Health Sciences Faculty, Health Sciences Research Centre, Beira Interior University, Covilhã, Portugal.
Eur Neurol. 2012;68(4):209-13. doi: 10.1159/000341343. Epub 2012 Sep 26.
Cerebrovascular disease is the second most common non-metastatic neurological disorder in oncological patients. The aims of this study were to determine the prevalence of cancer in stroke patients and to compare mechanisms of stroke between patients with and without malignancy.
This retrospective study involved patients with ischemic stroke admitted over 1 year to a Neurology Department. Demographic and clinical data, cardiovascular risk factors, and laboratory findings were recorded. The etiology was classified following the TOAST criteria. Participants were classified as stroke and cancer patients (diagnosis of malignancy before stroke or cancer diagnosed after admission) or as control stroke patients.
Over 1 year, 291 stroke patients (268 ischemic) were admitted. Sixteen ischemic patients had a malignancy (5.9%), and in 12 patients, malignancy was the only cause found for the stroke; in 4 patients, malignancy was a coexisting condition. Coexistent stroke and cancer was significantly related to higher median levels of fibrinogen, D-dimers, and erythrocyte sedimentation rate (ESR). Logistic regression analysis showed that D-dimer and ESR levels were independently related to cancer, with odds ratios of 1.004 (95% CI 1.001-1.007, p=0.02) and 1.075 (95% CI 1.031-1.121, p=0.001), respectively.
Almost 6% of ischemic stroke patients had a concomitant malignancy. In most of them, cancer was the only cause of stroke found. Patients with stroke and malignancy exhibited raised D-dimer, fibrinogen, and ESR levels, suggesting the prothrombotic state was a principal mechanism underlying stroke. D-dimer and ESR assessments may be useful in identifying underlying disorders in ischemic stroke.
脑血管疾病是肿瘤患者中第二常见的非转移性神经系统疾病。本研究旨在确定卒中患者中的癌症患病率，并比较伴有和不伴有恶性肿瘤的卒中患者的发病机制。
本回顾性研究纳入了 1 年内神经内科收治的缺血性卒中患者。记录人口统计学和临床数据、心血管危险因素和实验室检查结果。病因按照 TOAST 标准分类。将患者分为卒中合并癌症患者（卒中前诊断为恶性肿瘤或入院后诊断为癌症）和单纯卒中患者。
在 1 年期间，共收治了 291 例卒中患者（268 例缺血性）。16 例缺血性患者患有恶性肿瘤（5.9%），其中 12 例患者的恶性肿瘤是卒中的唯一病因，4 例患者的恶性肿瘤是并存疾病。并存的卒中合并癌症与较高的纤维蛋白原、D-二聚体和红细胞沉降率（ESR）中位数水平显著相关。Logistic 回归分析显示，D-二聚体和 ESR 水平与癌症独立相关，比值比分别为 1.004（95%可信区间 1.001-1.007，p=0.02）和 1.075（95%可信区间 1.031-1.121，p=0.001）。
近 6%的缺血性卒中患者伴有合并恶性肿瘤。在大多数患者中，癌症是唯一发现的卒中病因。伴有卒中合并癌症的患者表现出升高的 D-二聚体、纤维蛋白原和 ESR 水平，提示血栓形成状态是卒中的主要发病机制。D-二聚体和 ESR 的评估可能有助于识别缺血性卒中的潜在疾病。
