Highlights
- •The association of SCI with cancer is infrequent but its recognition is clinically relevant.
- •Cancer-associated SCI affects mainly to men in the seventh decade.
- •The most frequent neoplasm associated to SCI is intravascular large B-cell lymphoma.
- •Up to 83% of the patients die in the first year after the diagnosis.
- •Age, CVRF or previously known cancer are not statistically associated with a higher mortality.
Abstract
Objective
The association between spinal cord infarction (SCI) and cancer is an infrequent condition
but requires an accurate diagnosis to establish the appropriate treatment. Clinical
features and prognosis of cancer-associated SCI have never been assessed. The aim
of this systematic review is to describe the characteristics and outcomes of patients
with cancer-associated SCI. Illustratively, a case of ovarian cancer-related SCI is
presented.
Material and methods
Two authors independently analysed three different bibliographic databases looking
for cancer-associated SCI case reports and case series. Data regarding age, sex, cardiovascular
risk factors (CVRF), history of known cancer, infarction localization, spinal cord
syndrome, Zalewski criteria classification, mechanism of ischemia, diagnostic tests,
treatment and functional outcome were registered. A statistical analysis was carried
out to identify factors related to mortality and survival time.
Results
A total of 48 articles met the inclusion criteria and 52 patients were identified.
The median age was 62 years. The most frequent neoplasm was intravascular large B-cell
lymphoma. The median survival time was 17.4 weeks and the cumulative probability of
survival at 12 months was 16.3%. In the group of deceased patients there was a higher
proportion of malignant neoplasms than in those who survived (94.7% vs. 5.3%, p < 0.01). There were no statistically significant differences in terms of mortality
or survival time depending on age, previously known cancer or CVRF.
Conclusion
Cancer-associated SCI entails a poor outcome. Mortality is increased in patients with
malignant neoplasm. No other prognosis factors could be identified.
Keywords
Abbreviations:
ASIA (American spinal injury association), CT (computerized tomography), CVRF (cardiovascular risk factors), IVLBCL (intravascular large B-cell lymphoma), MRC (Medical Research Council), MRI (magnetic resonance imaging), SCI (spinal cord infarction)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the Neurological SciencesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Spinal cord infarction. Report of 8 cases and review of the literature.Medicine (Baltimore). 1989; 68: 282-292
- Recovery after spinal cord infarcts: long-term outcome in 115 patients.Neurology. 2012; 78: 114-121https://doi.org/10.1212/WNL.0b013e31823efc93
- Management of neurologic complications of thoracic aortic surgery.J. Clin. Neurophysiol. 2007; 24: 336-343https://doi.org/10.1097/WNP.0b013e31811ec0b0
- Vascular disorders of the spinal cord.Contin Lifelong Learn Neurol. 2018; 24: 407-426https://doi.org/10.1212/CON.0000000000000595
- Characteristics of spontaneous spinal cord infarction and proposed diagnostic criteria.JAMA Neurol. 2019; 76: 56-63https://doi.org/10.1001/jamaneurol.2018.2734
- Stroke in cancer patients: a risk factor analysis.J. Neuro-Oncol. 2009; 94: 221-226https://doi.org/10.1007/s11060-009-9818-3
- Stroke among cancer patients.Nat. Commun. 2019; : 10https://doi.org/10.1038/s41467-019-13120-6
- Ischemic stroke: a paradoxical manifestation of cancer.Crit Rev Oncol Hematol. 2021; : 157https://doi.org/10.1016/j.critrevonc.2020.103181
- Cancer-associated stroke: pathophysiology, detection and management (review).Int. J. Oncol. 2019; 54: 779-796https://doi.org/10.3892/ijo.2019.4669
- Utility of a scoring system for differentiating cancer-associated stroke from cryptogenic stroke in patients with cancer.Neurol. Sci. 2020; 41: 1245-1250https://doi.org/10.1007/s10072-019-04231-5
