Cerebrovascular Complications in Patients with Cancer

ABSTRACT

Stroke in the cancer patient is most often caused by disorders of coagulation that are induced by the cancer, by cancer metastatic to the central nervous system, or by coagulation disorders or vascular injury induced by cancer therapy. Nonbacterial thrombotic endocarditis with diffuse thrombosis of cerebral vessels is often the cause of cerebral infarction. Venous occlusion is most common in leukemic patients but can also result from growth of solid tumor in the adjacent skull or dura. Chemotherapy administration is associated with a small risk of cerebral arterial or venous thrombosis. Radiation that is administered to the neck can result in delayed carotid atherosclerosis. Tumor embolization to the brain is a rare cause of stroke. Fungal septic cerebral emboli occur most commonly in leukemic patients who have undergone bone marrow transplant. Hemorrhages occur in the brain parenchyma or subdural space and are most commonly caused by acute disseminated intravascular coagulation or metastatic tumor. Hemolysis from chemotherapy administration is a rare cause of brain hemorrhage. Neuroimaging studies, measurement of coagulation function, and echocardiography are the must useful modalities to identify the cause of stroke.

KEYWORDS

Coagulopathy - nonbacterial thrombotic endocarditis - disseminated intravascular coagulation - venous occlusion

REFERENCES

• 1 Graus F, Rogers L R, Posner J B. Cerebrovascular complications in patients with cancer.  Medicine. 1985;  64 16-35
• 2 Chaturvedi S, Ansell J, Recht L. Should cerebral ischemic events in cancer patients be considered a manifestation of hypercoagulability?.  Stroke. 1994;  25 1215-1218
• 3 Cestari D M, Weine D M, Panageas K S, Segal A Z, DeAngelis L M. Stroke in patients with cancer-incidence and etiology.  Neurology. 2004;  62 2025-2030
• 4 Lee A Y. Cancer and thromboembolic disease: pathogenic mechanisms.  Cancer Treat Rev. 2002;  28 137-140
• 5 Rogers L R, Cho E-S, Kempin S, Posner J B. Cerebral infarction from non-bacterial thrombotic endocarditis: clinical and pathological study including the effects of anticoagulation.  Am J Med. 1987;  83 746-756
• 6 Reisner S A, Brenner B, Haijm N, Edoute Y, Markiewicz W. Echocardiography in nonbacterial thrombotic endocarditis: from autopsy to clinical entity.  J Am Soc Echocardiogr. 2000;  13 876-881
• 7 Reagan T J, Okazaki H. The thrombotic syndrome associated with carcinoma.  Arch Neurol. 1974;  31 390-395
• 8 Collins R C, Al-Mondhiry H, Chernik N L, Posner J B. Neurologic manifestations of intravascular coagulation in patients with cancer.  Neurology. 1975;  25 795-806
• 9 Raizer J J, DeAngelis L M. Cerebral sinus thrombosis diagnosed by MRI and MR venography in cancer patients.  Neurology. 2000;  54 1222-1226
• 10 Murros K E, Toole J F. The effect of radiation on carotid arteries.  Arch Neurol. 1989;  46 449-455
• 11 Edoute Y, Haim N, Rinkevich D, Brenner B, Reisner S A. Cardiac valvular vegetations in cancer patients: a prospective echocardiographic study of 200 patients.  Am J Med. 1997;  102 252-258
• 12 Patchell R A, White C L, Clark A W, Beschorner W E, Santos G W. Nonbacterial thrombotic endocarditis in bone marrow transplant patients.  Cancer. 1985;  55 631-635
• 13 Masjuan J, Pardo J, Callejo J M, Andres M T, Alvarez-Cermeno J C. Tamoxifen: a new risk factor for cerebral sinus thrombosis.  Neurology. 2004;  62 334-335
• 14 Singhal A B, Topcuoglu M A, Buonanno F S. Acute ischemic stroke patterns in infective and nonbacterial thrombotic endocarditis: a discussion-weighted magnetic resonance imaging study.  Stroke. 2002;  33 1267-1273
• 15 Lee A Y, Levine M N, Baker R I et al.. for the Randomized Comparison of Low-Molecular-Weight Heparin Versus Oral Anticoagulant Therapy for the Prevention of Recurrent Venous Thromboembolism in Patients with Cancer (CLOT) Investigators. Low molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer.  N Engl J Med. 2003;  349 146-153
