Medical College, Aga Khan University, Hospital, Karachi, Pakistan.
Cleveland Clinic Akron General, Akron, Ohio, USA.
J Stroke Cerebrovasc Dis. 2021 Jun;30(6):105728. doi: 10.1016/j.jstrokecerebrovasdis.2021.105728. Epub 2021 Mar 18.
Our review aims to present existing data on the safety of Intravenous thrombolysis (IVT) use in acute ischemic stroke (AIS) patients with concomitant central nervous system or systemic malignancies, with attention to special circumstances pertaining to specific cancer subtypes to help in acute decision making, especially for neurologists and emergency medicine physicians.
A literature search was conducted on electronic databases inclusive of Medline, EMBASE and CINAHL for articles published or available in English between January 1, 2000 to June 1, 2020 using the following search terms: "acute ischemic stroke," "cerebrovascular disease," "Intravenous thrombolysis," "tissue plasminogen activator," "cancer patients," and "neoplasm".
Recognition of stroke symptoms in patients with active cancer, in particularly those involving the brain, requires astute clinical judgement. Decision-making can be improved by understanding baseline functional status, cancer prognosis and expected disability from stroke, as well as utilizing diagnostic modalities such acute MRI where needed. While this article does not encourage use of IVT in patients with all malignancies, it lays the groundwork for decision making should thrombolysis be a consideration in a patient with AIS in a cancer patient.
本综述旨在介绍目前关于伴有中枢神经系统或全身恶性肿瘤的急性缺血性脑卒中（AIS）患者使用静脉溶栓（IVT）的安全性数据，重点关注与特定癌症亚型相关的特殊情况，以帮助进行急性决策，特别是对神经科医生和急诊医师。
我们在电子数据库中进行了文献检索，包括 Medline、EMBASE 和 CINAHL，检索了 2000 年 1 月 1 日至 2020 年 6 月 1 日期间发表或可用的英文文章，使用了以下搜索词：“急性缺血性脑卒中”、“脑血管疾病”、“静脉溶栓”、“组织型纤溶酶原激活物”、“癌症患者”和“肿瘤”。
在患有活动性癌症的患者中，特别是那些涉及大脑的患者中，识别出卒中症状需要敏锐的临床判断。通过了解基线功能状态、癌症预后和卒中引起的预期残疾，以及在需要时使用急性 MRI 等诊断方式，可以改善决策。虽然本文不鼓励在所有恶性肿瘤患者中使用 IVT，但它为在癌症患者中出现 AIS 时是否考虑溶栓治疗奠定了基础。
