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Cerebrovascular Complications of Cancer

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Cancer Neurology in Clinical Practice

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Abstract

A wide variety of cerebrovascular disorders can complicate the clinical course of cancer patients and, in rare instances, can be the presenting sign of cancer. Central nervous system (CNS) hemorrhage and ischemic events are typically symptomatic. Hemorrhage can occur into the parenchymal, subdural, epidural, or subarachnoid compartments and usually presents with symptoms typical for those sites. Cerebral infarction may cause focal signs, presenting as a transient ischemic attack (TIA) or infarction, or may cause encephalopathy when there are multiple and progressive small infarctions. The most common mechanisms of cerebrovascular disease in cancer patients are related to the presence of CNS tumor, either primary or metastatic, and coagulopathy. The coagulopathy in many instances is a direct effect of the neoplasm; in other cases it develops from cancer treatment. Cancer treatment can also result in blood vessel injury. Radiation therapy directed to the neck or brain can result in vessel stenosis, thrombosis and other vascular pathologies. Chemotherapy and molecularly-targeted agents can lead to vascular injury or thrombosis resulting in hemorrhage or infarction. Infection is a less common cause of stroke. It is important to identify cerebrovascular disease as the cause of neurologic symptoms in the cancer patient in order to determine appropriate evaluation and treatment. This is usually possible by a careful review of the cancer histology and sites of disease, types of antineoplastic therapy administered, and associated comorbidities. Laboratory studies of coagulation function and CNS imaging techniques are useful in identifying the precise etiology of the cerebrovascular disorder. Prompt diagnosis leads to appropriate therapy that, in certain patients, can improve the quality of life and survival as well as prevent additional vascular episodes.

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Authors and Affiliations

  1. Department of Neurology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA

    Lisa R. Rogers

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  1. Lisa R. Rogers
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Correspondence to Lisa R. Rogers .

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Editors and Affiliations

  1. Harrison Distinguished Teaching, Professor of Neurology, Neurological Surgery, and Medicine, University of Virginia, Charlottesville, Virginia, USA

    David Schiff

  2. Instructor, Harvard Medical School, Massachusetts General Hospital, Department of Neurology/Neuro-Oncology, Boston, Massachusetts, USA

    Isabel Arrillaga

  3. Professor of Neurology, Harvard Medical School, Dana-Farber/Brigham and Women’s Cancer Center, Center for Neuro-Oncology, Boston, Massachusetts, USA

    Patrick Y. Wen

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Rogers, L.R. (2018). Cerebrovascular Complications of Cancer. In: Schiff, D., Arrillaga, I., Wen, P. (eds) Cancer Neurology in Clinical Practice. Springer, Cham. https://doi.org/10.1007/978-3-319-57901-6_10

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