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Association of Acute Incidental Cerebral Microinfarcts With Subsequent Ischemic Stroke in Patients With Cancer: A

Jonathan Naftali1, Rani Barnea1, Avi Leader1

  • 1From the Departments of Neurology (J.N., R.B., K.P., A.T., G.R., E.A.) and Radiology (R.E., V.H.), Rabin Medical Center (T.S.), Petach Tikva; Faculty of Medicine (J.N., R.B., R.E., V.H., G.R., E.A.), Tel Aviv University, Israel; Department of Medicine (A.L.), Hematology Service, Memorial Sloan Kettering Cancer Center, New York City, NY; Departments of Neurology (S.B.) and Community Medicine and Epidemiology (W.S.), Lady Davis Carmel Medical Center, Haifa; and Ruth and Bruce Rappaport Faculty of Medicine (S.B., W.S.), Technion-Israel Institute of Technology, Haifa, Israel.

Neurology
|July 9, 2024
PubMed
Abstract

Insights

Acute incidental cerebral microinfarcts (CMIs) detected on brain MRI in cancer patients signal a higher risk of near-future stroke or TIA and mortality. This finding aids in guiding primary cerebrovascular risk prevention strategies.

Area of Science:

  • Neurology
  • Oncology
  • Radiology

Background:

  • Acute incidental cerebral microinfarcts (CMIs) are common brain ischemia detectable by MRI.
  • CMIs are more prevalent in cancer patients, but their predictive value for stroke is unknown.
  • This study investigates the association between CMIs and subsequent stroke or TIA in cancer patients.

Purpose of the Study:

  • To examine the association between acute incidental CMIs in cancer patients and subsequent ischemic stroke or transient ischemic attack (TIA).

Main Methods:

  • Retrospective cohort study using Israeli health records (Clalit Health Services).
  • Included adults with lung, breast, pancreatic, or colon cancer undergoing brain MRI (2014-2020).
  • Primary outcome: ischemic stroke/TIA; Secondary outcomes: intracranial hemorrhage, mortality. Analyzed using Cox proportional hazards models.

Main Results:

  • 1,618 cancer patients included; 59 (3.6%) had acute incidental CMIs.
  • Patients with CMIs showed a significantly higher risk of stroke/TIA (HR 2.97, p=0.035).
  • CMIs were also associated with increased mortality (HR 2.76, p<0.001), but not intracranial hemorrhage.

Conclusions:

  • Acute incidental CMIs on brain MRI in cancer patients are linked to increased near-future risk of ischemic stroke/TIA and mortality.
  • Detecting incidental CMIs may prompt primary cerebrovascular risk prevention and etiological workup.
  • This highlights the importance of CMI detection in oncological imaging.

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