Incidence and etiology of cerebrovascular disease in patients with malignancy.
Cerebrovascular disease is common in cancer patients and often arises from mechanisms unique to malignancy. Direct tumor effects include intratumoral hemorrhage, arterial and venous sinus invasion by tumor mass or leptomeningeal infiltrates, and tumor emboli. Complications of chemotherapy, radiation therapy, and hematopoietic stem-cell transplantion for cancer can occur before, during, or years after treatment. Coagulopathic conditions involve disseminated intravascular coagulation, thrombocytopenia, nonbacterial thrombotic endocarditis, and cerebral intravascular coagulation. Finally, septic infarction from fungal or bacterial sepsis and infectious vasculitis manifest in cancer patients immunocompromised by malignancy or cancer therapy. In many cases a combination of mechanisms is causative, and both hemorrhagic and ischemic stroke can occur simultaneously. Stroke type and mechanism, as well as the stage and pathology of the neoplasm, dictate proper management and help delineate prognosis.
Katz
Jeffrey M
JM
Department of Neurology and Neuroscience, New York Presbyterian Hospital-Weill Medical College of Cornell University, New York, NY 10021, USA. drjmk@yahoo.com
Segal
Alan Z
AZ
D000970:Antineoplastic Agents / Q000009:adverse effects; D004696:Endocarditis / Q000150:complications / Q000209:etiology; D006402:Hematologic Diseases / Q000150:complications / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D009369:Neoplasms / Q000150:complications*; D011832:Radiation Injuries / Q000150:complications; D018805:Sepsis / Q000150:complications / Q000209:etiology; D020521:Stroke / Q000209:etiology*; D014657:Vasculitis / Q000150:complications / Q000209:etiology
D000970:Antineoplastic Agents