Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
PLoS One. 2012;7(9):e44959. doi: 10.1371/journal.pone.0044959. Epub 2012 Sep 12.
We hypothesized that hidden malignancy could be detected in patients with cryptogenic stroke without active cancer when they showed the distinctive characteristics of cancer-related stroke.
Among 2,562 consecutive patients with acute ischemic stroke, patients with cryptogenic stroke were analyzed and categorized into two groups according to the presence of active cancer: cryptogenic stroke with active cancer (cancer-related stroke, CA-stroke) group and without active cancer (CR-stroke) group. Patients with active lung cancer without stroke were also recruited for comparison purposes (CA-control). Clinical factors, lesion patterns on diffusion-weighted MRI (DWI), and laboratory findings were analyzed among groups. A total of 348 patients with cryptogenic stroke were enrolled in this study. Among them, 71 (20.4%) patients had active cancer at the time of stroke. The D-dimer levels were significantly higher in patients with CA-stroke than those with CR-stroke or CA-control (both p<0.001). Regarding lesion patterns, patients with CA-stroke mostly had multiple lesions in multiple vascular territories, while more than 80% of patients with CR-stroke had single/multiple lesions in a single vascular territory (P<0.001). D-dimer levels (OR 1.11 per 1 µg/mL increase; 95% CI 1.06-1.15; P<0.001) and DWI lesion patterns (OR 7.13; 95% CI 3.42-14.87; P<0.001) were independently associated with CA-stroke. Workup for hidden malignancy was performed during hospitalization in 10 patients who showed elevated D-dimer levels and multiple infarcts involving multiple vascular territories but had no known cancer, and it revealed hidden malignancies in all the patients.
Patients with CA-stroke have distinctive D-dimer levels and lesion patterns. These characteristics can serve as clues to occult cancer in patients with cryptogenic stroke.
我们假设，当隐匿性恶性肿瘤患者表现出与癌症相关的脑卒中的特征性表现，而无活动性癌症时，可以在这些患者中检测到隐匿性恶性肿瘤。
在 2562 例连续急性缺血性脑卒中患者中，对隐匿性脑卒中患者进行了分析，并根据是否存在活动性癌症将其分为两组：伴有活动性癌症的隐匿性脑卒中（癌症相关脑卒中，CA-脑卒中）组和无活动性癌症的隐匿性脑卒中（CR-脑卒中）组。还招募了患有活动性肺癌但无脑卒中的患者作为对照（CA-对照组）。对各组的临床因素、弥散加权 MRI（DWI）上的病灶模式和实验室检查结果进行了分析。本研究共纳入 348 例隐匿性脑卒中患者。其中，71 例（20.4%）患者在脑卒中时患有活动性癌症。CA-脑卒中患者的 D-二聚体水平明显高于 CR-脑卒中患者或 CA-对照组患者（均 P<0.001）。关于病灶模式，CA-脑卒中患者大多有多发性多血管区域病灶，而超过 80%的 CR-脑卒中患者则有单一/多发性单血管区域病灶（P<0.001）。D-二聚体水平（每增加 1μg/mL 的 OR 1.11；95%CI 1.06-1.15；P<0.001）和 DWI 病灶模式（OR 7.13；95%CI 3.42-14.87；P<0.001）与 CA-脑卒中独立相关。在 10 例 D-二聚体水平升高且有多个涉及多个血管区域的梗死但无已知癌症的患者中进行了隐匿性恶性肿瘤检查，结果在所有患者中均发现了隐匿性恶性肿瘤。
CA-脑卒中患者具有独特的 D-二聚体水平和病灶模式。这些特征可以作为隐匿性脑卒中患者隐匿性癌症的线索。
