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Abstract(s)
O AVC e as neoplasias fazem parte das principais causas de morte e incapacidade em
Portugal e no mundo. Ao longo dos últimos anos, a comunidade científica tem vindo a
debruçar-se mais sobre a possibilidade de uma relação entre estas duas patologias,
nomeadamente da existência do AVC associado a neoplasia como um subtipo importante
de AVC.
Assim, o objetivo deste trabalho é alertar a comunidade médica para esta relação,
identificando a frequência desta patologia e explorando os mecanismos pela qual se
desenvolve. Além disso, pretende-se identificar o perfil clínico mais comum nestes
doentes, bem como indicar as melhores abordagens diagnósticas e terapêuticas, à luz do
conhecimento atual.
Com recurso à base de dados MedLine, foram selecionados os artigos em língua inglesa,
com base no seu fator de impacto e na pertinência para a temática em estudo.
Concluiu-se que o AVC associado a neoplasia, apesar de não ser tão frequente como
outros tipos de AVC, também não é raro. O tipo de AVC mais frequente é o isquémico e
a hipercoagulabilidade mediada pelo cancro é a principal causa para o desenvolvimento
desta patologia. O perfil clínico mais comum é de etiologia embólica, com défice focal
máximo inicial e padrão imagiológico de lesões múltiplas em vários territórios arteriais.
Por ser um tipo de AVC tão heterogéneo, não existem normas que possam guiar o
diagnóstico, contudo deve pensar-se num cancro oculto como causa de AVC em doentes
que, após excluídas as causas mais comuns de AVC, apresentem perfil clínico e
imagiológico embólico, associado a aumento dos níveis de D-dímeros e marcadores
inflamatórios, sem outras causas que os justifique. Nestes doentes, o tratamento do
cancro é fundamental, sendo que a anticoagulação possui também efeitos benéficos na
sobrevida destes pacientes.
Stroke and cancer are two of the main causes of death and disability in Portugal and worldwide. In the last decades, scientific community has been more focused on the possible association between these two pathologies, particularly the possibility of cancer associated stroke as an important subtype of stroke. This work aims to identify the frequency of cancer associated stroke and explore the mechanisms by which it develops, alerting medical professionals to this association. In addition, it is intended to identify the most common clinical profile in these patients as well as indicate the best diagnostic and therapeutic approaches, based on current knowledge. Using the Medline database, articles in English were selected based on their impact factor and relevance to the subject under study. It is concluded that cancer associated stroke is not frequent but not rare either. The most common type of stroke is ischemic, and cancer mediated hypercoagulability is the main cause for the development of this pathology. The most common clinical profile is embolic with an initial maximum focal deficit and imaging pattern of multiple lesions in more than one arterial territory. Because it is such a heterogeneous type of stroke, there are no guidelines that can help with the diagnosis, however occult cancer should be considered as the cause of stroke in patients who after excluding the most common causes of stroke, present with an embolic clinical and imaging profile associated with increased levels of D-dimers and inflammatory markers, without any other causes that justify them. In cancer associated stroke, cancer treatment is essential and anticoagulation also has beneficial effects in improving these patients survival.
Stroke and cancer are two of the main causes of death and disability in Portugal and worldwide. In the last decades, scientific community has been more focused on the possible association between these two pathologies, particularly the possibility of cancer associated stroke as an important subtype of stroke. This work aims to identify the frequency of cancer associated stroke and explore the mechanisms by which it develops, alerting medical professionals to this association. In addition, it is intended to identify the most common clinical profile in these patients as well as indicate the best diagnostic and therapeutic approaches, based on current knowledge. Using the Medline database, articles in English were selected based on their impact factor and relevance to the subject under study. It is concluded that cancer associated stroke is not frequent but not rare either. The most common type of stroke is ischemic, and cancer mediated hypercoagulability is the main cause for the development of this pathology. The most common clinical profile is embolic with an initial maximum focal deficit and imaging pattern of multiple lesions in more than one arterial territory. Because it is such a heterogeneous type of stroke, there are no guidelines that can help with the diagnosis, however occult cancer should be considered as the cause of stroke in patients who after excluding the most common causes of stroke, present with an embolic clinical and imaging profile associated with increased levels of D-dimers and inflammatory markers, without any other causes that justify them. In cancer associated stroke, cancer treatment is essential and anticoagulation also has beneficial effects in improving these patients survival.
Description
Keywords
Acidente Vascular Cerebral Avc Cancro Neoplasia