Cardiovascular Disease and Stroke (M Fink and J Safdieh, Section Editors)

Current Atherosclerosis Reports

, Volume 14, Issue 4, pp 373-381

First online:

Intracranial Hemorrhage in Patients with Cancer

  • Alan J. VelanderAffiliated withDivision of Stroke and Critical Care, Department of Neurology and Neuroscience, New York-Presbyterian Hospital/Columbia and Cornell Medical Centers
  • , Lisa M. DeAngelisAffiliated withDepartment of Neurology, Memorial Sloan-Kettering Cancer Center
  • , Babak B. NaviAffiliated withDivision of Stroke and Critical Care, Department of Neurology and Neuroscience, Weill Cornell Medical College Email author 

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Abstract

Intracranial hemorrhage (ICH) is a common neurological emergency in patients with cancer, typically occurring late in the disease course, although it occasionally heralds the cancer diagnosis. ICH in these patients often occurs from unique mechanisms, especially intratumoral hemorrhage or coagulopathy, whereas hypertensive hemorrhage is rare. Lung, melanoma, breast, and glioblastoma multiforme are the most commonly associated solid tumors, partly because of their ubiquity and frequent brain involvement, whereas leukemia is the most commonly associated hematological cancer. Patients typically present with focal neurological deficits, headache, and encephalopathy, and their initial diagnostic evaluation and management should follow standard guidelines, although steroids and/or surgical resection should be strongly considered in those with intratumoral hemorrhage. Short-term outcomes are comparable to ICH in the community, whereas long-term outcomes are generally poor, corresponding to the prognosis of the underlying cancer. This review focuses on the recent advances and special considerations in cancer-related intracranial hemorrhage.

Keywords

Cancer Malignancy Neoplasm Intracranial hemorrhage Hemorrhagic stroke Intracerebral hemorrhage Subarachnoid hemorrhage