• 16 DeBruijn S F, Budde M, Teunisse S, de Haan R J, Stam J. Long-term outcome of cognition and functional health after cerebral venous sinus thrombosis.  Neurology. 2000;  54 1687-1689
• 17 Fink J N, McAuley D L. Safety of anticoagulation for cerebral venous thrombosis associated with intracerebral hematoma.  Neurology. 2001;  57 1138-1139
• 18 Soleau S W, Schmidt R, Stevens S, Osborn A, MacDonald J D. Extensive experience with dural sinus thrombosis.  Neurosurgery. 2003;  52 534-544
• 19 Klein P, Haley E C, Wooten G F et al.. Focal cerebral infarctions associated with perivascular tumor infiltrates in carcinomatous leptomeningeal metastases.  Arch Neurol. 1989;  46 1149-1152
• 20 Anghel G, Pettinato G, Severino A et al.. Intravascular B-cell lymphoma: report of two cases with different clinical presentation but rapid central nervous system involvement.  Leuk Lymphoma. 2003;  44 1353-1359
• 21 Herman C, Kupsky W J, Rogers L, Duman R, Moore P. Leptomeningeal dissemination of malignant glioma simulating cerebral vasculitis: case report with angiographic and pathological studies.  Stroke. 1995;  26 2366-2370
• 22 Williams R L, Cidis Meltzer C, Smirniotopoulos J G, Fukui M B, Inman M. Cerebral MR imaging in intravascular lymphomatosis.  AJNR Am J Neuroradiol. 1998;  19 427-431
• 23 Matsumoto K, Ohta M, Takeshita I. Reversible non-thrombotic occlusion of the superior sagittal sinus caused by metastatic malignant lymphoma: case report.  Neurol Med Chir (Tokyo). 2003;  43 349-351
• 24 Calamia K T, Miller A, Shuster E A, Perniciaro C, Menke D M. Intravascular lymphomatosis. A report of ten patients with central nervous system involvement and a review of the disease process.  Adv Exp Med Biol. 1999;  455 249-265
• 25 Lee A Y, Levine M N. The thrombophilic state induced by therapeutic agents in the cancer patient.  Semin Thromb Hemost. 1999;  25 137-145
• 26 Gugliotta L, Mazucconi M G, Leone G et al.. Incidence of thrombotic complications in adult patients with acute lymphoblastic leukaemia receiving L-asparaginase during induction therapy: a retrospective study.  Eur J Haematol. 1992;  49 63-66
• 27 Kieslich M, Porto L, Lanfermann H, Jacobi G, Schwabe D, Bohles H. Cerebrovascular complications for L-asparaginase in the therapy of acute lymphoblastic leukemia.  J Pediatr Hematol Oncol. 2003;  25 484-487
• 28 Dorresteijn L D, Kappelle A C, Boogerd W et al.. Increased risk of ischemic stroke after radiotherapy on the neck in patients younger than 60 years.  J Clin Oncol. 2002;  20 282-288
• 29 Steele S R, Martin M J, Mullenix P S, Crawford J V, Cuadrado D S, Andersen C A. Focused high-risk population screening for carotid arterial stenosis after radiation therapy for head and neck cancer.  Am J Surg. 2004;  187 594-598
• 30 El Amrani M, Heinzlef O, Debroucker T, Roullet E, Bousser M-G, Amarenco P. Brain infarction following 5-fluorouracil and cisplatin therapy.  Neurology. 1998;  51 899-901
• 31 Pritchard K I, Paterson A H G, Paul N A, Zee B, Fine S, Pater J. for the NCI of Canada Clinical Trials Group Breast Cancer Site Group. Increased thromboembolic complications with concurrent tamoxifen and chemotherapy in a randomized trial of adjuvant therapy for women with breast cancer.  J Clin Oncol. 1996;  14 2731-2737
• 32 Lam W W, Leung S F, So N M et al.. Incidence of carotid stenosis in nasopharyngeal carcinoma patients after radiotherapy.  Cancer. 2001;  92 2357-2363
• 33 Ito Y, Arahata Y, Goto Y et al.. Cisplatin neurotoxicity presenting as reversible posterior leukoencephalopathy syndrome.  AJNR Am J Neuroradiol. 1998;  19 415-417
• 34 Cheng S W K, Wu L L H, Ting A C W, Lau H, Lam L K, Wei W I. Irradiation-induced extracranial carotid stenosis in patients with head and neck malignancies.  Am J Surg. 1999;  178 323-328
• 35 Kashyap V S, Moore W S, Quinones B, Baldrich W J. Carotid artery repair for radiation-associated atherosclerosis is a safe and durable procedure.  J Vasc Surg. 1999;  29 90-96
• 36 Leseche G, Castier Y, Chataigner O et al.. Carotid artery revascularization through a radiated field.  J Vasc Surg. 2003;  38 244-250
• 37 O'Neill B P, Dinapoli R P, Okazaki H. Cerebral infarction as a result of tumor emboli.  Cancer. 1987;  60 90-95
