Rogers Lisa R
Clinical Neuro-Oncology Program, Hermelin Brain Tumor Center, Department of Neurosurgery, Henry Ford Hospital, 2799 W Grand Blvd., Detroit, MI 48202, USA.
Semin Neurol. 2004 Dec;24(4):453-60. doi: 10.1055/s-2004-861539.
Stroke in the cancer patient is most often caused by disorders of coagulation that are induced by the cancer, by cancer metastatic to the central nervous system, or by coagulation disorders or vascular injury induced by cancer therapy. Nonbacterial thrombotic endocarditis with diffuse thrombosis of cerebral vessels is often the cause of cerebral infarction. Venous occlusion is most common in leukemic patients but can also result from growth of solid tumor in the adjacent skull or dura. Chemotherapy administration is associated with a small risk of cerebral arterial or venous thrombosis. Radiation that is administered to the neck can result in delayed carotid atherosclerosis. Tumor embolization to the brain is a rare cause of stroke. Fungal septic cerebral emboli occur most commonly in leukemic patients who have undergone bone marrow transplant. Hemorrhages occur in the brain parenchyma or subdural space and are most commonly caused by acute disseminated intravascular coagulation or metastatic tumor. Hemolysis from chemotherapy administration is a rare cause of brain hemorrhage. Neuroimaging studies, measurement of coagulation function, and echocardiography are the must useful modalities to identify the cause of stroke.
癌症患者发生中风最常见的原因是癌症诱发的凝血功能障碍、癌症转移至中枢神经系统、癌症治疗引起的凝血功能障碍或血管损伤。伴有脑血管弥漫性血栓形成的非细菌性血栓性心内膜炎常是脑梗死的病因。静脉闭塞在白血病患者中最为常见，但也可由邻近颅骨或硬脑膜的实体瘤生长所致。化疗给药与发生脑动脉或静脉血栓形成的风险较小有关。颈部放疗可导致迟发性颈动脉粥样硬化。肿瘤栓塞至脑部是中风的罕见病因。真菌性脓毒性脑栓塞最常见于接受过骨髓移植的白血病患者。出血发生在脑实质或硬膜下间隙，最常见的原因是急性弥散性血管内凝血或转移性肿瘤。化疗给药引起的溶血是脑出血的罕见病因。神经影像学检查、凝血功能检测和超声心动图是确定中风病因最有用的检查方法。
