J Neurosci Nurs. 2021 Oct 1;53(5):202-207. doi: 10.1097/JNN.0000000000000606.
Primary brain tumors are the leading cause of cancer mortality in the United States affecting approximately 90,000 Americans each year. A major complication for brain tumor survivors is acute ischemic stroke (AIS). Currently, there are limited research to provide guidelines for AIS prevention and management in adult brain tumor survivors. The purpose of this review is to discuss the most common risk factors for AIS in adult brain tumor survivors along with best evidence for assessment, screening, and strategies to prevent AIS in this population. METHODS: Relevant literature was identified by searching CINAHL and PubMed databases using the following keywords: "brain tumor survivors," "adults," "stroke," "risk factors," "guidelines," "prevention," and "management". Articles not pertaining to adult brain tumor survivors and AIS were excluded. RESULTS: The location of the tumor, dose, extent, and type of radiation contribute to the development of vascular injury and subsequent carotid stenosis among brain tumor survivors. Endothelial growth factor inhibitor and chemotherapy drugs induces vascular remodeling. Other symptoms such as neurological impairments and co-morbidities are also present among brain tumor survivors. Furthermore, AIS increases from the time of primary brain tumor diagnosis and incidence further increases among patients who were diagnosed with a brain tumor as a child. CONCLUSION: Nurses play a key role in the assessment, prevention, and identifying individuals who are at risk of AIS during brain tumor survivorship. Engaging patients and their caregivers on minimizing their risks of AIS is crucial in the outpatient setting. Annual surveillance visits that include intracranial artery imaging should be used to identify individuals considered most at risk for developing AIS symptoms.
原发性脑肿瘤是美国癌症死亡的主要原因,每年影响约 9 万名美国人。脑肿瘤幸存者的一个主要并发症是急性缺血性中风(AIS)。目前,对于成人脑肿瘤幸存者的 AIS 预防和管理,仅有有限的研究提供了指南。本综述的目的是讨论成人脑肿瘤幸存者发生 AIS 的最常见危险因素,以及评估、筛查和预防该人群 AIS 的最佳证据。
通过在 CINAHL 和 PubMed 数据库中使用以下关键词搜索相关文献:“脑肿瘤幸存者”、“成人”、“中风”、“危险因素”、“指南”、“预防”和“管理”。排除与成人脑肿瘤幸存者和 AIS 无关的文章。
肿瘤位置、剂量、范围和类型的放疗都会导致脑肿瘤幸存者发生血管损伤和随后的颈动脉狭窄。血管内皮生长因子抑制剂和化疗药物可诱导血管重塑。此外,脑肿瘤幸存者还存在神经功能障碍和合并症等其他症状。此外,AIS 从原发性脑肿瘤诊断时开始增加,并且在儿童期被诊断为脑肿瘤的患者中发病率进一步增加。
护士在脑肿瘤存活期间的评估、预防和识别发生 AIS 风险的个体中发挥着关键作用。让患者及其护理人员参与进来,尽量降低他们发生 AIS 的风险,这在门诊环境中至关重要。应每年进行包括颅内动脉成像在内的监测访问,以确定被认为最有可能出现 AIS 症状的个体。