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Related Subjects: |Neurological History taking |Causes of Stroke
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Mechanism | Causal factor | Associated tumour s | Stroke Characteristics |
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Hypercoagulability | Adenocarcinomas especially; secrete mucin; tumour 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 tumour of hypercoagulable state | Embolic appearing |
Nonbacterial 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 tumour to heart | Embolic appearing |
Hyperviscosity | Rare-“Thickened" blood causes hypoviscious obstruction of small end vessels | Polycythemia vera, multiple myeloma, Waldenstrom’s Macroglobulinemia, leptomeningeal carcinomatosis | Small end-vessels strokes |
Angio invasive/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 tumour s | Embolic stroke from the affected carotid |
Chemotherapy associated | Unknown | Associated with as cisplatin, methotrexate, L-asparaginase, thalidomide, lenalidomide, and bevacizumab | Varied |