- Methodological quality of case series studies: an introduction to the JBI critical appraisal tool.JBI Database Syst Rev Implement Reports. 2019; : 1-7https://doi.org/10.11124/JBISRIR-D-19-00099
- Chapter 7: systematic reviews of etiology and risk.JBI Manual for Evidence Synthesis. 2020; : 217-269https://doi.org/10.46658/JBIMES-20-01
- The 2019 revision of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI)—What’s new?.Spinal Cord. 2019; 57: 815-817https://doi.org/10.1038/s41393-019-0350-9
- Sudden paralysis in a 39-year-old woman with metastatic breast Cancer.JAMA Oncol. 2021; 7: 1239https://doi.org/10.1001/jamaoncol.2021.1008
- Spinal cord infarction and metastasis attributable to atrial Myxoma.JAMA Neurol. 2020; 77: 1030https://doi.org/10.1001/jamaneurol.2020.1495
- Intravascular lymphoma presenting as spinal cord infarction.Postgrad. Med. J. 2021; 97: 672-673https://doi.org/10.1136/postgradmedj-2020-138602
- Clinical reasoning: a 70-year-old man with rapid stepwise paraparesis and sensory loss.Neurology. 2020; 94: e651-e655https://doi.org/10.1212/WNL.0000000000008925
- Intravascular lymphomatosis presenting with spinal cord infarction and recurrent ischemic strokes.J. Stroke Cerebrovasc. Dis. 2019; 28: e132-e134https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.06.009
- Malignant Melanotic Schwannian tumor presenting with spinal cord infarction due to occlusion of the artery of Adamkiewicz: case report and review of the literature.World Neurosurg. 2019; 128: 422-425https://doi.org/10.1016/j.wneu.2019.04.267
- Sudden collapse due to medullary and cervical cord infarction—an unusual presentation of hepatocellular carcinoma.J. Forensic Sci. 2019; 64: 925-929https://doi.org/10.1111/1556-4029.13929
- An intra-aortic floating metastatic malignancy of unknown primary origin.Eur J Cardio-Thoracic Surg. 2018; 53: 477-478https://doi.org/10.1093/ejcts/ezx306
- Left ventricular Myxoma with embolization causes acute infrarenal aortic occlusion.Int. J. Angiol. 2018; 27: 43-45https://doi.org/10.1055/s-0037-1599240
- Intravascular large B-cell lymphoma involving large blood vessels, three autopsy cases.Pathol. Int. 2019; 69: 97-103https://doi.org/10.1111/pin.12751
- Spinal cord ischemia secondary to epidural metastasis from small cell lung carcinoma.Am J Case Rep. 2017; 18: 276-280https://doi.org/10.12659/AJCR.902813
- Spinal stroke in a pregnant female with an endodermal cyst of the cervical spinal cord (a case report and literature review).Zh. Vopr. Neirokhir. Im. N. N. Burdenko. 2016; 80: 74-81https://doi.org/10.17116/neiro201680674-81
- Spinal cord infarct as a presentation of cholangiocarcinoma with metastases.Ann Transl Med. 2015; 3: 2-5https://doi.org/10.3978/j.issn.2305-5839.2015.11.27
- Spinal cord infarction in a woman with cardiac fibroelastoma.Neurologist. 2011; 17: 47-48https://doi.org/10.1097/NRL.0b013e3181d2a956
- Spinal cord infarct as the initial clinical presentation of intravascular malignant lymphomatosis.J. Clin. Neurosci. 2009; 16: 570-573https://doi.org/10.1016/j.jocn.2008.04.027
- Intravascular lymphoma presenting as progressive paraparesis.J. Clin. Neurosci. 2008; 15: 1056-1058https://doi.org/10.1016/j.jocn.2007.04.026
- Spinal cord infarction caused by malignant intramedullary glioma: the traps of epidemiology and travel history.Br. J. Neurosurg. 2004; 18: 199-200https://doi.org/10.1080/02688690410001681127
- Paraplegia and sensory deficit caused by angiotropic large cell lymphoma.Am. J. Neuroradiol. 2004; 25: 1831-1835
- Intravascular malignant lymphomatosis.Neuroradiology. 2002; 44: 749-754https://doi.org/10.1007/s00234-002-0808-9
- Unusually located left atrial papillary fibroelastoma with probable embolization to the spinal cord.Echocardiography. 2001; 18: 523-526https://doi.org/10.1046/j.1540-8175.2001.00523.x
- Posterior spinal artery infarction and nonbacterial thrombotic endocarditis.Neurologia. 2002; 17: 117-120
- Nasal NK/T cell lymphoma presenting as transverse myelopathy.Virchows Arch. 2000; 436: 393-397https://doi.org/10.1007/s004280050465
