Mechanism and Outcome of Acute Ischemic Stroke in Cancer Patients
Condition: Ischemic Stroke; Cancer
MeSH terms: Stroke; Ischemic Stroke; Cerebral Infarction; Ischemia
Study type: Observational

Summary: 
      Stroke is a part of circulatory diseases which are the primary cause of death in Egypt. It
      accounts 14% of all deaths thus ranks the 2nd after ischemic heart disease. Cancer accounts
      9% of population mortality in Egypt. Nearly 108,600 Egyptians newly diagnosed with cancer
      each year. The interrelationship between stroke and cancer is complex. Cancer may directly or
      indirectly lead to stroke via: hypercoagulability, nonbacterial thrombotic endocarditis
      (NBTE), direct tumor compression of blood vessels or treatment-related effects which
      potentiate stroke.

      The risk of ischemic stroke after chemotherapy is largely increased by the use of certain
      types of chemotherapy not only by cancer histologic type. Brain infarction usually a
      subsequent complication appears sometimes shortly after chemotherapy. Chronic radiation
      vasculopathy that affects medium and large intra- and extra-cranial arteries is characterized
      by increasing rates of hemodynamic significant stenosis with time after radiotherapy.

      The study aims to clarify the relation between cancer and its treatment with ischemic stroke
      by discussing the different mechanisms by which a vascular insult happen causing neurological
      deficit. The study provides more information about cancer patients with higher risk to
      develop ischemic stroke more than other patients by identifying co morbidities and dosage of
      cancer treatment that causes cerebrovascular insults.
    

Detailed description: 
      -  Retrospective study was conducted on patients diagnosed with cancer receiving
           chemotherapy or radiotherapy to evaluate the relation between cancer or cancer therapies
           and ischemic stroke development.

        -  Patients had been recruited from the oncology center, nuclear medicine department and
           neurology department in Mansoura University and private centers.

      After obtaining informed consent, patients are subjected to the following:

        1. Detailed History taking of previous cerebrovascular insults and cancer diagnosis onset
           and therapies.

        2. Determination of major cerebrovascular risk factors as :

             -  Hypertension: which is diagnosed when a patient had received antihypertensive
                treatment or when hypertension is diagnosed during the hospital stay by repeated
                detection of blood pressure of 140/90 mm Hg .

             -  Diabetes mellitus (DM): diagnosis based on history of DM with or without current
                treatment or random blood glucose is 200mg/dl or higher.

             -  Hypercholesterolemia: diagnosis based on history of hypercholesterolemia with
                current treatment or serum cholesterol level >220mg/dl.

             -  Smoking: is coded when the patient is a current smoker or an ex-smoker within 5
                years.

             -  Cardiac abnormality

        3. Physical and neurological examination.

        4. Investigations:

             -  Laboratory investigations as complete blood count, lipid profile, coagulation
                profile, CRP , D dimer .

             -  Radiological investigations: MRI brain to detect vascular abnormalities that may be
                associated with cancer such as: lacunar infarction , white matter changes and
                microbleeds.

        5. For all patients in the prospective group the duration and type of chemotherapy, dose of
           radiotherapy was recorded.
    

Intervention name(s): Risk factors
Intervention type(s): Other
Intervention description(s): Risk factors: modifiable and unmodifiable risk factors
Observational model: Case-Control
Time perspective: Retrospective
Sampling method: Probability Sample
Study population: 
        -  Retrospective study was conducted on patients diagnosed with cancer receiving
             chemotherapy or radiotherapy to evaluate the relation between cancer or cancer
             therapies and ischemic stroke development.

          -  Patients had been recruited from the oncology center, nuclear medicine department and
             neurology department in Mansoura University and private centers.
      
Keywords: Ischemic Stroke, Cancer