Ischemic stroke: A paradoxical manifestation of cancer

Crit Rev Oncol Hematol. 2021 Jan:157:103181. doi: 10.1016/j.critrevonc.2020.103181. Epub 2020 Nov 16.


Introduction: Approximately 5-10 % of the patients with cryptogenic stroke have an underlying malignancy. Stroke as a complication of cancer increases the morbidity and mortality among cancer patients, leading to increased disability and healthcare costs.

Objective: To provide elements to guide physicians for when to suspect and evaluate for cancer in stroke patients.

Development: We performed a narrative review, portrayed in a question-answer format, to report relevant aspects of cancer stroke patients in the clinical practice and provide a guide based on the state-of-the-art literature. Conventional stroke mechanisms are only found in a fraction of patients with cancer. Although cardiovascular risk factors play an important role in both cancer and stroke pathogenesis, the recognition of more specific cancer-associated risk factors raises clinical suspicion for occult malignancy. We also expose the main type location and histology of tumors that are most commonly associated with stroke as well as potential blood biomarkers and current treatment considerations in the scenario of cancer associated stroke.

Conclusion: Subjects with active cancer are a patient population at increased risk for developing an ischemic stroke. Cryptogenic stroke patients have a higher risk of cancer diagnosis in the following 6-12 months. We recommend a multidisciplinary approach considering the high probability of a hidden malignancy and running a comprehensive evaluation including neurologic imaging, serological biomarkers and tight follow up.

Keywords: Cancer; Hypercoagulability (MeSH); Mortality; Prognosis; Risk factors; Stroke.

Publication types

  • Review

MeSH terms

  • Brain Ischemia* / complications
  • Brain Ischemia* / diagnosis
  • Brain Ischemia* / epidemiology
  • Humans
  • Ischemic Stroke*
  • Neoplasms* / complications
  • Neoplasms* / diagnosis
  • Neoplasms* / epidemiology
  • Risk Factors
  • Stroke* / diagnosis
  • Stroke* / epidemiology
  • Stroke* / etiology