r-n-jРоссийский неврологический журналRussian neurological journal2658-79472686-7192МИА10.30629/2658-7947-2025-30-3-13-22r-n-j-707Research ArticleИССЛЕДОВАНИЯ И КЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCLINICAL RESEARCHES AND CASE REPORTSОсобенности клинических проявлений ишемического инсульта на фоне злокачественных новообразованийFeatures of clinical manifestations of ischemic stroke in cancerАммосоваЛ. В.AmmosovaL. V.

Якутск

Yakutsk

l_v_d@mail.ruhttps://orcid.org/0000-0002-2019-2455ЧугуноваС. А.ChugunovaS. A.

Якутск

Yakutsk

sa.chugunova@mail.ruКривыхС. К.KrivykhS. K.

Якутск

Yakutsk

Sardana_95@mail.ruСеверо-Восточный федеральный университет им. М.К. Аммосова; «Республиканская больница №2 — Центр экстренной медицинской помощи»РоссияM.K. Ammosov North-Eastern Federal University; Republican Hospital №2 — Emergency Medical Care CenterRussian FederationКлиника медицинского института «Северо-Восточный федеральный университет им. М.К. Аммосова»РоссияClinic of the Medical Institute “M.K. Ammosov North-Eastern Federal University”Russian Federation2025080920253031322Copyright © Аммосова Л.В., Чугунова С.А., Кривых С.К., 20252025Аммосова Л.В., Чугунова С.А., Кривых С.К.Ammosova L.V., Chugunova S.A., Krivykh S.K.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.r-n-j.com/jour/article/view/707Введение

Введение. Определение особенностей клинических характеристик ишемического инсульта (ИИ) у онкологических больных сопряжено с трудностями в связи с наличием в патогенезе инсульта как традиционных, так и ассоциированных с раком механизмов. На сегодняшний день отсутствуют четкие диагностические критерии рак-ассоциированного инсульта, который нередко является одним из первых клинических проявлений онкологического процесса.

 Цель исследования

 Цель исследования: изучение особенностей клинических проявлений ишемического инсульта, ассоциированного со злокачественным новообразованием (ЗНО).

 Материал и методы

 Материал и методы. Проведен сравнительный анализ 84 случаев ИИ на фоне сопутствующего ЗНО (основная группа) и 239 случаев ИИ без ЗНО (группа сравнения). У всех пациентов оценивалась тяжесть ИИ по шкале NIHSS, подтип инсульта по TOAST, исход заболевания, локализация и размер очага инфаркта мозга по данным нейровизуализации; наличие геморрагической трансформации. Оценивались показатели коагуляционного гемостаза (международное нормализованное отношение (МНО), активированное частичное тромбопластиновое время (АЧТВ), протромбиновый индекс (ПТИ), фибриноген, количество тромбоцитов) при поступлении в стационар. Катамнез пациентов в основной группе исследовался по данным амбулаторных карт в системе РТМиС, методом телефонного опроса больных и их родственников через 3 месяца и 1 год после перенесенного инсульта.

 Результаты

 Результаты. За период наблюдения госпитализировано 2027 пациентов с ИИ, из них у 84 пациентов (основная группа) был установлен сопутствующий диагноз рака в активной стадии (4,14%). В основной группе у 20 пациентов (23,8%) ЗНО было диагностировано в период госпитализации в Региональный сосудистый центр по поводу ИИ. Наиболее частой локализацией ЗНО был рак толстой кишки (19,04%). Рак легких диагностирован в 13,1%, мочевого пузыря — в 10,7%. По гистологической картине наиболее часто выявлялись аденокарцинома — в 35 случаях (41,6%). Медиана возраста в основной группе составила 69 лет [65;75], в группе сравнения — 65 лет [58;72] (p < 0,001). В основной группе статистически значимо реже, чем в группе сравнения диагностировались атеротромботический (14,3% против 43,1%, p < 0,001) и кардиоэмболический подтипы инсульта (14,3% против 30,5%, p = 0,004). В основной группе чаще диагностировался подтипа ИИ другой установленной этиологии (13,1% против 3,8%, p = 0,003) и неустановленной этиологии по TOAST (47,6% против 8,8%, p < 0,001). В основной группе пациентов статистически значимо чаще диагностировались многоочаговые инфаркты, развившиеся одновременно в обоих каротидных бассейнах (9,5% против 2,5%, p = 0,011; ОШ = 4,09, 95% ДИ: 1,37-12,15). При поступлении пациентов в стационар значения ПТИ были выше в основной группе пациентов по сравнению с группой без ЗНО (102,5 [84,0; 111,0] против 87,7 [72,4; 99,0], p = 0,003). У пациентов с ИИ, которым ЗНО диагностировали в стационаре, отмечались более высокие показатели фибриногена и тромбоцитов (p = 0,022 и p = 0,008). Летальность в основной группе в течение 3 месяцев составила 21,4% (18 пациентов), в течение года — 42,9% (36 пациентов).

