Parikh Neal S, Burch Jaclyn E, Kamel Hooman, DeAngelis Lisa M, Navi Babak B
Department of Neurology, Weill Cornell Medicine, New York, New York.
Department of Neurology, Weill Cornell Medicine, New York, New York; Clinical and Translational Neuroscience Unit, Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York.
J Stroke Cerebrovasc Dis. 2017 Oct;26(10):2396-2403. doi: 10.1016/j.jstrokecerebrovasdis.2017.05.031. Epub 2017 Jun 21.
Stroke mechanisms and the risk of recurrent thromboembolism are incompletely understood in patients with primary brain tumors. We sought to better delineate these important clinical features.
We performed a retrospective cohort study of adults with primary brain tumors diagnosed with magnetic resonance imaging-confirmed acute ischemic stroke at the Memorial Sloan Kettering Cancer Center from 2005 to 2015. Study neurologists collected data on patients' cancer history, stroke risk factors, treatments, and outcomes. Stroke mechanisms were adjudicated by consensus. The primary outcome was recurrent thromboembolism (arterial or venous) and the secondary outcome was recurrent ischemic stroke. Kaplan-Meier statistics were used to calculate cumulative outcome rates, and Cox hazards analysis was used to evaluate the association between potential risk factors and outcomes.
We identified 83 patients with primary brain tumors and symptomatic acute ischemic stroke. Median survival after index stroke was 2.2 years (interquartile range, .5-7.0). Tumors were mostly gliomas (72%) and meningiomas (13%). Most strokes were from unconventional mechanisms, particularly radiation vasculopathy (36%) and surgical manipulation (18%). Small- or large-vessel disease or cardioembolism caused 13% of strokes, whereas 29% were cryptogenic. Cumulative recurrent thromboembolism rates were 11% at 30 days, 17% at 180 days, and 27% at 365 days, whereas cumulative recurrent stroke rates were 5% at 30 days, 11% at 180 days, and 13% at 365 days. We found no significant predictors of outcomes.
Patients with primary brain tumors generally develop strokes from rare mechanisms, and their risk of recurrent thromboembolism, including stroke, is high.
原发性脑肿瘤患者的卒中机制及复发性血栓栓塞风险尚未完全明确。我们试图更好地描述这些重要的临床特征。
我们对2005年至2015年在纪念斯隆凯特琳癌症中心经磁共振成像确诊为急性缺血性卒中的原发性脑肿瘤成年患者进行了一项回顾性队列研究。研究神经科医生收集了患者的癌症病史、卒中危险因素、治疗情况及预后数据。卒中机制经共识判定。主要结局为复发性血栓栓塞（动脉或静脉），次要结局为复发性缺血性卒中。采用Kaplan-Meier统计方法计算累积结局发生率，采用Cox风险分析评估潜在危险因素与结局之间的关联。
我们确定了83例原发性脑肿瘤合并症状性急性缺血性卒中患者。首次卒中后的中位生存期为2.2年（四分位间距，0.5 - 7.0年）。肿瘤大多为胶质瘤（72%）和脑膜瘤（13%）。大多数卒中源于非传统机制，尤其是放射性血管病（36%）和手术操作（18%）。小血管或大血管疾病或心源性栓塞导致13%的卒中，而29%为隐源性。30天时复发性血栓栓塞的累积发生率为11%，180天时为17%，365天时为27%，而30天时复发性卒中的累积发生率为5%，180天时为11%，365天时为13%。我们未发现结局的显著预测因素。
原发性脑肿瘤患者的卒中通常由罕见机制引起，其复发性血栓栓塞（包括卒中）风险较高。
