ArticleFrontiers in neurology
Beyond the coagulopathy phenotype in cancer-associated stroke: routine radiology report-based phenotyping and a practical diagnostic prioritization.
Article in Frontiers in neurology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Cancer-related ischemic stroke is commonly suspected when diffusion-weighted imaging (DWI) shows multi-territory infarction with markedly elevated D-dimer. However, the prevalence and clinical relevance of non-coagulopathy phenotypes in patients with active cancer are not well defined. Methods: We retrospectively studied consecutive ischemic stroke admissions undergoing MRI-DWI at a single center. Active cancer was defined as diagnosis or treatment within 6 months, or metastatic/recurrent disease. Infarct distribution (multi- vs. single-territory) was classified from official routine radiology reports by board-certified radiologists blinded to outcomes. We compared D-dimer across groups defined by cancer status and DWI distribution and examined predictors of multi-territory infarction within the active-cancer cohort using multivariable logistic regression. Results: Among patients with active cancer ( Conclusions: Routine report-based phenotyping indicates that the classic coagulopathy phenotype is a strong marker but represents a minority of strokes with active cancer. When multi-territory infarction accompanies elevated D-dimer, evaluation should prioritize malignancy activity, systemic thrombosis/coagulopathy, and non-bacterial thrombotic endocarditis; otherwise, a mechanism-oriented stroke work-up should be maintained, with attention to cancer treatment- and radiation-related vascular injury.
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