 Заключение

 Заключение. Рак-ассоциированная коагулопатия, вероятно, играет ведущую роль в развитии ИИ на фоне злокачественного процесса.

Determination of clinical characteristics of ischemic stroke (IS) in cancer patients is difficult due to the involvement of both traditional and cancer-associated mechanisms in stroke pathogenesis. To date, there are no clear diagnostic criteria for cancer-associated stroke, which is often one of the first clinical manifestations of the oncological process.

 The aim of the study — to research the clinical manifestations of ischemic stroke associated with cancer.

 Material and methods

 Material and methods. A comparative analysis of 84 cases of IS with concomitant cancer (main group) and 239 cases of IS without cancer (comparison group) was performed. All patients were assessed for the severity of IS according to the NIHSS scale, stroke subtype according to TOAST, disease outcome, localization and size of the cerebral infarction territory according to neuroimaging data; presence of hemorrhagic transformation. The parameters of coagulation hemostasis (international normalized ratio (INR), activated partial thromboplastin time (APTT), prothrombin index (PTI), fibrinogen, platelet count) were assessed at the time of admission to the hospital. The follow-up of patients in the main group was studied based on the data from outpatient cards in the RTMIS system, using a telephone survey of patients and their relatives 3 months and 1 year after the stroke.

Results

Results. During the observation period, 2027 patients with ischemic stroke were hospitalized, of which 84 patients (the main group) were diagnosed with active stage cancer (4.14%). In the main group, 20 patients (23.8%) were diagnosed with cancer during hospitalization at the Regional Vascular Center due to ischemic stroke. The most common localization in the study group was colon cancer (19.04%). Lung cancer was diagnosed in 13.1%, bladder cancer — in 10.7%. According to the histological type, adenocarcinomas were most often detected — in 35 cases (41.6%). The median age in the main group was 69 years [65;75], in the comparison group — 65 years [58;72] (p < 0.001). In the main group of diseases, large-artery atherosclerosis (14.3% vs. 43.1%, respectively, p < 0.001) and cardioembolic stroke subtypes (14.3% vs. 30.5%, respectively, p = 0.004) were diagnosed less frequently. In the main group, there was a more frequent diagnosis of the IS subtype of other determined etiology (13.1% vs. 3.8%, respectively; p = 0.003) and of undetermined etiology according to TOAST (47.6% vs. 8.8%, respectively; p < 0.001). In the main group, in patients, compared with the consequence without cancer, multifocal infarctions that developed simultaneously in both carotid basins were more often diagnosed (9.5% vs. 2.5%, respectively, p = 0.011; OR = 4.09, 95% CI: 1.37–12.15). Upon admission to the hospital, the PTI values were higher in the main group of patients compared to patients without cancer (102.5 [84.0; 111.0] versus 87.7 [72.4; 99.0], p = 0.003). In patients with ischemic stroke, who were diagnosed with cancer in the RVC, higher fibrinogen and platelet levels were noted (p = 0.022 and p = 0.008). Mortality within 3 months after the suffered ischemic stroke in the group was 21.4% (18 patients), within a year — 42.9% (36 patients).

Conclusion

Conclusion. Cancer-associated coagulopathy probably plays a leading role in the development of ischemic stroke in cancer.

