title: Frequency and mechanism of ischemic stroke associated with malignancy: a retrospective series.
abstract: BACKGROUND
  Cerebrovascular disease is the second most common non-metastatic neurological disorder in oncological patients. The aims of this study were to determine the prevalence of cancer in stroke patients and to compare mechanisms of stroke between patients with and without malignancy.
  
  
  METHODS
  This retrospective study involved patients with ischemic stroke admitted over 1 year to a Neurology Department. Demographic and clinical data, cardiovascular risk factors, and laboratory findings were recorded. The etiology was classified following the TOAST criteria. Participants were classified as stroke and cancer patients (diagnosis of malignancy before stroke or cancer diagnosed after admission) or as control stroke patients.
  
  
  RESULTS
  Over 1 year, 291 stroke patients (268 ischemic) were admitted. Sixteen ischemic patients had a malignancy (5.9%), and in 12 patients, malignancy was the only cause found for the stroke; in 4 patients, malignancy was a coexisting condition. Coexistent stroke and cancer was significantly related to higher median levels of fibrinogen, D-dimers, and erythrocyte sedimentation rate (ESR). Logistic regression analysis showed that D-dimer and ESR levels were independently related to cancer, with odds ratios of 1.004 (95% CI 1.001-1.007, p=0.02) and 1.075 (95% CI 1.031-1.121, p=0.001), respectively.
  
  
  CONCLUSIONS
  Almost 6% of ischemic stroke patients had a concomitant malignancy. In most of them, cancer was the only cause of stroke found. Patients with stroke and malignancy exhibited raised D-dimer, fibrinogen, and ESR levels, suggesting the prothrombotic state was a principal mechanism underlying stroke. D-dimer and ESR assessments may be useful in identifying underlying disorders in ischemic stroke.
authors.affiliation: Health Sciences Faculty, Health Sciences Research Centre, Beira Interior University, Covilhã, Portugal. fjalvarez@fcsaude.ubi.pt
authors.forename: F J
authors.initials: FJ
authors.lastname: Álvarez-Pérez
authors.forename: I
authors.initials: I
authors.lastname: Verde
authors.forename: M
authors.initials: M
authors.lastname: Usón-Martín
authors.forename: A
authors.initials: A
authors.lastname: Figuerola-Roig
authors.forename: J
authors.initials: J
authors.lastname: Ballabriga-Planas
authors.forename: A
authors.initials: A
authors.lastname: Espino-Ibañez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications / Q000453:epidemiology*