title: DWI Lesion Patterns in Cancer-Related Stroke--Specifying the Phenotype.
abstract: BACKGROUND
  Due to the lack of specific diagnostic markers, the diagnosis of cancer-related stroke strongly depends on its phenotype. Distinct DWI lesion patterns with involvement of multiple vascular territories have been reported repeatedly in cancer-related stroke but have not been addressed in detail in a selected cohort of prospectively recruited cancer patients with emphasis on hypercoagulable conditions.
  
  
  METHODS
  Ischemic stroke patients with known malignant cancer activity, laboratory evidence of strong plasmatic hypercoagulation (D-dimer levels > 3 µg/ml) and without competing stroke etiologies according to the recently introduced ASCOD (A - atherosclerosis, S - small vessel disease, C - cardiac pathology, O - other cause, and D - dissection) classification of evidence-rated etiology of stroke subtypes were included in the analysis. Cerebral MRI on admission was reviewed with respect to ischemic lesion patterns.
  
  
  RESULTS
  Thirty-two patients met the inclusion criteria. The mean D-dimer levels were 15.39 µg/ml (± 10.84). Acute infarction in ≥ 2 vascular territories was present in 27/32 (84%) patients. (Micro-) embolic scattering of infarction was present in 25/32 (78%) patients. Evidence for previous, potentially oligosymptomatic infarction was found in 16 (50%) patients, demonstrated by the additional presence of subacute or chronic ischemic lesions.
  
  
  CONCLUSIONS
  When excluding competing embolic and nonembolic stroke etiologies, the pattern of scattered DWI lesions in multiple vascular supply territories strongly dominates the phenotype of cancer-related stroke. Additionally, evidence of recurrent infarction is frequent in this cohort of patients. This is not only important for the diagnosis of cancer-related stroke itself but may prove helpful for the identification of cancer-related stroke patients with unknown malignancy at the time of stroke manifestation and evaluation of strategies for secondary prevention.
authors.affiliation: Department of Neurology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Christopher Jan
authors.initials: CJ
authors.lastname: Schwarzbach
authors.affiliation: Department of Neurology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Fatar
authors.affiliation: Department of Neurology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Eisele
authors.affiliation: Department of Neurology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Anne D
authors.initials: AD
authors.lastname: Ebert
authors.affiliation: Department of Neurology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Hennerici
authors.affiliation: Department of Neurology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Kristina
authors.initials: K
authors.lastname: Szabo
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000097:blood / Q000473:pathology; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009369:Neoplasms / Q000097:blood / Q000473:pathology*; D010641:Phenotype; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000473:pathology*; D019851:Thrombophilia / Q000097:blood / Q000150:complications
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: Acute stroke; Cerebral embolism; Diagnostic criteria; Embolic stroke; MRI-DWI; Recurrent stroke; Risk factors for stroke; Stroke and cancer