Cancer-related cryptogenic stroke involving the bilateral anterior and the posterior circulations: Diagnostic value of clinical and imaging characteristics

Frontiers in Neurology, 2022 · DOI: 10.3389/fneur.2022.1032984 · Published: December 12, 2022

Simple Explanation

This study investigates cancer-related cryptogenic stroke (CCS), a type of stroke where the cause is unknown and linked to cancer, affecting multiple brain regions. It aims to identify clinical and imaging features that can help diagnose CCS earlier. The study compared patients with CCS to those with cryptogenic stroke from other causes, focusing on blood markers and brain imaging patterns to find unique characteristics of CCS. The results suggest that certain blood test results (like D-dimer and FDP levels) and specific patterns on brain scans are more common in CCS patients and can be used as indicators for earlier diagnosis.

Study Duration

May 2017 to November 2021

Participants

12,580 patients with acute ischemic stroke, with 148 patients with cryptogenic stroke involving three circulations

Evidence Level

Not specified

Key Findings

1
Patients with cancer-related cryptogenic stroke (CCS) exhibited significantly higher levels of D-dimer, fibrin degradation product (FDP), international normalized ratio (INR), neutrophil to lymphocyte ratio (NLR), and platelets to lymphocyte ratio (PLR) compared to non-cancer cryptogenic stroke patients.
2
CCS patients also showed more frequent multiple lesions in three circulations (affecting both anterior and posterior brain regions) compared to non-cancer patients.
3
Combining D-dimer, FDP, INR, NLR, PLR, and multiple lesions in three circulations improved the predictive power for diagnosing cancer-related cryptogenic stroke.

Research Summary

This study analyzed clinical and imaging features of patients with cancer-related cryptogenic stroke (CCS) involving multiple brain circulations, aiming to improve early diagnosis. The research identified unique clinical characteristics in CCS patients, including higher D-dimer, FDP, INR, NLR, PLR, and more frequent multiple lesions in three circulations. The conclusion emphasizes that these diagnostic indicators can help identify CCS earlier, potentially improving patient outcomes.

Practical Implications

Early CCS Identification

The identified diagnostic indicators can help clinicians identify CCS earlier, leading to quicker interventions.

Personalized Treatment Strategies

Understanding the unique clinical and imaging features of CCS can help tailor treatment strategies for these patients.

Risk Stratification

The study's findings can aid in risk stratification for stroke patients, particularly those with cryptogenic stroke, to assess the likelihood of underlying cancer.

Study Limitations

1
Retrospective analysis with a relatively small sample size, which might lead to selection bias.
2
Patients with cryptogenic stroke involving a single circulations were not included in this study.
3
The mechanism of cancer-related hypercoagulable state was not fully understood, and there were large diﬀerences between individual cancer patients.

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