- Angiotropic large B-cell lymphoma with clinical features resembling subacute combined degeneration of the cord.Clin. Neurol. Neurosurg. 1999; 101: 275-279https://doi.org/10.1016/S0303-8467(99)00063-3
- Diffuse leptomeningeal gliomatosis associated with multifocal CNS infarcts.Surg. Neurol. 1998; 50: 356-362https://doi.org/10.1016/S0090-3019(97)00371-6
- Angiotropic large cell lymphoma.South. Med. J. 1995; 88: 235-238https://doi.org/10.1097/00007611-199502000-00016
- Intravascular lymphomatosis a systemic disease with neurologic manifestations.Cancer. 1993; 71: 3156-3164https://doi.org/10.1002/1097-0142(19930515)71:10<3156::AID-CNCR2820711043>3.0.CO;2-O
- Two cases of neoplastic angioendotheliomatosis presenting with myelopathy.Neurology. 1991; 41: 1139https://doi.org/10.1212/WNL.41.7.1139
- Intravascular malignant lymphomatosis (so-called malignant angioendotheliomatosis): a case confined to the lumbosacral spinal cord and nerve roots.Clin. Neuropathol. 1990; 9: 115-120
- Myelomalacia as clinical presentation of acute leukemia.Clin. Neurol. Neurosurg. 1989; 91: 95-97https://doi.org/10.1016/S0303-8467(89)80016-2
- Malignant angioendotheliomatosis-a true lymphoma: a case of intravascular malignant lymphomatosis studied by southern blot hybridization analysis.Hum. Pathol. 1988; 19: 475-478https://doi.org/10.1016/S0046-8177(88)80500-8
- Malignant angioendotheliosis involving the nervous system: support for a lymphoid origin of the neoplastic cells.J. Neurol. Neurosurg. Psychiatry. 1987; 50: 1173-1177https://doi.org/10.1136/jnnp.50.9.1173
- Neoplastic angioendotheliosis: a case of subacute dementia with unusual cerebral CT appearances and a review of the literature.J. Neurol. Neurosurg. Psychiatry. 1987; 50: 1022-1028https://doi.org/10.1136/jnnp.50.8.1022
- Malignant angioendotheliomatosis manifesting as ascending spinal cord dysfunction.N Y State J Med. 1987; 87: 470-472
- Immunohistochemical and electron microscopic findings in three cases.Cancer. 1985; 56: 1134-1143https://doi.org/10.1002/1097-0142(19850901)56:5<1134::aid-cncr2820560530>3.0.co;2-j
- Malignant Angioendotheliomatosis: an Angiotropic lymphoma?.Am. J. Clin. Pathol. 1985; 83: 244-248https://doi.org/10.1093/ajcp/83.2.244
- Neoplastic angioendotheliosis of the central nervous system.J. Neurol. 1984; 231: 14-19https://doi.org/10.1007/BF00313646
- Intramedullary spinal cord metastasis.Acta Neuropathol. 1983; 61: 214-218https://doi.org/10.1007/BF00691988
- Neoplastic angioendotheliosis of the spinal cord - case report.Acta Neuropathol. 1983; 62: 164-166https://doi.org/10.1007/BF00684937
- Neoplastic angioendotheliosis.J. Neurol. Sci. 1982; 53: 359-375https://doi.org/10.1016/0022-510x(82)90019-3
- Intravascular malignant histiocytosis mimicking central nervous system vasculitis: an immunopathological diagnostic approach.Ann. Neurol. 1982; 12: 489-492https://doi.org/10.1002/ana.410120515
- CNS embolism due to atrial Myxoma: clinical features and diagnosis.Arch. Neurol. 1980; 37: 485-488https://doi.org/10.1001/archneur.1980.00500570033004
- Intramedullary spinal cord metastasis associated with pencil-shaped softening of the spinal cord.Case report. J Neurosurg. 1980; 52: 718-721https://doi.org/10.3171/jns.1980.52.5.0718
- Spinal cord ischemia and left atrial Myxoma.Arch. Neurol. 1979; 36: 439https://doi.org/10.1001/archneur.1979.00500430069011
- Neoplastic angioendotheliosis: ultrastructural study and review of the literature.Ann. Neurol. 1978; 3: 393-399https://doi.org/10.1002/ana.410030505
- Angioendotheliomatosis of the central nervous system.Acta Neuropathol. 1974; 28: 75-78https://doi.org/10.1007/BF00687520
- Intramedullary syndrome due to an extradural neurinoma near the foramen magnum.J. Neurol. 1978; 218: 145-148https://doi.org/10.1007/BF02402174
- Intramedullary spinal cord metastases: clinical and radiographic findings in nine cases.Neurology. 1972; 22: 1222-1231https://doi.org/10.1212/wnl.22.12.1222
- Spinal cord embolism.J. Neurol. Neurosurg. Psychiatry. 1967; 30: 446-454https://doi.org/10.1136/jnnp.30.5.446
- Spinal cord infarction: aetiology, imaging findings, and prognostic factors in a series of 41 patients.Neurologia. 2021; https://doi.org/10.1016/j.nrl.2020.11.014
