Introduction
Cancers causing stroke
Cancers with haemorrhagic metastases
Aetiologies
Possible mechanism: see See paper
Mechanism Causal factor Associated tumours Stroke Characteristics Hypercoagulability Adenocarcinomas especially; secrete mucin; tumours activate coagulation cascade; release pro-coagulant cytokines Adenocarcinoma of breast, lung, prostate, etc. Also brain, kidney or hematologic malignancies Embolic appearing infarcts, end vessels Venous-to-arterial embolism PFO, right-to-left shunt Uncertain, likely similar to tumours of hypercoagulable state Embolic appearing Non bacterial thrombotic endocarditis Sterile vegetations, clumps of platelets and fibrin develop on aortic valve Adenocarcinoma is most common Multiple widely distributed small and large strokes Direct tumour compression of vessel Tumour growth and resultant oedema compresses major intracranial vessel Glioblastoma multiforme, metastasis to brain
Large vessel, MCA common Tumour embolism Rare- cardiac tumour causes embolization of malignant cells Atrial or aortic valve myxoma, metastatic tumours to heart Embolic appearing Hyperviscocity Rare-“Thickened” blood causes hypoviscious obstruction of small end vessels Polycythemia vera, multiple myeloma, Waldenstrom’s Macroglobulinemia, leptomeningeal carcinomatosis Small end-vessels strokes Angioinvasive/infiltrative Rare-Hematologic malignancies infiltrate blood vessel wall, causing irregularities that predispose to arterial embolism B-cell lymphoma Multiple vascular territory infarcts Post –radiation vasculopathy Radiation after head and neck cancer causes vasculopathy leading to accelerated atherosclerosis, predisposing to vessel wall irregularities and embolism Squamous cell carcinoma, other head and neck tumours Embolic stroke from the affected carotid Chemotherapy associated Unknown Associated with as cisplatin, methotrexate, L-aspariginase, thalidomide, lenalidomide, and bevacizumab Varied Clinical
Marantic endocarditis
Investigations
Differentials
Management
References and further reading
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Cancer and Stroke
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