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Identifying ischemic stroke associated with cancer: a multiple model derived from a case-control analysis.

Rebecca Kassubek1, Lars Bullinger2, Jan Kassubek3

  • 1Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany. rebecca.kassubek@rku.de.

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Cancer-associated ischemic stroke indicates a worse prognosis. A new algorithm combining imaging and lab markers like C-reactive protein can help identify patients with previously unknown cancer.

Keywords:
C-reactive proteinCancerGranulocytesIschemic strokeLactate dehydrogenaseMagnetic resonance imaging

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Area of Science:

  • Neurology
  • Oncology

Background:

  • Ischemic stroke in cancer patients often has a worse prognosis.
  • Cancer-associated stroke may be the first sign of an unknown malignancy.
  • Diagnostic tools for cancer-associated stroke are lacking.

Purpose of the Study:

  • To develop and validate a diagnostic algorithm for cancer-associated ischemic stroke.
  • To identify clinical and laboratory features distinguishing cancer-associated stroke.

Main Methods:

  • Retrospective analysis of 68 ischemic stroke patients with active solid malignancy.
  • Comparison with 68 age- and sex-matched controls without cancer.
  • Analysis of neurological assessment, risk factors, neuroimaging, and laboratory findings.

Main Results:

  • Cancer-associated strokes presented with more severe deficits, higher rates of deterioration and death.
  • Ischemic lesions frequently involved multiple territories with co-existing acute/subacute infarctions.
  • Elevated C-reactive protein, granulocytosis, and lactate dehydrogenase were observed in cancer patients.

Conclusions:

  • A diagnostic algorithm combining lesion territory, inflammation, and cell turnover markers shows promise.
  • This model achieved 75% sensitivity and 95% specificity in detecting cancer-associated stroke.
  • The findings suggest a potential method to identify stroke patients with previously undiagnosed malignancy.