia University, New York, NY
- Epidemiology (M.S.V.E.), Columbia University, New York, NY
| | - Heather Hull
- Department of Neurology, University of California, Davis (H.H., G.C.J., F.R.S., B.P.A., B.S.)
| | - Glen C Jickling
- Department of Neurology, University of California, Davis (H.H., G.C.J., F.R.S., B.P.A., B.S.)
| | - Frank R Sharp
- Department of Neurology, University of California, Davis (H.H., G.C.J., F.R.S., B.P.A., B.S.)
| | - Bradley P Ander
- Department of Neurology, University of California, Davis (H.H., G.C.J., F.R.S., B.P.A., B.S.)
| | - Boryana Stamova
- Department of Neurology, University of California, Davis (H.H., G.C.J., F.R.S., B.P.A., B.S.)
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Ohara T, Farhoudi M, Bang OY, Koga M, Demchuk AM. The emerging value of serum D-dimer measurement in the work-up and management of ischemic stroke. Int J Stroke 2019; 15:122-131. [DOI: 10.1177/1747493019876538] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Elevated D-dimer levels are a marker of both thrombin formation and fibrinolysis. Currently D-dimer measurement is routinely used for ruling out venous thromboembolism and diagnosis/monitoring of disseminated intravascular coagulation. Recent emerging data suggest that D-dimer may become an important biomarker in ischemic stroke as well as in cardiovascular diseases. Aims To outline the clinical utility of D-dimer in work-up and management of ischemic stroke. Summary D-dimer measurement is most useful in stroke with active cancer as it can confirm etiologic diagnosis, predict recurrent stroke risk, and aid treatment decision in cancer-associated stroke. In cryptogenic stroke, high D-dimer levels can also provide clues for the cause of stroke as occult cancer and undetected cardiac embolic source as occult atrial fibrillation and may be helpful in treatment decision making of secondary stroke prevention. Serial D-dimer measurements should be further studied to monitor antithrombotic therapy effectiveness in both cardiogenic and cryptogenic etiologies. Conclusion Accumulating data suggests the utility of D-dimer test in the management of ischemic stroke, although the evidence is still limited. Future studies would clarify the role of D-dimer measurement in ischemic stroke.
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Affiliation(s)
- Tomoyuki Ohara
- Calgary Stroke Program, Hotchkiss Brain Institute, Departments of Clinical Neurosciences and Radiology, Cumming School of Medicine University of Calgary, Calgary, Canada
- Department of Neurology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Mehdi Farhoudi
- Calgary Stroke Program, Hotchkiss Brain Institute, Departments of Clinical Neurosciences and Radiology, Cumming School of Medicine University of Calgary, Calgary, Canada
- Neurosciences Research Center, Neurology Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Andrew M Demchuk
- Calgary Stroke Program, Hotchkiss Brain Institute, Departments of Clinical Neurosciences and Radiology, Cumming School of Medicine University of Calgary, Calgary, Canada
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Wang F, Hu XY, Cui ZM, Fang XM, Dai Z, Wang T, Guo DL. Clinical and Imaging Characteristics of Malignant Tumor Concurrent with Stroke. Cancer Biother Radiopharm 2019; 34:504-510. [PMID: 31295003 DOI: 10.1089/cbr.2019.2853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objectives: The present study aimed to retrospectively compare the clinical and imaging characteristics and laboratory data of patients with malignant tumor concurrent with acute ischemic stroke (IS) and patients with cerebral infarction only, and to analyze the potential related risk factors. Method: A total of 126 patients with acute cerebral infarction concurrent with malignant tumor were collected and assigned to the malignant tumor group. In addition, 120 patients hospitalized for routine acute IS during the same period were randomly selected as the control group. Demographic data and common risk factors of cerebrovascular disease, laboratory data, and imaging characteristics in these two groups were compared. Results: In the malignant tumor group, the age of onset was relatively low, and the National Institutes of Health Stroke Scale score, 90 d recurrence rate, and fatality rate were higher than for those in the control group (p < 0.05). However, most patients had no traditional risk factors of stroke. Biochemical results revealed that the peripheral hemoglobin of patients with malignant tumor and cerebral infarction was lower than for those in the control group (p < 0.05). Furthermore, the levels of D-dimer, fibrinogen, tumor markers CA125, CA199, and carcinoembryonic antigen were significantly elevated, and the difference was statistically significant (p < 0.05). Magnetic resonance imaging results revealed that multiple intracranial infarcts were more common in patients in the malignant tumor group, and the difference was statistically significant compared with patients with cerebral infarction only (p < 0.05). Conclusion: Patients with cancer and IS had fewer traditional stroke risk factors but more anemia as well as higher D-dimer level, tumor marker rate, short-term mortality, and stroke recurrence rate. Furthermore, lower age of onset and other characteristics, including multiple intracranial infarcts, can be regarded as important characteristics of such patients.
