title: First-ever stroke as initial presentation of systemic cancer.
abstract: BACKGROUND
  Stroke is a frequent complication in patients with cancer, occurring in nearly 15% of patients with cancer. However, cerebrovascular disease as the first manifestation of cancer has rarely been reported.
  
  
  METHODS
  We retrospectively reviewed all 5106 patients admitted for ischemic stroke to our stroke department between 1991 to 2004, and identified a group of 24 patients (0.4%) who had an underlying malignancy.
  
  
  RESULTS
  The mean age of the 24 patients was 52 +/- 4.1 years and 62.5% were women. Vascular risk factors were found in only 41% of patients. The principal mechanisms of stroke pathogenesis were nonbacterial thrombotic endocarditis (8/24), diffuse intravascular coagulation (6/24), and atherosclerosis (5/24). The most frequent neoplasms were lung and breast cancer. All patients but 4 were diagnosed with an underlying malignancy at the second ischemic event. Mean follow-up of surviving patients was 29 months (3-60). Nineteen patients died (79%), with a median survival of 58 days after cerebral infarction.
  
  
  CONCLUSIONS
  A systemic cancer workup should be considered in patients in whom stroke origin is unclear or who have an early vascular recurrence. Stroke as the first manifestation of an underlying malignancy is mostly secondary to specific cancer-related causes. Outcome is poor and correlates with both severity of neurologic disability and the stage of tumor.
authors.affiliation: Neurology Department, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium. ftaccone@ulb.ac.be
authors.forename: Fabio Silvio
authors.initials: FS
authors.lastname: Taccone
authors.forename: Sandrine M
authors.initials: SM
authors.lastname: Jeangette
authors.forename: Serge A
authors.initials: SA
authors.lastname: Blecic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000150:complications; D002545:Brain Ischemia / Q000453:epidemiology / Q000209:etiology*; D002544:Cerebral Infarction / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D015897:Comorbidity; D004211:Disseminated Intravascular Coagulation / Q000209:etiology; D019320:Embolism, Paradoxical / Q000209:etiology; D004696:Endocarditis / Q000150:complications; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D009360:Neoplastic Cells, Circulating; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D019851:Thrombophilia / Q000209:etiology