Malignancy and Stroke

Cerebrovascular disease, in particular stroke, is a common complication in cancer patients, secondary in incidence only to brain metastases. Autopsy studies suggest that a substantial proportion of strokes in these patients is overlooked in the clinical setting. In general, the clinical presentation of stroke in cancer patients and in nononcologic patients is similar. Embolic focal cerebral ischemia is the most frequent type of stroke with a reported ratio of approximately 55%, which is substantially lower than the ratio of approximately 80% in the general population. The underlying malignancy influences the proportion of embolic versus hemorrhagic stroke. The most common cause of stroke in cancer patients is nonbacterial thrombotic endocarditis (NBTE), a noninfectious type of endocarditis characterized by sterile fibrin vegetations. Other common causes, in the order of frequency, include tumor-induced coagulopathy, atherosclerosis, modification of blood viscosity, and therapy-induced stroke. There is no general agreement whether cancer is an independent risk factor for stroke such as traditional risk factors like hypertension or smoking. The challenge to the clinician is to elaborate whether the stroke is specifically related to cancer or whether it is due to vascular comorbidity like in the general population. The treatment of stroke in cancer patients is usually similar to the treatment of stroke in the general population, except for the treatment of the underlying malignancy if applicable.