title: Cryptogenic subtype predicts reduced survival among cancer patients with ischemic stroke.
abstract: OBJECTIVE
  Cryptogenic stroke is common in patients with cancer. Autopsy studies suggest that many of these cases may be because of marantic endocarditis, which is closely linked to cancer activity. We, therefore, hypothesized that among patients with cancer and ischemic stroke, those with cryptogenic stroke would have shorter survival.
  
  
  METHODS
  We retrospectively analyzed all adult patients with active systemic cancer diagnosed with acute ischemic stroke at a tertiary care cancer center from 2005 through 2009. Two neurologists determined stroke mechanisms by consensus. Patients were diagnosed with cryptogenic stroke if no specific mechanism could be determined. The diagnosis of marantic endocarditis was restricted to patients with cardiac vegetations on echocardiography or autopsy and negative blood cultures. Patients were followed until July 31, 2012, for the primary outcome of death. Kaplan-Meier statistics and the log-rank test were used to compare survival between patients with cryptogenic stroke and patients with known stroke mechanisms. Multivariate Cox proportional hazard analysis evaluated the association between cryptogenic stroke and death after adjusting for potential confounders.
  
  
  RESULTS
  Among 263 patients with cancer and ischemic stroke, 133 (51%) were cryptogenic. Median survival in patients with cryptogenic stroke was 55 days (interquartile range, 21-240) versus 147 days (interquartile range, 33-735) in patients with known stroke mechanisms (P<0.01). Cryptogenic stroke was independently associated with death (hazard ratio, 1.64; 95% confidence interval, 1.25-2.14) after adjusting for age, systemic metastases, adenocarcinoma histology, and functional status.
  
  
  CONCLUSIONS
  Cryptogenic stroke is independently associated with reduced survival in patients with active cancer and ischemic stroke.
authors.affiliation: From the Department of Neurology (B.B.N., A.E.M., N.T.C., H.K., C.I., L.M.D.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K., C.I.), Weill Cornell Medical College, New York, NY; Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY (B.B.N., S.S., J.B.S., L.M.D.); and Department of Neurology, College of Physicians and Surgeons and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.). ban9003@med.cornell.edu.
authors.forename: Babak B
authors.initials: BB
authors.lastname: Navi
authors.affiliation: From the Department of Neurology (B.B.N., A.E.M., N.T.C., H.K., C.I., L.M.D.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K., C.I.), Weill Cornell Medical College, New York, NY; Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY (B.B.N., S.S., J.B.S., L.M.D.); and Department of Neurology, College of Physicians and Surgeons and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.).
authors.forename: Samuel
authors.initials: S
authors.lastname: Singer
authors.affiliation: From the Department of Neurology (B.B.N., A.E.M., N.T.C., H.K., C.I., L.M.D.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K., C.I.), Weill Cornell Medical College, New York, NY; Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY (B.B.N., S.S., J.B.S., L.M.D.); and Department of Neurology, College of Physicians and Surgeons and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.).
authors.forename: Alexander E
authors.initials: AE
authors.lastname: Merkler
authors.affiliation: From the Department of Neurology (B.B.N., A.E.M., N.T.C., H.K., C.I., L.M.D.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K., C.I.), Weill Cornell Medical College, New York, NY; Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY (B.B.N., S.S., J.B.S., L.M.D.); and Department of Neurology, College of Physicians and Surgeons and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.).
authors.forename: Natalie T
authors.initials: NT
authors.lastname: Cheng
authors.affiliation: From the Department of Neurology (B.B.N., A.E.M., N.T.C., H.K., C.I., L.M.D.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K., C.I.), Weill Cornell Medical College, New York, NY; Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY (B.B.N., S.S., J.B.S., L.M.D.); and Department of Neurology, College of Physicians and Surgeons and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.).
authors.forename: Jacqueline B
authors.initials: JB
authors.lastname: Stone
authors.affiliation: From the Department of Neurology (B.B.N., A.E.M., N.T.C., H.K., C.I., L.M.D.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K., C.I.), Weill Cornell Medical College, New York, NY; Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY (B.B.N., S.S., J.B.S., L.M.D.); and Department of Neurology, College of Physicians and Surgeons and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.).
authors.forename: Hooman
authors.initials: H
authors.lastname: Kamel
authors.affiliation: From the Department of Neurology (B.B.N., A.E.M., N.T.C., H.K., C.I., L.M.D.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K., C.I.), Weill Cornell Medical College, New York, NY; Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY (B.B.N., S.S., J.B.S., L.M.D.); and Department of Neurology, College of Physicians and Surgeons and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.).
authors.forename: Costantino
authors.initials: C
authors.lastname: Iadecola
authors.affiliation: From the Department of Neurology (B.B.N., A.E.M., N.T.C., H.K., C.I., L.M.D.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K., C.I.), Weill Cornell Medical College, New York, NY; Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY (B.B.N., S.S., J.B.S., L.M.D.); and Department of Neurology, College of Physicians and Surgeons and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.).
authors.forename: Mitchell S V
authors.initials: MS
authors.lastname: Elkind
authors.affiliation: From the Department of Neurology (B.B.N., A.E.M., N.T.C., H.K., C.I., L.M.D.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K., C.I.), Weill Cornell Medical College, New York, NY; Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY (B.B.N., S.S., J.B.S., L.M.D.); and Department of Neurology, College of Physicians and Surgeons and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.).
authors.forename: Lisa M
authors.initials: LM
authors.lastname: DeAngelis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000145:classification / Q000150:complications / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000145:classification / Q000150:complications / Q000401:mortality*; D015996:Survival Rate
keywords: endocarditis, non-infective; mortality; survival