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Affiliation(s)
- Feng Wang
- Department of Neurology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Xiao-Yun Hu
- Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Zhi-Ming Cui
- Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Xiang-Ming Fang
- Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Zheng Dai
- Department of Neurology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Tao Wang
- Department of Neurology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Dao-Liu Guo
- Department of Neurology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
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Hsu JY, Liu AB. Anticoagulants for cancer-associated ischemic stroke. Tzu Chi Med J 2019; 31:144-148. [PMID: 31258288 PMCID: PMC6559024 DOI: 10.4103/tcmj.tcmj_55_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/24/2018] [Accepted: 02/14/2019] [Indexed: 12/21/2022] Open
Abstract
Patients with cancer-associated ischemic stroke pose similar clinical manifestations and image characteristics, mainly embolic infarction, as patients with atrial fibrillation do. D-dimer, a degraded product of fibrin polymer, is a useful indicator of hypercoagulability, which frequently increases in cancer-associated stroke, but not in stroke resulted from atrial fibrillation. The level of serum D-dimer is associated with mortality, prognosis, and recurrence of systemic thromboembolism in these patients. Theoretically, drugs block coagulation cascade, such as heparin and low-molecular-weight-heparin (LMWH), oral direct anticoagulants, could attenuate the status of hypercoagulation and decrease the amount of D-dimer. These drugs may be helpful to prevent thromboembolic events in patients with cancer-associated hypercoagulability. Vitamin K antagonist, warfarin, decreases the production of coagulation factors, but not interrupts coagulation cascade may not be helpful to decrease hypercoagulability, but increase the risk of bleeding. However, the treatment of cancer-associated embolic stroke is still controversial. This article reviews relevant clinical studies and proposes the applicability of direct oral anticoagulants from the pathophysiological mechanism.
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Affiliation(s)
- Jin-Yi Hsu
- Department of Neurology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - An-Bang Liu
- Department of Neurology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
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45
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Schapira AHV. Progress in neurology 2017-2018. Eur J Neurol 2018; 25:1389-1397. [DOI: 10.1111/ene.13846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A. H. V. Schapira
- Department of Clinical and Movement Neurosciences; UCL Queen Square Institute of Neurology; London UK
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46
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Qin QX, Cheng XM, Lu LZ, Wei YF, Wang DC, Li HH, Li GH, Liang HB, Li SY, Chen L, Liang ZJ. Biomarkers and potential pathogenesis of colorectal cancer-related ischemic stroke. World J Gastroenterol 2018; 24:4950-4958. [PMID: 30487704 PMCID: PMC6250925 DOI: 10.3748/wjg.v24.i43.4950] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/02/2018] [Accepted: 11/08/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the specific biomarkers and potential pathogenesis of colorectal cancer-related ischemic stroke (CRCIS).
METHODS A retrospective study was conducted on CRCIS patients (colorectal cancer patients with ischemic stroke without conventional stroke risk factors) registered at seven centers between January 2007 and December 2017. Clinical data and laboratory and imaging findings were compared with age- and sex- matched patients with colorectal cancer (CRC) without ischemic stroke that were admitted to the same hospital during the same period. Univariate and multivariate analyses were performed to analyze the independent risk factors for CRCIS. A receiver operator characteristic curve was configured to calculate the optimal cut-off value of the products of the independent risk factors for CRCIS.
