Numerous types of
cancer have been shown to be associated with either ischemic or
hemorrhagic stroke. In this review, the epidemiology and pathophysiology of
stroke in
cancer patients is discussed, while providing vital information on the diagnosis and management of patients with
cancer and
stroke.
Cancer may mediate
stroke pathophysiology either directly or via coagulation disorders that establish a state of hypercoagulation, as well as via
infections.
Cancer treatment options, such as
chemotherapy,
radiotherapy and surgery have all been shown to aggravate the risk of
stroke as well. The clinical manifestation varies greatly depending upon the underlying cause; however, in general, cancer‑associated
strokes tend to appear as multifocal in neuroimaging. Furthermore, several
serum markers have been identified, such as high D‑Dimer levels and
fibrin degradation products. Managing
cancer patients with
stroke is a delicate matter. The
cancer should not be considered a
contraindication in applying thrombolysis and recombinant tissue
plasminogen activator (rTPA) administration, since the risk of
hemorrhage in
cancer patients has not been reported to be higher than that in the general population. Anticoagulation, on the contrary, should be carefully examined. Clinicians should weigh the benefits and risks of anticoagulation treatment for each patient individually; the new oral
anticoagulants appear promising; however, low‑molecular‑weight
heparin remains the first choice. On the whole,
stroke is a serious and not a rare complication of
malignancy. Clinicians should be adequately trained to handle these patients efficiently.