title: Characteristics of cryptogenic stroke in cancer patients.
abstract: OBJECTIVE
  To clarify the characteristics of cryptogenic stroke in patients with active cancer.
  
  
  METHODS
  Patients with or without cancer diagnosed with acute ischemic stroke between January 2006 and February 2015 were extracted from a prospectively collected stroke database of Osaka University Hospital. Patients were categorized according to the presence of active cancer and known stroke mechanisms.
  
  
  RESULTS
  Among 1191 patients with acute ischemic stroke, 145 (12%) had active cancer. Patients with active cancer were diagnosed more often with cryptogenic stroke than were patients without cancer (47% vs. 12%, P < 0.001). Compared with cryptogenic stroke patients without cancer, cryptogenic stroke patients with active cancer had fewer atherosclerotic risk factors, lower nutrition status, higher plasma D-dimer levels, and multiple vascular lesions. In a multivariate logistic analysis, plasma D-dimer level (odds ratio [OR] per 1 standard deviation increase: 6.30; 95% confidence interval [CI]: 2.94-15.69; P < 0.001), and the presence of multiple vascular lesions (OR: 6.40; 95% CI: 2.35-18.35; P < 0.001) were independent predictors of active cancer. When comparing active cancer patients who had known stroke mechanisms with those who had cryptogenic stroke, high plasma D-dimer levels, multiple vascular lesions, and receiving chemotherapy and/or radiation therapy were associated with cryptogenic stroke etiology.
  
  
  CONCLUSIONS
  In cryptogenic stroke, patients with active cancer has a unique pathology characterized by high plasma D-dimer levels and multiple vascular lesions. The hypercoagulable state and malnutrition due to cancer and its treatments potentially influence the development of cryptogenic stroke in cancer patients.
authors.affiliation: Department of Neurology Osaka University Graduate School of Medicine Osaka Japan.
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Gon
authors.affiliation: Department of Neurology Osaka University Graduate School of Medicine Osaka Japan.
authors.forename: Shuhei
authors.initials: S
authors.lastname: Okazaki
authors.affiliation: Department of Neurology Osaka University Graduate School of Medicine Osaka Japan.
authors.forename: Yasukazu
authors.initials: Y
authors.lastname: Terasaki
authors.affiliation: Department of Neurology Osaka University Graduate School of Medicine Osaka Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Sasaki
authors.affiliation: Department of Neurosurgery Osaka University Graduate School of Medicine Osaka Japan.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Yoshimine
authors.affiliation: Department of Neurology Osaka University Graduate School of Medicine Osaka Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Sakaguchi
authors.affiliation: Department of Neurology Osaka University Graduate School of Medicine Osaka Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Mochizuki