RESULTS A total of 114 CRCIS patients and 114 CRC patients were included. Multiple lesions in multiple vascular territories were common in CRCIS patients (71, 62.28%). The levels of plasma D-dimer, carcinoembryonic antigen (CEA), cancer antigen 125, and neutrophil count were significantly higher in CRCIS patients than in CRC patients. Multiple logistic regression analysis revealed that plasma D-dimer levels [odds ratio (OR) = 1.002, 95% confidence interval (CI): 1.001-1.003, P < 0.001], CEA levels (OR = 1.011, 95%CI: 1.006-1.015, P < 0.001), and neutrophil count levels (OR = 1.626, 95%CI: 1.268-2.087, P < 0.001) were independent risk factors for CRCIS. In addition, receiver operator characteristic curve revealed that the area under curve for the products of plasma D-dimer, CEA, and neutrophil count was 0.889 ± 0.022 (95%CI: 0.847-0.932, P < 0.001), and the optimal cut-off value for the product was 252.06, which was called the CRCIS Index, with a sensitivity of 86.0% and specificity of 79.8%.
CONCLUSION Hypercoagulability induced by elevated CEA and neutrophils may be an important cause of CRCIS. The CRCIS index, which serves as a biomarker of CRCIS, needs further study.
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Affiliation(s)
- Qi-Xiong Qin
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Province, China
| | - Xue-Min Cheng
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Province, China
| | - Li-Zhi Lu
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Province, China
| | - Yun-Fei Wei
- Department of Neurology, The Second Affiliated Hospital of Guangxi Medical University, Nanning 530007, Guangxi Province, China
| | - Da-Cheng Wang
- Department of Neurology, The Ninth Affiliated Hospital of Guangxi Medical University, Beihai 536000, Guangxi Province, China
| | - Hai-Hua Li
- Department of Neurology, Fusui County People’s Hospital, Chongzuo 532100, Guangxi Province, China
| | - Guo-Hui Li
- Department of Neurology, Wuzhou Red Cross Hospital, Wuzhou 543002, Guangxi Province, China
| | - Hong-Bin Liang
- Department of Neurology, Cenxi People’s Hospital, Cenxi 543200, Guangxi Province, China
| | - Sheng-Yu Li
- Department of Neurology, Wuming County People’s Hospital, Nanning 530100, Guangxi Province, China
| | - Li Chen
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Province, China
| | - Zhi-Jian Liang
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Province, China
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Wang L, Xu Y, Tuo M, Zhang L, Zhang H, Wang J. Recurrent stroke in a patient of lung cancer without pulmonary mass: A case report. Medicine (Baltimore) 2018; 97:e9815. [PMID: 29384885 PMCID: PMC5805457 DOI: 10.1097/md.0000000000009815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Repeated occurring stroke in short intervals with hypercoagulability is unusual so in such cases the conventional vascular risk factors might not be the causes of stroke. PATIENT CONCERNS We have presented a case of 60-year-old male presenting with recurrent stroke due to thrombophilia. DIAGNOSES Lung cancer was detected by superficial lymph nodes ultrasound and further pathological examination. INTERVENTIONS The patient suffered a recurrent stroke and he had persistently high level of D-dimer which suggested the diagnosis of thrombophilia, thus, he was treated with low-molecular-weight heparin. Unfortunately, the treatment was not effective for the patient and he died before any other treatments could be administered. OUTCOMES Despite anticoagulant therapy, the patient suffered multiple episodes of stroke and ultimately died. LESSONS This case of recurrent stroke with coagulation disorders without evidence of cancer in imaging and blood test is rare. So in a stroke patient, we should consider malignancy or metastasis as a differential diagnosis as it may be the first manifestation of active cancer elsewhere.
