Cancer-Associated Stroke: The Bergen NORSTROKE Study

Area of Science:

• Neurology
• Oncology
• Hematology

Background:

• Malignancy can precipitate ischemic stroke through various mechanisms, including coagulation cascade alterations and inflammatory responses.
• Tumor-secreted factors and associated infections can create a prothrombotic state, increasing stroke risk.

Purpose of the Study:

• To determine the incidence of cancer in patients with recent ischemic stroke.
• To identify potential associations between stroke and specific cancer subtypes.

Main Methods:

• Utilized data from the Norwegian Stroke Research Registry (NORSTROKE) for ischemic stroke patients.
• Collected blood samples on admission and analyzed stroke etiology using Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria.
• Obtained cancer diagnosis information from patient records and The Cancer Registry of Norway.

Main Results:

• Cancer was diagnosed in 4.3% of 1,282 ischemic stroke patients without prior cancer history.
• The median time to cancer diagnosis post-stroke was 14 months; 41.8% were diagnosed within one year.
• Lung cancer was the most frequent type (19.0%). Elevated D-dimer, older age, and smoking were associated with post-stroke cancer.

Conclusions:

• Cancer-associated stroke is uncommon, and routine cancer screening in acute ischemic stroke patients is generally not recommended.
• Consider underlying malignancy in stroke patients presenting with elevated blood coagulation factors, C-reactive protein, advanced age, or smoking history.
• An unknown stroke etiology does not reliably predict the presence of malignancy.