The relationship between malignant tumors and ischemic stroke. II. Chronology of diagnoses and treatment of strokes

Abstract

Cancer and stroke occur in similar patient populations, and they have similar traditional risk factors (hypertension, hyperlipidemia, obesity, diabetes, and smoking), therefore, it is beneficial to study the relationship between cancer and stroke. Patients diagnosed with cancer have an increased incidence of acute ischemic cerebral events within the first 6 months up to a year post diagnosis. The reverse relationship is also true for patients diagnosed with stroke and then cancer. Interestingly, patients may have a stroke as their first indication to an underlying developing cancer and will most often be diagnosed with cancer sometime within six months to a year after the cerebral incident. When cancer is diagnosed immediately after a cryptogenic stroke (unknown etiology), the stroke may be a result of cancer-associated hypercoagulability. The most common malignancies observed in the cancer-stroke patients are lung, breast and melanoma. Currently, there are no pharmacologic recommendations for primary stroke prevention in cancer patients. For acute ischemic stroke, life expectancy and the potential for hemorrhagic complications should be con¬sidered when deciding on thrombolytic treatment. Only a few case series have been reported on mechanical thrombectomy in malignancies, and there are no guideline recommendations yet. Secondary prevention is advised through low molecular weight heparin. Understanding cancer-associated hypercoagulability and the ways we can prevent the combined effects of cancer and stroke is a crucial gap that requires further studies. Additionally, guides to aid in the recognition of underlying malignancy in patients suffering from cryptogenic stroke need to be estab¬lished.