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Updated: Jul 4, 2026
10:01
Modeling Brain Metastasis by Internal Carotid Artery Injection of Cancer Cells
Published on: August 2, 2022
First-ever stroke as initial presentation of systemic cancer
Fabio Silvio Taccone1, Sandrine M Jeangette, Serge A Blecic
1Neurology Department, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium. ftaccone@ulb.ac.be
Summary
Cerebrovascular disease is a rare initial sign of cancer. In patients with unclear stroke origins or early recurrence, a cancer workup is advised due to poor outcomes associated with cancer-related stroke.
Area of Science:
- Neurology
- Oncology
- Vascular Medicine
Background:
- Stroke is a common complication in cancer patients, affecting nearly 15%.
- Cerebrovascular disease presenting as the initial manifestation of cancer is infrequently reported.
Purpose of the Study:
- To investigate the incidence and characteristics of ischemic stroke as the first presentation of underlying malignancy.
- To identify stroke mechanisms and outcomes in cancer patients.
Main Methods:
- Retrospective review of 5106 ischemic stroke patients admitted between 1991-2004.
- Identification of 24 patients (0.4%) with underlying malignancy.
Main Results:
- The mean age was 52 years, with 62.5% women; only 41% had vascular risk factors.
- Primary stroke mechanisms included nonbacterial thrombotic endocarditis (33%), diffuse intravascular coagulation (25%), and atherosclerosis (21%).
- Most malignancies (lung, breast cancer) were diagnosed at the second ischemic event, with a 79% mortality rate and poor median survival of 58 days.
Conclusions:
- A systemic cancer workup is recommended for patients with unclear stroke etiology or early vascular recurrence.
- Stroke as an initial cancer manifestation is often due to specific cancer-related causes.
- Outcomes are poor, correlating with neurological disability severity and cancer stage.
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