ишемический инсультзлокачественные новообразованиякоагулопатиягемостазischemic strokecancercoagulopathyhemostasisReferencesDardiotis E, Aloizou AM, Markoula S, Siokas V, Tsarouhas K, Tzanakakis G, Libra M, Kyritsis AP, Brotis AG, Aschner M, Gozes I, Bogdanos DP, Spandidos DA, Mitsias PD, Tsatsakis A. Cancer-associated stroke: Pathophysiology, detection and management (Review). Int J Oncol. 2019;54(3):779–796. https://doi.org/10.3892/ijo.2019.4669Dardiotis E, Aloizou AM, Markoula S, Siokas V, Tsarouhas K, Tzanakakis G, Libra M, Kyritsis AP, Brotis AG, Aschner M, Gozes I, Bogdanos DP, Spandidos DA, Mitsias PD, Tsatsakis A. Cancer-associated stroke: Pathophysiology, detection and management (Review). Int J Oncol. 2019;54(3):779–796. https://doi.org/10.3892/ijo.2019.4669Bang OY, Chung JW, Lee MJ, Seo WK, Kim GM, Ahn MJ. Cancer-Related Stroke: An Emerging Subtype of Ischemic Stroke with Unique Pathomechanisms. J Stroke. 2020;22(1):1–10. https://doi.org/10.5853/jos.2019.02278Bang OY, Chung JW, Lee MJ, Seo WK, Kim GM, Ahn MJ. Cancer-Related Stroke: An Emerging Subtype of Ischemic Stroke with Unique Pathomechanisms. J Stroke. 2020;22(1):1–10. https://doi.org/10.5853/jos.2019.02278Graus F, Rogers LR, Posner JB. Cerebrovascular complications in patients with cancer. Medicine (Baltimore). 1985;64(1):16–35. https://doi.org/10.1097/00005792-198501000-00002Graus F, Rogers LR, Posner JB. Cerebrovascular complications in patients with cancer. Medicine (Baltimore). 1985;64(1):16–35. https://doi.org/10.1097/00005792-198501000-00002Varki A. Trousseau’s syndrome: multiple defi nitions and multiple mechanisms. Blood. 2007;110(6):1723–9. https://doi.org/10.1182/blood-2006-10-053736Varki A. Trousseau’s syndrome: multiple defi nitions and multiple mechanisms. Blood. 2007;110(6):1723–9. https://doi.org/10.1182/blood-2006-10-053736Navi BB, Reiner AS, Kamel H, Iadecola C, Okin PM, Tagawa ST, Panageas KS, DeAngelis LM. Arterial thromboem-bolic events preceding the diagnosis of cancer in older persons. Blood. 2019;133(8):781–789. https://doi.org/10.1182/blood-2018-06-860874Navi BB, Reiner AS, Kamel H, Iadecola C, Okin PM, Tagawa ST, Panageas KS, DeAngelis LM. Arterial thromboem-bolic events preceding the diagnosis of cancer in older persons. Blood. 2019;133(8):781–789. https://doi.org/10.1182/blood-2018-06-860874Taccone FS, Jeangette SM, Blecic SA. First-ever stroke as initial presentation of systemic cancer. J Stroke Cerebrovasc Dis. 2008;17(4):169–74. https://doi.org/10.1016/j.jstrokecerebrovasdis.2008.01.007Taccone FS, Jeangette SM, Blecic SA. First-ever stroke as initial presentation of systemic cancer. J Stroke Cerebrovasc Dis. 2008;17(4):169–74. https://doi.org/10.1016/j.jstrokecerebrovasdis.2008.01.007Lee KP, Huang HC, Tsai JY, Hsu LC. Eff ects of cancer on stroke recurrence and mortality: A single-center retrospective cohort study. eNeurologicalSci. 2023;32:100474. https://doi.org/10.1016/j.ensci.2023.100474Lee KP, Huang HC, Tsai JY, Hsu LC. Eff ects of cancer on stroke recurrence and mortality: A single-center retrospective cohort study. eNeurologicalSci. 2023;32:100474. https://doi.org/10.1016/j.ensci.2023.100474Kim H, Kim JT, Lee JS, Kim BJ, Kang J, Lee KJ, Park JM, Kang K, Lee SJ, Kim JG, Cha JK, Kim DH, Park TH, Lee KB, Lee J, Hong KS, Cho YJ, Park HK, Lee BC, Yu KH, Oh MS, Kim DE, Ryu WS, Choi JC, Kwon JH, Kim WJ, Shin DI, Yum KS, Sohn SI, Hong JH, Lee SH, Park MS, Choi KH, Lee J, Bae HJ. Stroke of Other Determined Etiology: Results From the Nationwide Multicenter Stroke Registry. Stroke. 