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Selvik HA, Bjerkreim AT, Thomassen L, Waje-Andreassen U, Naess H, Kvistad CE. When to Screen Ischaemic Stroke Patients for Cancer. Cerebrovasc Dis 2018; 45:42-47. [PMID: 29402826 DOI: 10.1159/000484668] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 10/25/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND PURPOSE Ischemic stroke can be the first manifestation of cancer and it is therefore important to ascertain which stroke patients should be considered for cancer-diagnostic investigations. We aimed to determine the frequency of active cancer in patients with acute ischemic stroke and to compare clinical findings in stroke patients with active cancer to ischemic stroke patients with no history of cancer. Finally, we aimed to develop a predictive and feasible score for clinical use to uncover underlying malignancy. METHODS All ischemic stroke patients admitted to the stroke unit in the Department of Neurology, Haukeland University Hospital were consecutively included in the Norwegian Stroke Research Registry (NORSTROKE). Stroke etiology was determined by the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Data on cancer diagnoses was obtained from patients' medical records and the Cancer Registry of Norway. Active cancer was defined as cancer diagnosis, metastasis of known cancer, recurrent cancer or receiving cancer treatment, all within 12 months before or after the index stroke. Based on variables independently associated with active cancer, a predictive score was developed using the area under the receiver operating characteristic (AUC-ROC) curves. Bayes' theorem was used to calculate post-test probabilities of active cancer. RESULTS Of the 1,646 ischemic stroke patients included, 82 (5.0%) had active cancer. Increased D-dimer (OR = 1.1, 95% CI: 1.1-1.2, p = <0.001), lower Hb (OR = 0.6, 95% CI: 0.5-0.7, p = <0.001), smoking (OR = 2.2, 95% CI: 1.2-4.3, p = 0.02) and suffering a stroke of undetermined etiology (OR = 1.9, 95% CI: 1.1-3.3, p = 0.03) were factors independently associated with active cancer. These were included in the final predictive score which gave an AUC of 0.73 (95% CI: 0.65-0.81) in patients younger than 75 years of age. Assuming the prevalence of cancer to be 5%, the score shows that if a patient fulfills all 3 score points, the probability of active cancer is 53%. CONCLUSIONS Active cancer was found in 5% of our ischemic stroke patients. We found that a clinical score comprising elevated D-dimer ≥3 mg/L, lower Hb ≤12.0 g/dL and previous or current smoking is feasible for predicting active cancer in ischemic stroke patients.
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Affiliation(s)
- Henriette Aurora Selvik
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Anna Therese Bjerkreim
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Lars Thomassen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Ulrike Waje-Andreassen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Halvor Naess
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway.,Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
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49
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Gon Y, Kabata D, Yamamoto K, Shintani A, Todo K, Mochizuki H, Sakaguchi M. Validation of an algorithm that determines stroke diagnostic code accuracy in a Japanese hospital-based cancer registry using electronic medical records. BMC Med Inform Decis Mak 2017; 17:157. [PMID: 29202795 PMCID: PMC5715513 DOI: 10.1186/s12911-017-0554-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/19/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND This study aimed to validate an algorithm that determines stroke diagnostic code accuracy, in a hospital-based cancer registry, using electronic medical records (EMRs) in Japan. METHODS The subjects were 27,932 patients enrolled in the hospital-based cancer registry of Osaka University Hospital, between January 1, 2007 and December 31, 2015. The ICD-10 (international classification of diseases, 10th revision) diagnostic codes for stroke were extracted from the EMR database. Specifically, subarachnoid hemorrhage (I60); intracerebral hemorrhage (I61); cerebral infarction (I63); and other transient cerebral ischemic attacks and related syndromes and transient cerebral ischemic attack (unspecified) (G458 and G459), respectively. Diagnostic codes, both "definite" and "suspected," and brain imaging information were extracted from the database. We set the algorithm with the combination of the diagnostic code and/or the brain imaging information, and manually reviewed the presence or absence of the acute cerebrovascular disease with medical charts. RESULTS A total of 2654 diagnostic codes, 1991 "definite" and 663 "suspected," were identified. After excluding duplicates, the numbers of "definite" and "suspected" diagnostic codes were 912 and 228, respectively. The proportion of the presence of the disease in the "definite" diagnostic code was 22%; this raised 51% with the combination of the diagnostic code and the use of brain imaging information. When adding the interval of when brain imaging was performed (within 30 days and within 1 day) to the diagnostic code, the proportion increased to 84% and 90%, respectively. In the algorithm of "definite" diagnostic code, history of stroke was the most common in the diagnostic code, but in the algorithm of "definite" diagnostic code and the use of brain imaging within 1 day, stroke mimics was the most frequent. CONCLUSIONS Combining the diagnostic code and clinical examination improved the proportion of the presence of disease in the diagnostic code and achieved appropriate accuracy for research. Clinical research using EMRs require outcome validation prior to conducting a study.
