Cancer-associated stroke: Pathophysiology, detection and management (Review)

Dardiotis,Efthimios; Aloizou,Athina-Maria; Markoula,Sofia; Siokas,Vasileios; Tsarouhas,Konstantinos; Tzanakakis,Georgios; Libra,Massimo; Kyritsis,Athanassios P.; Brotis,Alexandros G.; Aschner,Michael; Gozes,Illana; Bogdanos,Dimitrios P.; Spandidos,Demetrios A.; Mitsias,Panayiotis D.; Tsatsakis,Aristidis

doi:10.3892/ijo.2019.4669

Cancer-associated stroke: Pathophysiology, detection and management (Review)

Authors:
- Efthimios Dardiotis
- Athina-Maria Aloizou
- Sofia Markoula
- Vasileios Siokas
- Konstantinos Tsarouhas
- Georgios Tzanakakis
- Massimo Libra
- Athanassios P. Kyritsis
- Alexandros G. Brotis
- Michael Aschner
- Illana Gozes
- Dimitrios P. Bogdanos
- Demetrios A. Spandidos
- Panayiotis D. Mitsias
- Aristidis Tsatsakis
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Affiliations: Department of Neurology, Laboratory of Neurogenetics, University of Thessaly, University Hospital of Larissa, 41100 Larissa, Greece, Department of Neurology, University Hospital of Ioannina, 45110 Ioannina, Greece, Department of Cardiology, University Hospital of Larissa, 41100 Larissa, Greece, Laboratory of Anatomy-Histology-Embryology, Medical School, University of Crete, 71003 Heraklion, Greece, Department of Biomedical and Biotechnological Sciences, Pathology and Oncology Section, University of Catania, 95124 Catania, Italy, Department of Neurosurgery, University of Thessaly, University Hospital of Larissa, 41100 Larissa, Greece, Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY 10461, USA, The Lily and Avraham Gildor Chair for the Investigation of Growth Factors, The Elton Laboratory for Molecular Neuroendocrinology, Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Sagol School of Neuroscience and Adams Super Center for Brain Studies, Tel Aviv University, Tel Aviv 69978, Israel, Department of Rheumatology and Clinical Immunology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 40500 Larissa, Greece, Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece, Department of Neurology, School of Medicine, University of Crete, 71003 Heraklion, Greece, Laboratory of Toxicology, School of Medicine, University of Crete, 71003 Heraklion, Greece
Published online on: January 2, 2019 https://doi.org/10.3892/ijo.2019.4669
Pages: 779-796
Copyright: © Dardiotis et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Numerous types of cancer have been shown to be associated with either ischemic or hemorrhagic stroke. In this review, the epidemiology and pathophysiology of stroke in cancer patients is discussed, while providing vital information on the diagnosis and management of patients with cancer and stroke. Cancer may mediate stroke pathophysiology either directly or via coagulation disorders that establish a state of hypercoagulation, as well as via infections. Cancer treatment options, such as chemotherapy, radiotherapy and surgery have all been shown to aggravate the risk of stroke as well. The clinical manifestation varies greatly depending upon the underlying cause; however, in general, cancer‑associated strokes tend to appear as multifocal in neuroimaging. Furthermore, several serum markers have been identified, such as high D‑Dimer levels and fibrin degradation products. Managing cancer patients with stroke is a delicate matter. The cancer should not be considered a contraindication in applying thrombolysis and recombinant tissue plasminogen activator (rTPA) administration, since the risk of hemorrhage in cancer patients has not been reported to be higher than that in the general population. Anticoagulation, on the contrary, should be carefully examined. Clinicians should weigh the benefits and risks of anticoagulation treatment for each patient individually; the new oral anticoagulants appear promising; however, low‑molecular‑weight heparin remains the first choice. On the whole, stroke is a serious and not a rare complication of malignancy. Clinicians should be adequately trained to handle these patients efficiently.

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