Journal of Neurology

, Volume 263, Issue 1, pp 150–156 | Cite as

Poor short-term outcome in patients with ischaemic stroke and active cancer

  • Markus Kneihsl
  • Christian Enzinger
  • Gerit Wünsch
  • Michael Khalil
  • Valeriu Culea
  • Tadeja Urbanic-Purkart
  • Franz Payer
  • Kurt Niederkorn
  • Franz Fazekas
  • Thomas GattringerEmail author
Original Communication


Stroke risk is increased in cancer patients and cancer activity has been claimed to play a role in the development of ischaemic stroke (IS). We wanted to further test these assumptions and to explore the impact of such relation on short-term prognosis. We identified all IS patients that were admitted to the neurological department of our primary and tertiary care university hospital between 2008 and 2014 (n = 4918) and reviewed their medical records for an additional diagnosis of cancer. Cancer patients were categorized into those with “active cancer” (AC: recurrent malignant tumour, metastases, ongoing chemo-/radiotherapy) and “non-active cancer” (NAC). We compared demographic, clinical and neuroimaging features of both patient groups and assessed their association with in-hospital mortality. 300 IS patients with known cancer were identified (AC: n = 73; NAC: n = 227). IS patients with AC were significantly younger (70.3 ± 10.6 vs. 74.9 ± 9.9 years), had more severe strokes at admission (NIHSS: median 5 vs. 3), more frequently cryptogenic strokes (50.7 vs. 32.5 %) and more often infarcts in multiple vascular territories of the brain (26 vs. 5.2 %) compared to IS patients with NAC. In-hospital mortality was significantly higher in AC patients (21.9 vs. 6.2 %). Multivariate analysis identified AC (odds ratio [OR] 3.70, 95 % confidence interval [CI] 1.50–9.30), NIHSS at admission (OR 1.10, CI 1.10–1.20) and C-reactive protein level (OR 1.01, CI 1.00–1.02) as factors significantly and independently associated with in-hospital death. Our findings support a direct role of AC in the pathogenesis and prognosis of acute IS. This needs to be considered in the management and counselling of such patients.


Clinical neurology Ischaemic stroke Cancer Outcome 


Compliance with ethical standards

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest. The authors have nothing to disclose relating to the subject matter of this article.


This work receives no specific funding.

Ethical Standards

The study was approved by the hospital institutional review board and the ethics committee of the Medical University of Graz.


