DWI lesion patterns in cancer-related stroke: specifying the phenotype
Background: Due to the lack of specific diagnostic markers, the diagnosis of cancer-related stroke strongly depends on its phenotype. Distinct DWI lesion patterns with involvement of multiple vascular territories have been reported repeatedly in cancer-related stroke but have not been addressed in d...
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| Main Authors: | , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
October 30, 2015
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| In: |
Cerebrovascular diseases. Extra
Year: 2015, Volume: 5, Issue: 3, Pages: 139-145 |
| ISSN: | 1664-5456 |
| DOI: | 10.1159/000439549 |
| Online Access: | Verlag, Volltext: http://dx.doi.org/10.1159/000439549 Verlag, Volltext: https://www.karger.com/Article/FullText/439549 
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| Author Notes: | Christopher Jan Schwarzbach, Marc Fatar, Philipp Eisele, Anne D. Ebert, Michael G. Hennerici, Kristina Szabo |
MARC
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| 520 | |a Background: Due to the lack of specific diagnostic markers, the diagnosis of cancer-related stroke strongly depends on its phenotype. Distinct DWI lesion patterns with involvement of multiple vascular territories have been reported repeatedly in cancer-related stroke but have not been addressed in detail in a selected cohort of prospectively recruited cancer patients with emphasis on hypercoagulable conditions. Patients and Methods: Ischemic stroke patients with known malignant cancer activity, laboratory evidence of strong plasmatic hypercoagulation (D-dimer levels >3 µg/ml) and without competing stroke etiologies according to the recently introduced ASCOD (A - atherosclerosis, S - small vessel disease, C - cardiac pathology, O - other cause, and D - dissection) classification of evidence-rated etiology of stroke subtypes were included in the analysis. Cerebral MRI on admission was reviewed with respect to ischemic lesion patterns. Results: Thirty-two patients met the inclusion criteria. The mean D-dimer levels were 15.39 µg/ml (±10.84). Acute infarction in ≥2 vascular territories was present in 27/32 (84%) patients. (Micro-) embolic scattering of infarction was present in 25/32 (78%) patients. Evidence for previous, potentially oligosymptomatic infarction was found in 16 (50%) patients, demonstrated by the additional presence of subacute or chronic ischemic lesions. Conclusion: When excluding competing embolic and nonembolic stroke etiologies, the pattern of scattered DWI lesions in multiple vascular supply territories strongly dominates the phenotype of cancer-related stroke. Additionally, evidence of recurrent infarction is frequent in this cohort of patients. This is not only important for the diagnosis of cancer-related stroke itself but may prove helpful for the identification of cancer-related stroke patients with unknown malignancy at the time of stroke manifestation and evaluation of strategies for secondary prevention. | ||
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