Objective: Ischemic stroke with occult cancer is a relatively rare but a significant complication in clinical practice. The aim of this study is to clarify the characteristics of cryptogenic stroke patients with occult cancer.
Methods: Between January 2006 and February 2015, 1191 patients with acute ischemic stroke were extracted from a prospectively collected stroke database of Osaka University Hospital. Among them, 165(14%) patients, including 108 patients without diagnosed cancer and 57 patients with active caner at the time of ischemic stroke onset, were diagnosed with cryptogenic stroke etiology. We compared the clinical characteristics between cryptogenic stroke patients with occult cancer and without cancer. All data are expressed as median and interquartile ranges or counts and percentages.
Results: Among 108 patients without diagnosed cancer in cryptogenic stroke etiology, there were 11 patients with occult cancer and 97 patients without cancer. Compared with the cryptogenic stroke patients without cancer, those patients with occult cancer had lower body mass index (18.4 [16.5-20.4] vs 22.9 [20.3-25.6] kg/m2, p < 0.001), lower serum albumin (3.3 [2.4-3.5] vs 4.0 [3.7-4.2] g/dl, p < 0.001), higher plasma D-dimer levels (5.89 [0.80-12.55] vs 0.48 [0.27-0.93] μg/ml, p < 0.0001) and C-reactive protein (0.51 [0.13-6.22] vs 0.13 [0.04-0.34] mg/dl, p = 0.01), and more multiple vascular lesions (73% vs 14%, p < 0.0001). Five patients (45%) presented with distal metastases at diagnosis.
Conclusion: Cryptogenic stroke patients with occult cancer have lower nutritional status, higher plasma D-dimer levels, and more multiple vascular lesion patterns. In patients with cryptogenic stroke having such characteristics, a detailed examination is needed to check for the presence of cancer.