• 38 Lefkovitz N W, Roessmann U, Kori S H. Major cerebral infarction from tumor embolus.  Stroke. 1986;  17 555-557
• 39 Murata J, Sawamura Y, Takahashi A et al.. Intracerebral hemorrhage caused by a neoplastic aneurysm from small-cell lung carcinoma: case report.  Neurosurgery. 1993;  32 124-126
• 40 Pickering L, Cox I, Pandha H. Left atrial sarcoma presenting as cerebral infarction.  Lancet Oncol. 2001;  2 705-706
• 41 Urrutia V, Jichici D, Thomas C E, Nunes L W, Schwartzman R J. Embolic stroke secondary to an aortic arch tumor: a case report.  Angiology. 2000;  51 959-962
• 42 Brown D V, Faber L P, Tuman K J. Perioperative stroke caused by arterial tumor embolism.  Anesth Analg. 2004;  98 806-809
• 43 Coplin W M, Cochran M S, Levine S R, Crawford S W. Stroke after bone marrow transplantation-frequency, aetiology and outcome.  Brain. 2001;  124 1043-1051
• 44 Kawanami T, Kurita K, Yamakawa M, Omoto E, Kato T. Cerebrovascular disease in acute leukemia: A clinicopathological study of 14 patients.  Intern Med. 2002;  41 1130-1134
• 45 Walsh T J, Hier D B, Caplan L R. Aspergillosis of the central nervous system: clinicopathological analysis of 17 patients.  Ann Neurol. 1985;  18 574-582
• 46 Antman K H, Skarin A T, Mayer R J et al.. Microangiopathic hemolytic anemia and cancer: a review.  Medicine. 1979;  58 377-384
• 47 Gordon L I, Kwaan H C. Thrombotic microangiopathy manifesting as thrombotic thrombocytopenic purpura/hemolytic uremic syndrome in the cancer patient.  Semin Thromb Hemost. 1999;  25 217-221
• 48 Humphreys B D, Sharman J P, Henderson J M et al.. Gemcitabine-associated thrombotic microangiopathy.  Cancer. 2004;  100 2664-2670
• 49 Pitner S E, Johnson W W. Chronic subdural hematoma in childhood acute leukemia.  Cancer. 1973;  32 185-190
• 50 Jourdan E, Dombret H, Glaisner S, Miclea J M, Castaigne S, Degos L. Unexpected high incidence of intracranial subdural haematoma during intensive chemotherapy for acute myeloid leukaemia with a monoblastic component.  Br J Haematol. 1995;  89 527-530
• 51 Graus F, Saiz A, Sierra J et al.. Neurologic complications of autologous and allogeneic bone marrow transplantation in patients with leukemia: a comparative study.  Neurology. 1996;  46 1004-1009
• 52 Tallman M S, Andersen J W, Schiffer C A et al.. A prospective randomized study of all-trans retinoic acid induction and maintenance therapy for patients with acute promyelocytic leukemia.  N Engl J Med. 1997;  337 1021-1028
• 53 Colosimo M, McCarthy N, Jayasinghe R, Morton J, Taylor K, Durrant S. Diagnosis and management of subdural haematoma complicating bone marrow transplantation.  Bone Marrow Transplant. 2000;  25 549-552
• 54 Lieu A S, Hwang S L, Howng S L, Chai C Y. Brain tumors with hemorrhage.  J Formos Med Assoc. 1999;  98 365-367
• 55 Minette S E, Kimmel D W. Subdural hematoma in patients with systemic cancer.  Mayo Clin Proc. 1989;  64 637-642
• 56 McIver J I, Scheithauer B W, Rydberg C H, Atkinson J LD. Metastatic hepatocellular carcinoma presenting as epidural hematoma: case report.  Neurosurgery. 2001;  49 447-449
• 57 Wurthner J U, Kohler G, Behringer D, Lindemann A, Mertelsmann R, Lubbert M. Leukostasis followed by hemorrhage complicating the initiation of chemotherapy in patients with acute myeloid leukemia and hyperleukocytosis: a clinicopathologic report of four cases.  Cancer. 1999;  85 368-374
• 58 Nowacki P, Fryze C, Zdziarska B, Zyluk B, Grzelec H, Dudzik T. Central nervous system leukostasis in patients with leukemias and lymphomas.  Folia Neuropathol. 1995;  33 59-65
• 59 McKenzie C R, Rengachary S S, McGregor D H, Dixon A, Suskind D L. Subdural hematoma associated with metastatic neoplasms.  Neurosurgery. 1990;  27 619-625
• 60 Bromberg J E, Vandertop W P, Jansen G H. Recurrent subdural haematoma as the primary and sole manifestation of chronic lymphocytic leukaemia.  Br J Neurosurg. 1998;  12 373-376
• 61 Atlas S W, Grossman R I, Gomori J M et al.. Hemorrhagic intracranial malignant neoplasms: spin-echo MR imaging.  Radiology. 1987;  164 71-77