title: Ischemic stroke in patients with cancer: is it different from usual strokes?
abstract: BACKGROUND
  It remains unclear whether the characteristics of ischemic stroke in patients with cancer (ISC) differ from usual ischemic strokes (non-ISC). Although a small number of studies have been conducted to characterize ISC, the status of cancer has rarely been considered seriously.
  
  
  OBJECTIVE
  We aimed to investigate the features of ISC according to the status of cancer, and compare their characteristics with those of non-ISC.
  
  
  METHODS
  We assessed and classified 204 ISC patients into two groups: 104 with active (ISC-active) and 100 with inactive (ISC-inactive) cancer. For each ISC patient, two age- and gender-matched ischemic stroke patients without history of cancer were selected as non-ISC control subjects. We compared the clinical/laboratory data, stroke mechanisms, and diffusion weighted imaging (DWI) lesion patterns between ISC-active and non-ISC patients, and between ISC-inactive and non-ISC patients.
  
  
  RESULTS
  ISC-active patients demonstrated higher C-reactive protein (CRP) and D-dimer, more frequent cryptogenic stroke and patterns of multiple DWI lesions (in bilateral anterior or in anterior and posterior circulations), and less prevalent conventional risk factors than non-ISC patients, while ISC-inactive patients revealed no such marked differences. Among ISC-active patients, both elevated CRP and D-dimer levels were associated with cryptogenic mechanism and multiple lesion patterns. Furthermore, ISC-active patients with cryptogenic strokes tended to have multiple lesion patterns and metastasis.
  
  
  CONCLUSIONS
  ISC-active, but not ISC-inactive, is distinct in terms of risk factors, stroke mechanisms, and lesion patterns. Chronic inflammation and an activated coagulation system may contribute to the pathogenic mechanism of strokes, the extent of each depending on the activity and severity of cancer.
authors: Stroke Center and Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea.
authors: Eun-Jae
authors: EJ
authors: Lee
authors: Hyun-Wook
authors: HW
authors: Nah
authors: Joo-Young
authors: JY
authors: Kwon
authors: Dong-Wha
authors: DW
authors: Kang
authors: Sun U
authors: SU
authors: Kwon
authors: Jong S
authors: JS
authors: Kim
mesh_terms: D000368:Aged; D001921:Brain / Q000473:pathology; D002545:Brain Ischemia / Q000150:complications*; D001932:Brain Neoplasms / Q000150:complications* / Q000453:epidemiology; D002097:C-Reactive Protein / Q000378:metabolism; D016022:Case-Control Studies; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D020521:Stroke / Q000150:complications* / Q000209:etiology*
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D002097:C-Reactive Protein
keywords: cancer; coagulopathy; stroke