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Affiliation(s)
- Yasufumi Gon
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Daijiro Kabata
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Keichi Yamamoto
- Department of Drug and Food Clinical Evaluation, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Ayumi Shintani
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kenichi Todo
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hideki Mochizuki
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Manabu Sakaguchi
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
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50
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Takasugi J, Yamagami H, Noguchi T, Morita Y, Tanaka T, Okuno Y, Yasuda S, Toyoda K, Gon Y, Todo K, Sakaguchi M, Nagatsuka K. Detection of Left Ventricular Thrombus by Cardiac Magnetic Resonance in Embolic Stroke of Undetermined Source. Stroke 2017; 48:2434-2440. [PMID: 28818863 DOI: 10.1161/strokeaha.117.018263] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/08/2017] [Accepted: 07/19/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE We aimed to use contrast-enhanced cardiac magnetic resonance (CE-CMR) imaging to elucidate the prevalence of left ventricular (LV) thrombus in patients suspected of embolic stroke of undetermined source (ESUS) with previous myocardial infarction or LV dysfunction (LV ejection fraction [LVEF] <50%). METHODS We prospectively investigated 797 consecutive patients who presented to our hospital with acute ischemic stroke between 2014 and 2015. Patients with myocardial infarction or LVEF<50% underwent CE-CMR imaging. ESUS was diagnosed according to proposal criteria based on transthoracic echocardiography findings. RESULTS The prevalence of ESUS was 22% (178 of 797) on initial diagnosis. Among 60 patients with myocardial infarction or LVEF<50%, the stroke subtypes were as follows: small artery disease, 17% (10 of 60); large artery atherosclerosis, 5% (3 of 60); cardioembolic stroke, 49% (29 of 60); ESUS, 23% (14 of 60); and undetermined causes other than ESUS, 6% (4 of 60). Of 60 patients examined via CE-CMR, LV thrombus was confirmed in 12 patients, whereas only 1 had been detected on transthoracic echocardiography (P=0.04). Importantly, 29% (4 of 14) of patients with ESUS had LV thrombus. A prediction model based on CE-CMR findings showed higher performance in LV thrombus detection, permitting a net improvement of 0.46 (95% confidence interval, 0.08-0.82; P=0.016) in cardioembolic stroke reclassification. Compared with patients without LV thrombus, those with LV thrombus had lower LVEF (median: 26% versus 40%; P=0.003). Notably, 42% (5 of 12) of patients with LV thrombus had LVEF≥30%. CONCLUSIONS When ESUS-suspected patients have myocardial infarction or LV dysfunction, CE-CMR may help improve detection of cardioembolic stroke and provide relevant information for anticoagulation therapy. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02251665.
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Affiliation(s)
- Junji Takasugi
- From the Departments of Neurology (J.T., H.Y., T.T., Y.O., K.N.), Cerebrovascular Medicine (K.T.), Cardiovascular Medicine (T.N., S.Y.), and Radiology (Y.M.), National Cerebral and Cardiovascular Center, Osaka, Japan; and Department of Neurology, Osaka University Graduate School of Medicine, Japan (J.T., Y.G., K.T., M.S.)
| | - Hiroshi Yamagami
- From the Departments of Neurology (J.T., H.Y., T.T., Y.O., K.N.), Cerebrovascular Medicine (K.T.), Cardiovascular Medicine (T.N., S.Y.), and Radiology (Y.M.), National Cerebral and Cardiovascular Center, Osaka, Japan; and Department of Neurology, Osaka University Graduate School of Medicine, Japan (J.T., Y.G., K.T., M.S.).
| | - Teruo Noguchi
- From the Departments of Neurology (J.T., H.Y., T.T., Y.O., K.N.), Cerebrovascular Medicine (K.T.), Cardiovascular Medicine (T.N., S.Y.), and Radiology (Y.M.), National Cerebral and Cardiovascular Center, Osaka, Japan; and Department of Neurology, Osaka University Graduate School of Medicine, Japan (J.T., Y.G., K.T., M.S.)
