DWI lesion patterns in cancer-related stroke

• Verfasst von: Schwarzbach, Christopher Jan [VerfasserIn]
• Verfasst von: Fatar, Marc [VerfasserIn]
• Verfasst von: Eisele, Philipp [VerfasserIn]
• Verfasst von: Ebert, Anne [VerfasserIn]
• Verfasst von: Hennerici, Michael G. [VerfasserIn]
• Verfasst von: Szabo, Kristina [VerfasserIn]
• Titel: DWI lesion patterns in cancer-related stroke
• Titelzusatz: specifying the phenotype
• Verf.angabe: Christopher Jan Schwarzbach, Marc Fatar, Philipp Eisele, Anne D. Ebert, Michael G. Hennerici, Kristina Szabo
• E-Jahr: 2015
• Jahr: October 30, 2015
• Umfang: 7 S.
• Fussnoten: Gesehen am 19.11.2018
• Titel Quelle: Enthalten in: Cerebrovascular diseases. Extra
• Ort Quelle: Basel : Karger, 2011
• Jahr Quelle: 2015
• Band/Heft Quelle: 5(2015), 3, Seite 139-145
• ISSN Quelle: 1664-5456
• DOI: doi:10.1159/000439549
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1583821198

Abstract

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.