Mai Hui, Xia Jun, Wu Yongjun, Ke Junlong, Li Junliang, Pan Jiangang, Chen Wubiao, Shao Yiming, Yang Zhi, Luo Saihua, Sun Yonghua, Zhao Bin, Li Longxuan
Department of Neurology, Guangdong Medical College Affiliated Hospital, 57 South Renmin Road, Zhanjiang 524001, Guangdong, PR China.
Department of Radiology, Guangdong Medical College Affiliated Hospital, Zhanjiang, PR China.
J Clin Neurosci. 2015 Feb;22(2):296-302. doi: 10.1016/j.jocn.2014.05.039. Epub 2014 Oct 18.
We investigated the clinical and imaging characteristics of initial and recurrent strokes in patients with occult lung cancer associated ischemic stroke (OLCA-stroke). A retrospective review of all ischemic stroke patients with occult lung cancer in the absence of conventional stroke etiologies between 2005 and 2013 was conducted. We compared the initial and recurrent lesion patterns on diffusion-weighted MRI in patients with OLCA-stroke, with respect to vascular territory involved, number and size of lesions, clinical presentation, cancer subtypes, recurrences and fatalities, and outcome of survivors. Thirteen patients with confirmed OLCA-stroke were identified. All had elevated D-dimer levels, six had central lung cancer and seven had peripheral lung cancer. Eight (62%) had adenocarcinoma, and nine (69%) had metastasis. Ten (77%) patients had multiple lesions in multiple vascular territories. Twelve (92%) patients suffered recurrent strokes. Multiple small and large disseminated lesions in multiple vascular territories were more frequent in recurrent strokes in comparison with initial strokes. The middle cerebral artery was most frequently involved in recurrent strokes, followed by the posterior circulation territory and anterior cerebral artery, which were of similar frequency as initial strokes. Overall, 58% of patients had their first recurrent stroke within the first month, and 69% had a poor outcome, especially for those with multiple recurrent strokes and metastases. Occult cancer should be considered in the setting of multiple and recurrent embolic strokes within the short term in the absence of conventional stroke etiologies. The severity of malignancy and cancer treatments and stroke influenced the recurrences and outcome.
我们研究了隐匿性肺癌相关性缺血性卒中（OLCA-卒中）患者初次和复发性卒中的临床及影像学特征。对2005年至2013年间所有无传统卒中病因的隐匿性肺癌缺血性卒中患者进行了回顾性研究。我们比较了OLCA-卒中患者在扩散加权磁共振成像上初次和复发性病变模式，涉及血管区域、病变数量和大小、临床表现、癌症亚型、复发及死亡情况以及幸存者的预后。确定了13例确诊为OLCA-卒中的患者。所有患者D-二聚体水平均升高，6例为中央型肺癌，7例为周围型肺癌。8例（62%）为腺癌，9例（69%）有转移。10例（77%）患者在多个血管区域有多处病变。12例（92%）患者发生复发性卒中。与初次卒中相比，复发性卒中中多个血管区域出现多发小病灶和大的播散性病灶更为常见。复发性卒中最常累及大脑中动脉，其次是后循环区域和大脑前动脉，其频率与初次卒中相似。总体而言，58%的患者在第一个月内发生首次复发性卒中，69%的患者预后不良，尤其是那些有多次复发性卒中和转移的患者。在无传统卒中病因的情况下，短期内发生多次和复发性栓塞性卒中时应考虑隐匿性癌症。恶性肿瘤的严重程度、癌症治疗及卒中影响复发和预后。
