Screening tools for malignancy in patients with cryptogenic stroke: Systematic review

Area of Science:

• Neurology
• Oncology
• Diagnostic Medicine

Background:

• Cryptogenic ischemic stroke (CIS) is associated with occult malignancies in up to 20% of cases.
• Early cancer detection during stroke evaluation presents a critical clinical opportunity.
• Current international guidelines lack consensus on systematic malignancy screening in CIS patients.

Purpose of the Study:

• To review current evidence on clinical features, scores, and laboratory tests for guiding malignancy screening in CIS patients.
• To propose a decision-making flowchart for malignancy screening in ischemic stroke.
• To highlight the clinical implications and need for evidence-based guidelines for cancer screening in CIS.

Main Methods:

• Systematic literature search of PubMed, MEDLINE, and Cochrane databases.
• Inclusion of 12 studies meeting predefined criteria for review.
• Analysis of clinical features, predictive scores, and laboratory tests for malignancy detection.

Main Results:

• Elevated D-dimer levels and multiple infarcts across different cerebral circulations are key markers for occult malignancy.
• A risk stratification approach using D-dimer cut-offs and stroke patterns on brain imaging is proposed.
• Recommended diagnostic workup targets prevalent cancers like gastrointestinal, lung adenocarcinoma, and gender-related cancers.

Conclusions:

• Malignancy screening in cryptogenic ischemic stroke patients can lead to early cancer diagnosis.
• A structured approach utilizing D-dimer levels and neuroimaging findings can guide the diagnostic workup.
• There is a critical need for evidence-based guidelines to standardize malignancy screening in this patient population.