CRYPTOGENIC EMBOLIC STROKE AND CANCER

JOAQUIN CARNEADO-RUIZ^1,2,3*

• ¹Puerta de Hierro University Hospital Majadahonda, Madrid, Spain
• ²Instituto de Investigación Sanitaria Puerta de Hierro - Segovia de Arana, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
• ³Autonomous University of Madrid, Madrid, Madrid, Spain

Oncologic disease and cerebrovascular diseases are among the diseases with the highest incidence and which cause the greatest disability and mortality. The connection relationship between cancer and cerebrovascular disease has been the subject of studyied for decades and remainscontinue to be a challenge. Stroke, in relation to oncologic diseasesdisease, hashave particularities in itstheir diagnosis and treatment. Cancer is an established risk factor for ischemic stroke. The highest risk occurs in the first 6 months after cancer diagnosis and in patients with metastases. Between 2% and 10% of patients with cryptogenic stroke are diagnosed with cancer within 1a year of diagnosis. The mechanism underlying cryptogenic ischemic stroke related toassociated with oncologic disease is acquired hypercoagulability, which is the most frequent mechanism of underlying stroke in patients with cancercancer patients. Sometimes, cancer presentation occurs through non-bacterial thrombotic endocarditis with cerebral infarction is the form of presentation of cancer. Strokes are usually more severe, , theirits clinical presentation can be focal or multifocal, and D-dimer levels areis significantly elevated in patients with cancer-associated strokestroke. Magnetic resonance imagingRI [A1] neuroimaging usually showsshow embolic lesions in several arterial territories, in both carotid territories and in the vertebrobasilar territory. They present a higher risk of recurrence, recurrence of thromboembolism, early neurological deterioration, and mortality. PatientsPatient with stroke and cancer should be considered forin applying thrombolysis (recombinant tissue plasminogen activator or tenecteplase) and endovascular treatment. Low- molecular- weight heparin [A2] is usually used empirically when a hypercoagulable state is suspected, and the few studies we have supportedsupport the use of direct oral anticoagulants as an option with similar efficacy. TheOur objective ofwith this review wasis to synthesize all the relevant information we haveavailable to date on neoplasia as a cause of cryptogenic embolic stroke and to offer a useful informationwork for daily clinical practice. [A1]Abbreviations should be avoided for terms mentioned only once in the abstract. [A2]Here, “Low-molecular-weight” is the compound adjective for “heparin,” and therefore should be hyphenated for clarity.