Ischemic stroke in patients with primary brain tumors

Background: Primary brain tumor patients are at increased risk for stroke from disease and treatment-specific mechanisms. Methods: We conducted a retrospective review of patients with primary brain tumors diagnosed with MRI-confirmed ischemic stroke between 1996 and 2006. Data were collected including risk factors, diagnostic workup, and treatment for stroke. Modified Rankin Scale (MRS) scores at stroke diagnosis were determined, and stroke etiology was assigned using Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria for nonpostoperative strokes. Results: Sixty-eight cases of confirmed ischemic stroke in 66 patients (56% men) were analyzed. The median age at time of stroke was 60 years. The distribution of stroke risk factors was comparable to the general stroke population. The most common brain tumors were gliomas, 60%; meningiomas, 25%; and primary CNS lymphoma, 6%. Stroke was the initial clinical diagnosis in only 43% of cases. The distribution of stroke etiology was operative complication, 49%; cardioembolic, 12%; small vessel lacune, 12%; large vessel, 6%; other, 15%; and undetermined, 7%. Seventeen patients (25%) had strokes related to delayed effects of radiation. The median latency from radiation to stroke diagnosis was 3.2 years. Therapy for secondary prevention of stroke was added in one-half of patients. Median survival from the time of stroke was 1.7 years and was correlated with MRS scores. Conclusions: Treatment complications from surgery and radiotherapy account for the majority of ischemic strokes in patients with primary brain tumors. Stroke is often a missed diagnosis that can contribute additional neurologic disability in an already susceptible patient population.