2022;53(8):2597-2606. https://doi.org/10.1161/strokeaha.121.037582Kim H, Kim JT, Lee JS, Kim BJ, Kang J, Lee KJ, Park JM, Kang K, Lee SJ, Kim JG, Cha JK, Kim DH, Park TH, Lee KB, Lee J, Hong KS, Cho YJ, Park HK, Lee BC, Yu KH, Oh MS, Kim DE, Ryu WS, Choi JC, Kwon JH, Kim WJ, Shin DI, Yum KS, Sohn SI, Hong JH, Lee SH, Park MS, Choi KH, Lee J, Bae HJ. Stroke of Other Determined Etiology: Results From the Nationwide Multicenter Stroke Registry. Stroke. 2022;53(8):2597-2606. https://doi.org/10.1161/strokeaha.121.037582Bao L, Zhang S, Gong X, Cui G. Trousseau Syndrome Related Cerebral Infarction: Clinical Manifestations, Laboratory Findings and Radiological Features. J Stroke Cerebrovasc Dis. 2020;29(9):104891. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104891Bao L, Zhang S, Gong X, Cui G. Trousseau Syndrome Related Cerebral Infarction: Clinical Manifestations, Laboratory Findings and Radiological Features. J Stroke Cerebrovasc Dis. 2020;29(9):104891. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104891Nouh AM, Staff I, Finelli PF. Three Territory Sign: An MRI marker of malignancy-related ischemic stroke (Trousseau syndrome). Neurol Clin Pract. 2019;9(2):124–128. https://doi.org/10.1212/cpj.0000000000000603Nouh AM, Staff I, Finelli PF. Three Territory Sign: An MRI marker of malignancy-related ischemic stroke (Trousseau syndrome). Neurol Clin Pract. 2019;9(2):124–128. https://doi.org/10.1212/cpj.0000000000000603Ling Y, Li Y, Zhang X, Dong L, Wang J. Clinical features of Trousseau’s syndrome with multiple acute ischemic strokes. Neurol Sci. 2022;43(4):2405–2411. https://doi.org/10.1007/s10072-021-05619-yLing Y, Li Y, Zhang X, Dong L, Wang J. Clinical features of Trousseau’s syndrome with multiple acute ischemic strokes. Neurol Sci. 2022;43(4):2405–2411. https://doi.org/10.1007/s10072-021-05619-yGuo L, Wang L, Liu W. Ability of the number of territories involved on DWI-MRI to predict occult systemic malignancy in cryptogenic stroke patients. J Stroke Cerebrovasc Dis. 2020;29(7):104823. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104823Guo L, Wang L, Liu W. Ability of the number of territories involved on DWI-MRI to predict occult systemic malignancy in cryptogenic stroke patients. J Stroke Cerebrovasc Dis. 2020;29(7):104823. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104823Tsushima M, Metoki N, Hagii J, Saito S, Shiroto H, Yasujima M, Kato T, Kudo N, Toyama Y, Yokono Y, Nozaka M, Kawamura Y, Nakata M, Tomita H. D-dimer and C-reactive Protein as Potential Biomarkers for Diagnosis of Trousseau’s Syndrome in Patients with Cerebral Embolism. J Stroke Cerebrovasc Dis. 2020;29(2):104534. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104534Tsushima M, Metoki N, Hagii J, Saito S, Shiroto H, Yasujima M, Kato T, Kudo N, Toyama Y, Yokono Y, Nozaka M, Kawamura Y, Nakata M, Tomita H. D-dimer and C-reactive Protein as Potential Biomarkers for Diagnosis of Trousseau’s Syndrome in Patients with Cerebral Embolism. J Stroke Cerebrovasc Dis. 2020;29(2):104534. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104534Finelli PF, Nouh A. Three-Territory DWI Acute Infarcts: Diagnostic Value in Cancer-Associated Hypercoagulation Stroke (Trousseau Syndrome). AJNR Am J Neuroradiol. 2016;37(11):2033-2036. https://doi.org/10.3174/ajnr.a4846Finelli PF, Nouh A. Three-Territory DWI Acute Infarcts: Diagnostic Value in Cancer-Associated Hypercoagulation Stroke (Trousseau Syndrome). AJNR Am J Neuroradiol. 