Ischemic Stroke in Critically Ill Patients with Malignancy

PLoS One. 2016 Jan 11;11(1):e0146836. doi: 10.1371/journal.pone.0146836. eCollection 2016.

Abstract

Background: Cerebrovascular diseases are a frequent cause of neurological symptoms in patients with cancer. The clinical characteristics of ischemic stroke (IS) in patients with cancer have been reported in several studies; however, limited data are available regarding critically ill patients with cancer who develop IS during their stay in the intensive care unit (ICU).

Methods: All consecutive patients who underwent brain magnetic resonance imaging (MRI) for suspicion of IS with acute abnormal neurologic symptoms or who developed signs of IS while in the ICU were retrospectively evaluated. We compared the clinical characteristics and diffusion-weighted imaging (DWI) lesion patterns between patients finally diagnosed as having or not having IS.

Results: Over the study period, a total of 88 patients underwent brain MRI for suspicion of IS, with altered mental status in 55 (63%), hemiparesis in 28 (32%), and seizure in 20 (23%). A total of 43 (49%) patients were ultimately diagnosed with IS. Multiple DWI lesions (41%) were more common than single lesions (8%). The etiologies of IS were not determined in the majority of patients (n = 27, 63%). In the remaining 16 (37%) patients, the most common aetiology of IS was cardioembolism (n = 8), followed by large-vessel atherosclerosis (n = 3) and small-vessel occlusion (n = 2). However, brain metastases were newly diagnosed in only 7 (8%) patients. Univariate comparison of the baseline characteristics between patients with or without IS did not reveal any significant differences in sex, malignancy type, recent chemotherapy, vascular risk factors, or serum D-dimer levels at the time of suspicion of IS. Thrombotic events were more common in the IS group than in the non-IS group (P = 0.028). However, patients who were ultimately diagnosed with IS had more hemiparesis symptoms at the time of suspicion of IS (P = 0.001). This association was significant even after adjusting for potentially confounding factors (adjusted odds ratio 5.339; 95% confidence interval, 1.521-19.163).

Conclusions: IS developed during ICU stays in critically ill patients with cancer have particular features that may be associated with cancer-related mechanism.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Atherosclerosis / complications
  • Brain / pathology
  • Brain Ischemia / complications
  • Brain Ischemia / rehabilitation*
  • Brain Neoplasms / complications
  • Cerebrovascular Disorders / complications*
  • Critical Illness
  • Diffusion Magnetic Resonance Imaging
  • Embolism / complications
  • Female
  • Heart / physiopathology
  • Humans
  • Intensive Care Units
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Neoplasm Metastasis
  • Neoplasms / complications*
  • Neoplasms / rehabilitation*
  • Odds Ratio
  • Paresis / complications
  • Paresis / rehabilitation
  • Retrospective Studies
  • Risk Factors
  • Stroke / complications
  • Stroke Rehabilitation*

Grants and funding

This study was supported by a grant from the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (HI14C0743). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. In addition, Samsung Medical Center provided support in the form of salaries for all of authors, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.