A patient with cancer can develop a stroke. The patient may have a history of cancer, or the stoke may be the first manifestation of an occult malignancy. The underlying factors will help determine the optimum management.
Many patients with cancer are older so share general risk factors for stroke:
(1) older age
(2) atherosclerosis
(3) smoking
For a tumor outside the brain the risk of stroke is high if there is a hypercoagulable state associated with the tumor.
In a primary brain tumor stroke may occur due to:
(1) complications of surgery
(2) complications of radiation (primarily vasculopathy)
Other risk factors:
(1) marantic endocarditis
(2) severe hypotension following surgery or hemorrhage
(3) surgery and/or radiation to the brain for a metastasis
Differential diagnosis:
(1) direct mass effect of a tumor mass in the brain
(2) CNS infection
When evaluating a patient with stroke it is important to look for clinical and laboratory findings of an occult neoplasm.
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