Cerebrovascular complications in cancer patients

The clinician should be alert to the possibility of cerebrovascular disease in cancer patients who develop signs of diffuse or focal cerebral dysfunction. The cause of cerebrovascular disease can usually be determined by knowing the primary tumor type, extent of metastatic disease, and type of antineoplastic treatment. Symptomatic infarctions are more common than hemorrhages in patients with carcinoma, and NBTE and cerebral intravascular coagulation are the most common causes of infarction. Brain hemorrhages in patients with carcinoma are usually from hemorrhage into metastatic tumor. Symptomatic hemorrhages are much more common than infarction in patients with leukemia, and hemorrhages may be caused by coagulopathy or central nervous system infiltration. Infarction in leukemia is usually due to septic embolism or intravascular coagulation. By determining the cause of cerebrovascular disease in the cancer patient, the clinician can often recommend appropriate treatment and predict the clinical outcome.