Cerebrovascular complications in cancer patients

Cerebrovascular disease is a frequent cause of cerebral symptoms in cancer patients. The largest study of these disorders is an autopsy study from Memorial Sloan-Kettering Center, in which 500 out of 3426 patients (14.6%) dying with systemic cancer were found to have cerebral infarctions or hemorrhages [1]. Table 1 shows the type of cerebrovascular disorder and the percentage of patients who were symptomatic. This study documents that the causes of stroke are often unique to the cancer patient, as compared with patients without cancer. The typical causes are coagulation disorders related to the cancer, cerebral metastasis, complications of cancer treatment, and cerebral infection. The type of stroke depends on the type and stage of cancer and the type of antineoplastic treatment. Tables 2 and 3 correlate the pathologic condition with the tumor type and clinical setting. The study by Gratis et al [1] encompassed patients dying between 1970 and 1981. It is likely that the type and etiology of cerebrovascular disease in cancer patients is different now, because of advances in antineoplastic therapies, including radiotherapy, chemotherapy, immunotherapy, and the use of bone marrow transplant. In a retrospective review, Coplin et al [2] identified cerebral hemorrhage or infarction in 36 out of 1245 patients (2.9%) undergoing bone marrow transplant. In patients with primary brain tumors, there may be vascular disorders related to the growth of the tumor, neovascularity, or tumor treatment. The cerebrovascular disorders associated with systemic cancer and primary central nervous system tumors are reviewed in this article, with an emphasis on the clinical presentation and tests that aid in the diagnosis. Identifying the disorder can lead to effective treatment and, in some patients, can lead to the diagnosis of cancer.