  1. 1.
    World health organization. Changing history. World health report 2004, pp 120–125Google Scholar
  2. 2.
    Zöller B, Ji J, Sundquist J, Sundquist K (2012) Risk of haemorrhagic and ischaemic stroke in patients with cancer: a nationwide follow-up study from Sweden. Eur J Cancer 48:1875–1883CrossRefPubMedGoogle Scholar
  3. 3.
    Grisold W, Oberndorfer S, Struhal W (2009) Stroke and cancer: a review. Acta Neurol Scand 119:1–16CrossRefPubMedGoogle Scholar
  4. 4.
    Cestari DM, Weine DM, Panageas KS, Segal AZ, DeAngelis LM (2004) Stroke in patients with cancer: incidence and aetiology. Neurology 64:2025–2030CrossRefGoogle Scholar
  5. 5.
    Zhang YY, Cordato D, Shen Q, Sheng AZ, Hung WT, Chan DK (2007) Risk factor, pattern, etiology and outcome in ischemic stroke patients with cancer: a nested case-control study. Cerebrovasc Dis 23:181–187CrossRefPubMedGoogle Scholar
  6. 6.
    Kim K, Lee JH (2014) Risk factors and biomarkers of ischemic stroke in cancer patients. J Stroke 16:91–96PubMedCentralCrossRefPubMedGoogle Scholar
  7. 7.
    Schwarzbach CJ, Schaefer A, Ebert A et al (2012) Stroke and cancer: the importance of cancer-associated hypercoagulation as a possible stroke etiology. Stroke 43:3029–3034CrossRefPubMedGoogle Scholar
  8. 8.
    Karlińska AG, Gromadzka G, Karliński MA, Członkowska A (2015) The activity of malignancy may determine stroke pattern in cancer patients. J Stroke Cerebrovasc Dis 24(2):348–353CrossRefGoogle Scholar
  9. 9.
    Kim SG, Hong JM, Kim HY et al (2010) Ischemic stroke in cancer patients with and without conventional mechanisms: a multicenter study in Korea. Stroke 41:798–801CrossRefPubMedGoogle Scholar
  10. 10.
    Navi BB, Singer S, Merkler AE et al (2014) Cryptogenic subtype predicts reduced survival among cancer patients with ischemic stroke. Stroke 45:2292–2297PubMedCentralCrossRefPubMedGoogle Scholar
  11. 11.
    Lee EJ, Nah HW, Kwon JY, Kang DW, Kwon SU, Kim JS (2014) Ischemic stroke in patients with cancer: is it different from usual stroke. Int J Stroke 9:406–412CrossRefPubMedGoogle Scholar
  12. 12.
    Aarnio K, Joensuu H, Haapaniemi E et al (2015) Cancer in young adults with ischemic stroke. Stroke 46:1601–1606. doi: 10.1161/STROKEAHA.115.008694 CrossRefPubMedGoogle Scholar
  13. 13.
    Lee AY, Levine MN, Prins M et al (2003) Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 349(2):146–153CrossRefPubMedGoogle Scholar
  14. 14.
    Goldstein L, Samsa G (1997) Reliability of the national institutes of health stroke scale. Stroke 28:307–310CrossRefPubMedGoogle Scholar
  15. 15.
    Adams HP, Bendixen BH, Kappelle LJ et al (1993) Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in acute stroke treatment. Stroke 24:35–41CrossRefPubMedGoogle Scholar
  16. 16.
    Rolfs A, Fazekas F, Grittner U et al (2013) Acute cerebrovascular disease in the young: the stroke in young fabry patients study. Stroke 44(2):340–349CrossRefPubMedGoogle Scholar
  17. 17.
    Rodriguez-Yanez M, Castillo J (2008) Role of inflammatory markers in brain ischemia. Curr Opin Neurol 21:353–357CrossRefPubMedGoogle Scholar
  18. 18.
    Coussens LM, Werb Z (2002) Inflammation and cancer. Nature 420:860–867PubMedCentralCrossRefPubMedGoogle Scholar
  19. 19.
    Navi BB, Reiner AS, Kamel H et al (2015) Association between incident cancer and subsequent stroke. Ann Neurol 77(2):291–300CrossRefPubMedGoogle Scholar
  20. 20.
    Iodice S, Gandini S, Löhr M, Lowenfels AB, Maisonneuve P (2008) Venous thromboembolic events and organ-specific occult cancers: a review and meta-analysis. J Thromb Haemost 6(5):781–788CrossRefPubMedGoogle Scholar
  21. 21.
    Wahrenbrock M, Borsig L, Le D, Varki N, Varki A (2003) Selectin-mucin interactions as a probable molecular explanation for the association of Trousseau syndrome with mucinous adenocarcinomas. J Clin Investig 112(6):853–862PubMedCentralCrossRefPubMedGoogle Scholar
  22. 22.
    Kang DW, Chalela JA, Ezzeddine MA, Warach S (2003) Association of ischemic lesion patterns on early diffusion-weighted imaging with TOAST stroke subtypes. Arch Neurol 60:1730–1734CrossRefPubMedGoogle Scholar
  23. 23.
    Edoute Y, Haim N, Rinkevich D, Brenner B, Reisner SA (1997) Cardiac valvular vegetations in cancer patients: a prospective echocardiographic study of 200 patients. Am J Med 102(3):252–258CrossRefPubMedGoogle Scholar
  24. 24.
    Gattringer T, Ferrari J, Knoflach M et al (2014) Sex-related differences of acute stroke unit care: results from the Austrian stroke unit registry. Stroke 45(6):1632–1638CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Markus Kneihsl
    • 1
  • Christian Enzinger
    • 1
    • 2
  • Gerit Wünsch
    • 3
  • Michael Khalil
    • 1
  • Valeriu Culea
    • 1
  • Tadeja Urbanic-Purkart
    • 1
  • Franz Payer
    • 1
  • Kurt Niederkorn
    • 1
  • Franz Fazekas
    • 1
  • Thomas Gattringer
    • 1
    Email author
  1. 1.Department of NeurologyMedical University of GrazGrazAustria
  2. 2.Division of Neuroradiology, Department of RadiologyMedical University of GrazGrazAustria
  3. 3.Institute for Medical Informatics, Statistics and DocumentationMedical University of GrazGrazAustria

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