Analysis Of Clinical And Imaging Features Of Patients With Acute Cerebral Infarction Complicated With Malignant Cancer

Background: The risk of cardiovascular and cerebrovascular events increased in cancer patients,and the patterns and mechanisms underlying stroke in cancer patients differ from those of the conventional etiology.Not all strokes are associated with cancer in cancer patients.Patients with cerebral infarction complicated with malignant cancer often have higher D-dimer value.In this study,we further investigated the characteristics distinguishing cancer-associated ischemic stroke and the relationship of D-dimer value with cancer-associated ischemic stroke.Methods: We conducted a retrospective review of acute ischemic stroke patients with cancer(cancer group,n = 61)who were admitted to the First Affiliated Hospital of Anhui Medical University,China,from January 2012 to May 2016.Acute ischemic stroke patients without cancer were selected consecutively from February 10 to March10 2015 as the control group(n = 76).The clinical features and infarct patterns on MRI diffusion-weighted imaging(DWI)were analyzed.Cerebrovascular distribution was divided into 3 circulations and 23 vascular territories,and acute multiple brain infarcts(AMBIs)were defined as discrete DWI lesions in >1 vascular territory.The lesions of cerebral infarction were divided into 3 types: big,middle and small.The maximum axial diameter for small lesions less than 10 mm;middle lesions:>10 mm and ?30 mm;big lesions >30 mm.Results: Cancer patients had higher average D-dimer and fibrinogen degradation product values,and a lower fibrinogen value,while 54.7% of cancer patients had D-dimer values ?5.0 ?g/ml and 24.5% were normal.Stroke risk factors were fewer in the cancer group.The numbers of infarct-affected vascular territories,AMBIs,and AMBIs in multiple circulations were significantly higher in the cancer group.These features were particularly evident in cancer patients whose D-dimer values were >5.0?g/ml,while those with D-dimer values ?5.0 ?g/ml were similar to controls.The 5.0?g/ml D-dimer cutoff divided CAIS patients more sensitively than grouping by metastatic/non-metastatic or active/inactive cancer.In the patients with acute cerebral infarction as the initial manifestation of occult cancer,the primary cancer of 11patients(84.6%)originated from the digestive system or lung,and 84.6% had cancer metastasis.Eight patients(61.5%)had recurrence of stroke,in which 6 cases occurred within one month.Tumor markers were detected in 12 patients,and 8 patients(66.7%)were positive.Elevated D-dimer and FDP value were observed respectively in 11patients(91.7%)and 10 patients(100%).Acute multiple brain infarctions were observed in 11 patents(84.6%),in which 10 cases(76.9%)located in ?2 cerebral circulations,and 8 cases(61.5%)in both anterior and posterior circulations.The total number of infarct lesions in thirteen patients were 75,in which 74.7% were small,21.3% were medium and 4.0% were large.Conclusions: AMBIs in >2 vascular territories and AMBIs in both the anterior and posterior circulations are imaging characteristics of CAIS.D-dimer >5 ?g/ml is an effective cutoff value and a sensitive index for identifying CAIS patients.In the patients with acute cerebral infarction as the initial manifestation of occult cancer,they have following characteristics: primary cancer mainly locates in the digestive system or lung,and cancer metastasis ratio is very high.The positive rates of elevated D-dimer and FDP values are higher than that of cancer markers.The infarct lesions are more likely to occur in multiple circulations with small size,especially in both the anterior and posterior circulations.