Stroke and cancer

Over the past decades, a large literature was dedicated to the association between stroke and cancer. Interest for the topic should amplify as the co-prevalence for stroke and cancer is expected to increase in the future with aging of the population and improvement of outcomes in large subgroups of cancers.

At time, consistent epidemiological data provide evidence for close relationships between these two leading causes of death and disability worldwide:

five to ten percent of patients with acute stroke present with an active cancer whether or not previously identified [1], and another 3 to 5% receive a new cancer diagnosis during the two years after their ischemic stroke [2];

the short-term risk of both ischemic and hemorrhagic strokes is increased among patients with newly diagnosed solid or hematological cancers [3], [4]. The risk of ischemic stroke was found to be more than two-fold higher in cancer patients than in matched controls [5];

in the subgroup of patients with cryptogenic stroke, the rate of the association reaches 20% [6], [7] and no other cause of stroke is found in patients with active cancer in 40 to 50% of the cases against 20 to 40% in the general population [8];

vestiges of cerebrovascular diseases are found at autopsy in 15% of cancer patients, with half of them having experienced clinical symptoms during their lifetime [9].

The aim of the present paper is to provide some practical clues for neurologists about the stroke and cancer association. The following questions will be considered:

how frequent are the different subtypes of stroke in cancer patients?;

what kind of stroke mechanisms can be favored by active cancer?;

are biomarkers identified that could suggest an occult neoplasia in stroke patients?;

how does cancer influence acute and long-term stroke treatments?;

how does cancer modify outcomes in stroke?

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