Carneado-Ruiz Joaquin
Neurology Department, Medicine Universidad Autonoma de Madrid, Madrid, Spain.
Stroke Unit, Neurosonology Laboratory, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain.
Front Neurol. 2025 Jun 13;16:1537779. doi: 10.3389/fneur.2025.1537779. eCollection 2025.
Oncologic and cerebrovascular diseases are among the diseases with the highest incidence rate and are leading causes of disability and mortality. The relationship between cancer and cerebrovascular disease has been studied for decades, yet it remains a challenge. Stroke, in relation to oncologic diseases, has particularities in its diagnosis and treatment. Cancer is an established risk factor for ischemic stroke. The highest risk of stroke occurs within the first 6 months after a cancer diagnosis and in patients with metastases. Between 2 and 10% of patients initially diagnosed with cryptogenic stroke are subsequently diagnosed with cancer within 1 year. The mechanism underlying cryptogenic ischemic stroke associated with oncologic disease is acquired hypercoagulability, which is the most frequent mechanism underlying stroke in patients with cancer. Sometimes, cancer presents itself as non-bacterial thrombotic endocarditis (NBTE) with cerebral infarction. Strokes are usually more severe, and their clinical presentation can be focal or multifocal. D-dimer levels are significantly elevated in patients with cancer-associated stroke. Magnetic resonance imaging (MRI) usually shows embolic lesions across several arterial territories, including both carotid territories and the vertebrobasilar territory. Patients with cancer-associated stroke face a higher risk of recurrence, recurrent thromboembolism, early neurological deterioration, and mortality. Patients with both stroke and cancer should be considered for thrombolysis (recombinant tissue plasminogen activator (rTPA) or tenecteplase) and endovascular treatment. Low-molecular-weight heparin is usually used empirically when a hypercoagulable state is suspected, and few studies have supported the use of direct oral anticoagulants as an option with similar efficacy. The objective of this review was to synthesize all relevant information available to date on neoplasia as a cause of cryptogenic embolic stroke and to provide useful insights for everyday clinical practice.
肿瘤疾病和脑血管疾病是发病率最高的疾病，也是导致残疾和死亡的主要原因。癌症与脑血管疾病之间的关系已研究了数十年，但仍然是一个挑战。与肿瘤疾病相关的中风在诊断和治疗方面具有特殊性。癌症是缺血性中风的既定危险因素。中风的最高风险发生在癌症诊断后的前6个月内以及有转移的患者中。最初被诊断为隐源性中风的患者中，有2%至10%在1年内随后被诊断出患有癌症。与肿瘤疾病相关的隐源性缺血性中风的潜在机制是获得性高凝状态，这是癌症患者中风最常见的潜在机制。有时，癌症表现为伴有脑梗死的非细菌性血栓性心内膜炎（NBTE）。中风通常更严重，其临床表现可以是局灶性或多灶性的。癌症相关性中风患者的D-二聚体水平显著升高。磁共振成像（MRI）通常显示多个动脉区域的栓塞病变，包括颈动脉区域和椎基底动脉区域。癌症相关性中风患者面临更高的复发、复发性血栓栓塞、早期神经功能恶化和死亡风险。同时患有中风和癌症的患者应考虑进行溶栓治疗（重组组织型纤溶酶原激活剂（rTPA）或替奈普酶）和血管内治疗。当怀疑存在高凝状态时，通常经验性使用低分子量肝素，很少有研究支持使用直接口服抗凝剂作为具有类似疗效的选择。本综述的目的是综合迄今为止所有关于肿瘤作为隐源性栓塞性中风病因的相关信息，并为日常临床实践提供有用的见解。
