Navi BB, Singer S, Merkler AE, Cheng NT, Stone JB, Kamel HK, et al. Cryptogenic Subtype Predicts Reduced Survival Among Cancer Patients With Ischemic Stroke. Stroke. 2014
It is traumatic to experience a stroke and probably even more to not know what caused it. In about one-third of patients with acute ischemic stroke no clear etiology is found. It is hard to predict the recurrence risk of stroke in such patients particularly as the inciting factor or cause is not known. About 7% of patients with cancer experience a clinically significant stroke. These strokes can break their treatment cycles and often lead to significant disability. The authors in this article attempt to elucidate the frequency of cryptogenic stroke in patients with underlying malignancy as well as their outcomes after a cryptogenic stroke.
Their results indicate that adenocarcinomas of solid organs such as lung, GI or GU tract were most often associated with ischemic stroke and stroke typically occurred about 10 months after cancer diagnosis. 69% of patients had disseminated disease at the time of stroke occurrence and stroke work up was equally comprehensive for the cryptogenic and non-cryptogenic stroke types. 133 of 263 patients were identified to have cryptogenic stroke and 76 of these had a cardioembolic appearing imaging pattern. Median survival among those with cryptogenic stroke was significantly lower (47 days vs. 141 days) as compared to those with known stroke mechanism and even lower in those that appeared cardioembolic (31 days). After adjusting for age, functional status, adenocarcinoma histology and known metastases, cryptogenic stroke type remained and independent predictor of death. (HR 1.64 95% CI (1.25-2.14)).