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Ischaemic stroke with malignancy may often be caused by paradoxical embolism
Y Iguchi1, K Kimura, K Kobayashi
1Department of Stroke Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki City, Okayama, 701-0192, Japan. yigu@med.kawasaki-m.ac.jp
Journal of Neurology, Neurosurgery, and Psychiatry
|July 19, 2006
Summary
Malignancy is linked to a higher prevalence of right-to-left shunt (RLS), a condition increasing stroke risk. Paradoxical brain embolism is a key mechanism in cancer patients experiencing ischemic stroke.
Area of Science:
- Neurology
- Oncology
- Cardiology
Background:
- Ischemic stroke in cancer patients is uncommon but poorly understood.
- The specific mechanisms linking malignancy and stroke require further investigation.
Purpose of the Study:
- To investigate the mechanisms of ischemic stroke in patients with malignancy.
- To specifically examine the role of right-to-left shunt (RLS) in these cases.
Main Methods:
- Prospective study of 184 consecutive ischemic stroke patients within 24 hours of onset.
- Contrast saline transcranial Doppler used to detect RLS.
- Assessment for deep venous thrombosis (DVT) or pulmonary embolism in patients with RLS to diagnose paradoxical brain embolism.
Main Results:
- Right-to-left shunt (RLS) was detected in 18% of patients.
- Malignancy was present in 5% of patients.
- RLS was significantly more frequent in patients with malignancy (55%) compared to those without (15%).
- All six patients with RLS and malignancy had evidence of DVT or pulmonary embolism and severe disability prior to stroke.
Conclusions:
- Paradoxical brain embolism is a significant mechanism contributing to ischemic stroke in patients with malignancy.
- Early detection of RLS and associated conditions like DVT is crucial in cancer patients presenting with stroke.
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