The aim of the present study was to investigate the frequency of having occult malignancy in patients with acute ischemic stroke and their clinical characteristics. We retrospectively enrolled 1,714 consecutive ischemic stroke patients within 7 days of onset. The patients were divided into two groups: the Non-M group had no malignancy, and the M group had malignancy. We compared the clinical characteristics of the two groups. Of 1,714 ischemic stroke patients, 51 patients (3.0%; M group) were newly diagnosed as having malignancy. The M group was significantly older than the Non-M group (p = 0.009). Hemoglobin (Hb) was less and D-dimer was higher in the M group than in the Non-M group (p < 0.001). The patients with both D-dimer ≧1.3 ng/dl and Hb <12.8 g/dl more frequently had occult malignancy than patients without (p = 0.0088).

1.
Graus F, Rogers LR, Posner JB: Cerebrovascular complications in patients with cancer. Medicine 1985;64:16.
2.
Lim SP, Hakim SZ, Schoenhoff DD: Nonbacterial thrombotic endocarditis. Chest 1987;92:176–177.
3.
Markides V, Nihoyannopoulos P: Non-bacterial thrombotic endocarditis. Eur J Echocardiogr 2000;1:291–294.
4.
Blanchard DG, Ross RS, Dittrich HC: Nonbacterial thrombotic endocarditis. Chest 1981;70:867–869.
5.
Naschitz JE, Yeshurun D, Eldar S, Lev LM: Diagnosis of cancer-associated vascular disorders. Cancer 1996;77:1759–1767.
6.
Chaturvedi S, Ansell J, Recht L: Should cerebral ischemic events in cancer patients be considered a manifestation of hypercoagulabity? Stroke 1994;25:1215–1218.
7.
Cestari DM, Weine DM, Panageas KS, Segal AZ, DeAngelis LM: Stroke in patients with cancer: incidence and etiology. Neurology 2004;62:2025.
8.
Yamamoto Y, Georgiadis AL, Chang HM, Caplan LR: Posterior cerebral artery territory infarcts in the New England Medical Center Posterior Circulation Registry. Arch Neurol 1999;56:824–832.
9.
Singhal AB, Topcuoglu MA, Buonanno FS: Acute ischemic stroke patterns in infective and nonbacterial thrombotic endocarditis: a diffusion-weighted magnetic resonance imaging study. Stroke 2002;33:1267–1273.
10.
Goldstein LB, Jones MR, Matchar DB, Edwards LJ, Hoff J, Chilukuri V, Armstrong SB, Horner RD, Bamford J: Improving the reliability of stroke subgroup classification using the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria editorial comment: classifying the mechanisms of ischemic stroke. Stroke 2001;32:1091.
11.
Lopez JA, Fishbein MC, Siegel RJ: Echocardiographic features of nonbacterial thrombotic endocarditis. Am J Cardiol 1987;59:478–480.
12.
Nomura K, Sobue T, Nakatani H, Maehara M, Kiryu Y, Tsukuma H, Doi M: Cancer Statistics in Japan 2005. Tokyo, Foundation for Promotion Cancer Research, 2006.
13.
Holzner B, Kemmler G, Greil R, Kopp M, Zeimet A, Raderer M, Hejna M, Zochbauer S, Krajnik G, Huber H: The impact of hemoglobin levels on fatigue and quality of life in cancer patients. Ann Oncol 2002;13:965–973.
14.
Grogan M, Thomas GM, Melamed I, Wong FLW, Pearcey RG, Joseph PK, Portelance L, Crook J, Jones KD: The importance of hemoglobin levels during radiotherapy for carcinoma of the cervix. Cancer 1999;86:1528–1536.
15.
Lind M, Vernon C, Cruickshank D, Wilkinson P, Littlewood T, Stuart N, Jenkinson C, Grey-Amante P, Doll H, Wild D: The level of haemoglobin in anaemic cancer patients correlates positively with quality of life. Br J Cancer 2002;86:1243.
16.
Cella D, Kallich J, McDermott A, Xu X: The longitudinal relationship of hemoglobin, fatigue and quality of life in anemic cancer patients: results from five randomized clinical trials. Ann Oncol 2004;15:979.
17.
Blackwell K, Haroon Z, Broadwater G, Berry D, Harris L, Iglehart JD, Dewhirst M, Greenberg C: Plasma D-dimer levels in operable breast cancer patients correlate with clinical stage and axillary lymph node status. J Clin Oncol 2000;18:600–608.
18.
Edoute Y, Haim N, Rinkevich D, Brenner B, Reisner SA: Cardiac valvular vegetations in cancer patients: a prospective echocardiographic study of 200 patients. Am J Med 1997;102:252–258.
19.
Cushman M, Folsom AR, Wang L, Aleksic N, Rosamond WD, Tracy RP, Heckbert SR: Fibrin fragment D-dimer and the risk of future venous thrombosis. Blood 2003;101:1243.
20.
ten Wolde M, Kraaijenhagen RA, Prins MH, Buller HR: The clinical usefulness of D-dimer testing in cancer patients with suspected deep venous thrombosis. Arch Intern Med 2002;162:1880–1884.
21.
Schutgens RE, Beckers MM, Haas FJ, Biesma DH: The predictive value of D-dimer measurement for cancer in patients with deep vein thrombosis. Haematologica 2005;90:214.
22.
Iguchi Y, Kimura K, Kobayashi K, Ueno Y, Inoue T: Ischemic stroke with malignancy may often be caused by paradoxical embolism. J Neural Neurosurg Psychiatry 2006;77:1336–1339.
23.
Taccone FS, Jeangette SM, Blecic SA: First-ever stroke as initial presentation of systemic cancer. J Stroke Cerebrovasc Dis 2008;17:169–174.
24.
Rogers L: Cerebrovascular complications in cancer patients. Neurol Clin 2003;21:167–192.
25.
McColl MD, Chalmers EA, Thomas A, Sproul A, Healey C, Rafferty I, McWilliam R, Eunson P: Factor V Leiden, prothrombin 20210G →A and the MTHFR C677T mutations in childhood stroke. Thromb Haemost 1999;81:690–694.
26.
Lalouschek W, Aull S, Serles W, Schnider P, Mannhalter C, Pabinger-Fasching I, Deecke L, Zeiler K: C677T MTHFR mutation and factor V Leiden mutation in patients with TIA/minor stroke: a case-control study. Thromb Res 1999;93:61–69.
27.
Refsum MH, Ueland MP, Nygard MO, Vollset SE: Homocysteine and cardiovascular disease. Ann Rev Med 1998;49:31–62.
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