2016;37(11):2033-2036. https://doi.org/10.3174/ajnr.a4846Wang JY, Zhang GJ, Zhuo SX, Wang K, Hu XP, Zhang H, Qu LD. D-dimer > 2.785 μg/ml and multiple infarcts ≥ 3 vascular territories are two characteristics of identifying cancer-associated ischemic stroke patients. Neurol Res. 2018;40(11):948–954. https://doi.org/10.1080/01616412.2018.1504179Wang JY, Zhang GJ, Zhuo SX, Wang K, Hu XP, Zhang H, Qu LD. D-dimer > 2.785 μg/ml and multiple infarcts ≥ 3 vascular territories are two characteristics of identifying cancer-associated ischemic stroke patients. Neurol Res. 2018;40(11):948–954. https://doi.org/10.1080/01616412.2018.1504179Liu M, Ellis D, Duncan A, Belagaje S, Belair T, Henriquez L, Rangaraju S, Nahab F. The Utility of the Markers of Coagulation and Hemostatic Activation Profi le in the Management of Embolic Strokes of Undetermined Source. J Stroke Cerebrovasc Dis. 2021;30(3):105592. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105592Liu M, Ellis D, Duncan A, Belagaje S, Belair T, Henriquez L, Rangaraju S, Nahab F. The Utility of the Markers of Coagulation and Hemostatic Activation Profi le in the Management of Embolic Strokes of Undetermined Source. J Stroke Cerebrovasc Dis. 2021;30(3):105592. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105592Ellis D, Rangaraju S, Duncan A, Hoskins M, Raza SA, Rahman H, Winningham M, Belagaje S, Bianchi N, Mohamed GA, Obideen M, Sharashidze V, Belair T, Henriquez L, Nahab F. Coagulation markers and echocardiography predict atrial fibrillation, malignancy or recurrent stroke after cryptogenic stroke. Medicine (Baltimore). 2018;97(51):e13830. https://doi.org/10.1097/md.0000000000013830Ellis D, Rangaraju S, Duncan A, Hoskins M, Raza SA, Rahman H, Winningham M, Belagaje S, Bianchi N, Mohamed GA, Obideen M, Sharashidze V, Belair T, Henriquez L, Nahab F. Coagulation markers and echocardiography predict atrial fibrillation, malignancy or recurrent stroke after cryptogenic stroke. Medicine (Baltimore). 2018;97(51):e13830. https://doi.org/10.1097/md.0000000000013830Nahab F, Sharashidze V, Liu M, Rathakrishnan P, El Jamal S, Duncan A, Hoskins M, Marmarchi F, Belagaje S, Bianchi N, Belair T, Henriquez L, Monah K, Rangaraju S. Markers of coagulation and hemostatic activation aid in identifying causes of cryptogenic stroke. Neurology. 2020;94(18):e1892-e1899. https://doi.org/10.1212/wnl.0000000000009365Nahab F, Sharashidze V, Liu M, Rathakrishnan P, El Jamal S, Duncan A, Hoskins M, Marmarchi F, Belagaje S, Bianchi N, Belair T, Henriquez L, Monah K, Rangaraju S. Markers of coagulation and hemostatic activation aid in identifying causes of cryptogenic stroke. Neurology. 2020;94(18):e1892-e1899. https://doi.org/10.1212/wnl.0000000000009365Salazar-Camelo RA, Moreno-Vargas EA, Cardona AF, Bayona-Ortiz HF. Ischemic stroke: A paradoxical manifestation of cancer. Crit Rev Oncol Hematol.2021;157:103181. https://doi.org/10.1016/j.critrevonc.2020.103181Salazar-Camelo RA, Moreno-Vargas EA, Cardona AF, Bayona-Ortiz HF. Ischemic stroke: A paradoxical manifestation of cancer. Crit Rev Oncol Hematol.2021;157:103181. https://doi.org/10.1016/j.critrevonc.2020.103181Costamagna G, Navi BB, Beyeler M, Hottinger AF, Alberio L, Michel P. Ischemic Stroke in Cancer: Mechanisms, Biomarkers, and Implications for Treatment. Semin Thromb Hemost. 2024;50(3):342–359. https://doi.org/10.1055/s-0043-1771270Costamagna G, Navi BB, Beyeler M, Hottinger AF, Alberio L, Michel P. Ischemic Stroke in Cancer: Mechanisms, Biomarkers, and Implications for Treatment. Semin Thromb Hemost. 