- Spinal cord infarction: a single center experience and the usefulness of evoked potential as an early diagnostic tool.Front. Neurol. 2020; 11: 1-10https://doi.org/10.3389/fneur.2020.563553
- Spinal cord infarction: clinical and radiological features.J. Stroke Cerebrovasc. Dis. 2018; 27: 2810-2821https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.06.008
- Cancer-associated ischemic stroke: a retrospective multicentre cohort study.Thromb. Res. 2018; 165: 33-37https://doi.org/10.1016/j.thromres.2018.03.011
- Pathophysiology, mechanism, and outcome of ischemic stroke in Cancer patients.J. Stroke Cerebrovasc. Dis. 2020; 29105299https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105299
- Spontaneous spinal cord infarction in Austria: a two-center comparative study.Ther. Adv. Neurol. Disord. 2022; 15 (17562864221076320)https://doi.org/10.1177/17562864221076321
- Intravascular lymphoma in the CNS: options for treatment.Curr. Treat. Options Neurol. 2017; 19: 1-8https://doi.org/10.1007/s11940-017-0471-4
- Neurological presentations of intravascular lymphoma (IVL): Meta-analysis of 654 patients.BMC Neurol. 2016; 16: 1-7https://doi.org/10.1186/s12883-015-0509-8
- Association between incident cancer and subsequent stroke.Ann. Neurol. 2015; 77: 291-300https://doi.org/10.1002/ana.24325
- Cancer-associated stroke: the Bergen NORSTROKE study.Cerebrovasc Dis Extra. 2015; 5: 107-113https://doi.org/10.1159/000440730
- Manifestaciones neurológicas de los mixomas cardiacos. Experiencia en un centro de referencia.Neurologia. 2013; 28: 529-534https://doi.org/10.1016/j.nrl.2013.03.006
- Neurological manifestations of atrial myxoma: a retrospective analysis.Oncol. Lett. 2018; 16: 4635-4639https://doi.org/10.3892/ol.2018.9218
- WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues WHO Classification of Tumours.4th edition. vol. 2. 2017
- Intravascular large B-cell lymphoma: a chameleon with multiple faces and many masks.Blood. 2018; 132: 1561-1567https://doi.org/10.1182/blood-2017-04-737445
- Lack of CD 29 (β1 integrin) and CD 54 (ICAM-1) adhesion molecules in intravascular lymphomatosis.Hum. Pathol. 2000; 31: 220-226https://doi.org/10.1016/S0046-8177(00)80223-3
- Stroke in patients with cancer.Neurology. 2004; 62 (2025 LP – 2030)
- Acute ischemic stroke on cancer patients, a distinct etiology? A case-control study.Acta Med Port. 2015; 28: 613-618https://doi.org/10.20344/amp.6156
- Stroke and cancer: the importance of cancer-associated hypercoagulation as a possible stroke etiology.Stroke. 2012; 43: 3029-3034https://doi.org/10.1161/STROKEAHA.112.658625
- Spinal cord infarction: prognosis and recovery in a series of 36 patients.Spinal Cord. 2001; 39: 520-525https://doi.org/10.1038/sj.sc.3101201
- Spinal cord infarction: etiology and outcome.Neurology. 1996; 47: 321-330https://doi.org/10.1212/WNL.47.2.321
- Characteristics of cryptogenic stroke in cancer patients.Ann Clin Transl Neurol. 2016; 3: 280-287https://doi.org/10.1002/acn3.291
- Ischemic stroke in cancer patients with and without conventional mechanisms: a multicenter study in Korea.Stroke. 2010; 41: 798-801https://doi.org/10.1161/STROKEAHA.109.571356
- Cancer and embolic stroke of undetermined source.Stroke. 2021; 52: 1121-1130https://doi.org/10.1161/STROKEAHA.120.032002
- Risk factors, biomarkers, etiology, outcome and prognosis of ischemic stroke in cancer patients.Asian Pacific J Cancer Prev. 2018; 19: 649-653https://doi.org/10.22034/APJCP.2018.19.3.649
- Spinal cord infarcts: risk factors, management, and prognosis.Curr. Treat. Options Neurol. 2017; 19: 28https://doi.org/10.1007/s11940-017-0464-3
- Clinical manifestation of cancer related stroke: retrospective case-control study.J. Neuro-Oncol. 2013; 111: 295-301https://doi.org/10.1007/s11060-012-1011-4
Article info
Publication history
Published online: February 04, 2023
Accepted:
January 31,
2023
Received in revised form:
December 9,
2022
Received:
September 28,
2022
Identification
Copyright
© 2023 Elsevier B.V. All rights reserved.
