Cerebrovascular Complications in Patients with Cancer

Abstract

The hypercoagulable state associated with cancer, known since the descriptions of Trousseau in the nineteenth century, has become a well-recognized cause of venous thromboembolism. It has only more recently become apparent that cancer increases the risk of arterial thromboembolism as well. In patients with cancer, cerebrovascular disease is the second leading cause of lesions of the central nervous system (CNS), only behind metastases (Graus F, Rogers LR, Posner, JB, Medicine 64:16-35, 1985). The most frequent cause of cerebrovascular disease in this population is stroke, both ischemic and hemorrhagic; this chapter will focus primarily on these entities. While patients with cancer remain at risk for conventional mechanisms of cerebrovascular disease, cancer patients have unique risk factors including complications of coagulation disorders, direct tumor effects, toxicity of cancer treatment, and increased risk of infection in the setting of immunosuppression. These features make this population distinct from the general population and should be considered carefully during their evaluation and care.