2024;50(3):342–359. https://doi.org/10.1055/s-0043-1771270Chi X, Zhao R, Pei H, Xing A, Hu S, Chen J, Mao Y, Zheng X. Diff usion-weighted imaging-documented bilateral small embolic stroke involving multiple vascular territories may indicate occult cancer: A retrospective case series and a brief review of the literature. Aging Med (Milton). 2020;3(1):53–59. https://doi.org/10.1002/agm2.12105Chi X, Zhao R, Pei H, Xing A, Hu S, Chen J, Mao Y, Zheng X. Diff usion-weighted imaging-documented bilateral small embolic stroke involving multiple vascular territories may indicate occult cancer: A retrospective case series and a brief review of the literature. Aging Med (Milton). 2020;3(1):53–59. https://doi.org/10.1002/agm2.12105Grazioli S, Paciaroni M, Agnelli G, Acciarresi M, Alberti A, D’Amore C, Caso V, Venti M, Guasti L, Ageno W, Squizzato A. Cancer-associated ischemic stroke: A retrospective multicentre cohort study. Thromb Res. 2018;165:33–37. https://doi.org/10.1016/j.thromres.2018.03.011Grazioli S, Paciaroni M, Agnelli G, Acciarresi M, Alberti A, D’Amore C, Caso V, Venti M, Guasti L, Ageno W, Squizzato A. Cancer-associated ischemic stroke: A retrospective multicentre cohort study. Thromb Res. 2018;165:33–37. https://doi.org/10.1016/j.thromres.2018.03.011Nezu T, Hosomi N, Aoki S, Naito H, Torii T, Kurashige T, Sugiura T, Kuzume D, Morimoto Y, Yoshida T, Yagita Y, Oyama N, Eto F, Shiga Y, Kinoshita N, Kamimura T, Ueno H, Ohshita T, Maruyama H. Short-term or long-term outcomes for stroke patients with cancer according to biological markers. J Neurol Sci. 2022;436:120246. https://doi.org/10.1016/j.jns.2022.120246Nezu T, Hosomi N, Aoki S, Naito H, Torii T, Kurashige T, Sugiura T, Kuzume D, Morimoto Y, Yoshida T, Yagita Y, Oyama N, Eto F, Shiga Y, Kinoshita N, Kamimura T, Ueno H, Ohshita T, Maruyama H. Short-term or long-term outcomes for stroke patients with cancer according to biological markers. J Neurol Sci. 2022;436:120246. https://doi.org/10.1016/j.jns.2022.120246Göcmen J, Steinauer F, Kielkopf M, Branca M, Kurmann CC, Mujanovic A, Clénin L, Silimon N, Boronylo A, Scutelnic A, Meinel T, Kaesmacher J, Bücke P, Seiff ge D, Costamagna G, Michel P, Fischer U, Arnold M, Navi BB, Pabst T, Berger MD, Jung S, Beyeler M. Mortality in acute ischemic stroke patients with new cancer diagnosed during the index hospitalization versus after discharge. J Stroke Cerebrovasc Dis. 2024;33(10):107899. https://doi.org/10.1016/j.jstrokecerebrovasdis.2024.107899Göcmen J, Steinauer F, Kielkopf M, Branca M, Kurmann CC, Mujanovic A, Clénin L, Silimon N, Boronylo A, Scutelnic A, Meinel T, Kaesmacher J, Bücke P, Seiff ge D, Costamagna G, Michel P, Fischer U, Arnold M, Navi BB, Pabst T, Berger MD, Jung S, Beyeler M. Mortality in acute ischemic stroke patients with new cancer diagnosed during the index hospitalization versus after discharge. J Stroke Cerebrovasc Dis. 2024;33(10):107899. https://doi.org/10.1016/j.jstrokecerebrovasdis.2024.107899Lee MJ, Chung JW, Ahn MJ, Kim S, Seok JM, Jang HM, Kim GM, Chung CS, Lee KH, Bang OY. Hypercoagulability and Mortality of Patients with Stroke and Active Cancer: The OASIS-CANCER Study. J Stroke. 2017;19(1):77–87. https://doi.org/10.5853/jos.2016.00570Lee MJ, Chung JW, Ahn MJ, Kim S, Seok JM, Jang HM, Kim GM, Chung CS, Lee KH, Bang OY. Hypercoagulability and Mortality of Patients with Stroke and Active Cancer: The OASIS-CANCER Study. J Stroke. 2017;19(1):77–87. https://doi.org/10.5853/jos.2016.00570

The authors declare that there are no conflicts of interest present.