ISSN: 1755-5310 (Electronic)1755-5302 (Print)

Interventional Cardiology

Cerebrovascular Disease Scholarly Peer-review Journal

 Cerebrovascular disease is a crucial explanation for neurologic morbidity and mortality in patients with cancer, and its presence must be considered in any cancer patient who experiences cerebral symptoms. It is the second most common cause of pathologically definable central nervous system & disease found in cancer patients at autopsy and is often symptomatic. An autopsy study from the Memorial Sloan-Kettering Cancer Center identified cerebrovascular disease in 500 (14.6%) of 3426 cancer patients at autopsy (Graus et al., 1985). Of those patients in whom cerebrovascular disease was identified, 51% had experienced clinical symptoms associated with the disease. Identifying cerebrovascular disease within the cancer patient is vital because identification and treatment of the disorder can sometimes ameliorate neurologic symptoms and stop subsequent episodes. Even when a stroke occurs in the setting of advanced cancer, treatment can improve the patient’s quality of life. If a stroke occurs when cancer is limited, failure to identify and treat the cerebrovascular disease underlying the stroke may doom an otherwise successful outcome of the cancer treatment. In a small percentage of patients, stroke is the presenting sign of cancer, and identification of cerebrovascular disease in this subset may lead to the diagnosis of cancer. Identifying cerebrovascular disease in the patient with cancer presents a challenge to the clinician, as the pathogenesis is often unique to this group of patients. In cancer patients, the common risk factors for stroke, such as systemic and cerebral atherosclerosis, hypertension, and advanced age, are overshadowed by the pathophysiologic effects of cancer and its treatment. Coagulation disorders, toxicity of antineoplastic treatment, and direct effects of cerebral tumor are the most common causes of stroke in this group. Neuroimaging studies are helpful in identifying the type and location of stroke, but the most important clues to its etiology in cancer patients are the type and extent of systemic cancer, the presence of CNS metastasis, and the type of antineoplastic therapy. This chapter reviews the bleeding and cerebral infarction syndromes that occur in cancer patients, with emphasis on the clinical settings during which they occur and current methods of diagnosis and treatment.  

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