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 |
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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 |