Cerebrovascular complications of cancer

Introduction
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By Jai Grewal MD and Harpreet K Grewal MD

Cerebrovascular disease (sinus thrombosis, cerebral infarction, or hemorrhage) is a common complication of cancer and of cancer therapy. In this clinical article, Drs. Jai Grewal and Harpreet Grewal review the clinical milieu in which these disorders develop and summarize the methods of diagnosis, including characteristic abnormalities of clinical findings, coagulation function tests, and neuroimaging. The management of these vascular disorders can be challenging in this patient population because of comorbidities associated with cancer. Some vascular disorders are unique to the cancer patient, including radiation-induced carotid artery atherosclerosis and chemotherapy-induced vasculopathy. Until recently, reports of these latter conditions were anecdotal and infrequent. In recent years, large-scale studies have provided the first index of the frequency of these complications, particularly in lymphoma and breast cancer patients.

Key points

  • Cancer is a hypercoagulable state leading to an increased risk of venous and arterial thromboembolic events.
  • Cancer therapies such as radiation and chemotherapy have a range of adverse effects upon the CNS vasculature.
  • Patients with cancer are also at risk for intracranial hemorrhage from a variety of factors including thrombocytopenia, coagulopathy, and hemorrhagic brain metastases.

In This Article

Introduction
Historical note and nomenclature
Clinical manifestations
Clinical vignette
Etiology
Pathogenesis and pathophysiology
Epidemiology
Prevention
Differential diagnosis
Diagnostic workup
Prognosis and complications
Management
References cited
Contributors