| | - Yoshiaki Morita
- From the Departments of Neurology (J.T., H.Y., T.T., Y.O., K.N.), Cerebrovascular Medicine (K.T.), Cardiovascular Medicine (T.N., S.Y.), and Radiology (Y.M.), National Cerebral and Cardiovascular Center, Osaka, Japan; and Department of Neurology, Osaka University Graduate School of Medicine, Japan (J.T., Y.G., K.T., M.S.)
| | - Tomotaka Tanaka
- From the Departments of Neurology (J.T., H.Y., T.T., Y.O., K.N.), Cerebrovascular Medicine (K.T.), Cardiovascular Medicine (T.N., S.Y.), and Radiology (Y.M.), National Cerebral and Cardiovascular Center, Osaka, Japan; and Department of Neurology, Osaka University Graduate School of Medicine, Japan (J.T., Y.G., K.T., M.S.)
| | - Yoshinori Okuno
- From the Departments of Neurology (J.T., H.Y., T.T., Y.O., K.N.), Cerebrovascular Medicine (K.T.), Cardiovascular Medicine (T.N., S.Y.), and Radiology (Y.M.), National Cerebral and Cardiovascular Center, Osaka, Japan; and Department of Neurology, Osaka University Graduate School of Medicine, Japan (J.T., Y.G., K.T., M.S.)
| | - Satoshi Yasuda
- From the Departments of Neurology (J.T., H.Y., T.T., Y.O., K.N.), Cerebrovascular Medicine (K.T.), Cardiovascular Medicine (T.N., S.Y.), and Radiology (Y.M.), National Cerebral and Cardiovascular Center, Osaka, Japan; and Department of Neurology, Osaka University Graduate School of Medicine, Japan (J.T., Y.G., K.T., M.S.)
| | - Kazunori Toyoda
- From the Departments of Neurology (J.T., H.Y., T.T., Y.O., K.N.), Cerebrovascular Medicine (K.T.), Cardiovascular Medicine (T.N., S.Y.), and Radiology (Y.M.), National Cerebral and Cardiovascular Center, Osaka, Japan; and Department of Neurology, Osaka University Graduate School of Medicine, Japan (J.T., Y.G., K.T., M.S.)
| | - Yasufumi Gon
- From the Departments of Neurology (J.T., H.Y., T.T., Y.O., K.N.), Cerebrovascular Medicine (K.T.), Cardiovascular Medicine (T.N., S.Y.), and Radiology (Y.M.), National Cerebral and Cardiovascular Center, Osaka, Japan; and Department of Neurology, Osaka University Graduate School of Medicine, Japan (J.T., Y.G., K.T., M.S.)
| | - Kenichi Todo
- From the Departments of Neurology (J.T., H.Y., T.T., Y.O., K.N.), Cerebrovascular Medicine (K.T.), Cardiovascular Medicine (T.N., S.Y.), and Radiology (Y.M.), National Cerebral and Cardiovascular Center, Osaka, Japan; and Department of Neurology, Osaka University Graduate School of Medicine, Japan (J.T., Y.G., K.T., M.S.)
| | - Manabu Sakaguchi
- From the Departments of Neurology (J.T., H.Y., T.T., Y.O., K.N.), Cerebrovascular Medicine (K.T.), Cardiovascular Medicine (T.N., S.Y.), and Radiology (Y.M.), National Cerebral and Cardiovascular Center, Osaka, Japan; and Department of Neurology, Osaka University Graduate School of Medicine, Japan (J.T., Y.G., K.T., M.S.)
| | - Kazuyuki Nagatsuka
- From the Departments of Neurology (J.T., H.Y., T.T., Y.O., K.N.), Cerebrovascular Medicine (K.T.), Cardiovascular Medicine (T.N., S.Y.), and Radiology (Y.M.), National Cerebral and Cardiovascular Center, Osaka, Japan; and Department of Neurology, Osaka University Graduate School of Medicine, Japan (J.T., Y.G., K.T., M.S.)
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