Patterns of Acute Cerebral Infarcts in Patients with Active Malignancy Using Diffusion-Weighted Imaging

BACKGROUND AND PURPOSE: It is still controversial whether the nature of cerebral infarcts differs between cancer patients and the general population. The aim of this study is to delineate the characteristics of acute cerebral infarction in patients with active malignancy using diffusion-weighted imaging (DWI). MATERIALS AND METHODS: Seventy consecutive patients with both active malignancy and acute cerebral infarction (confirmed by DWI) were retrospectively included. These 70 were divided into 3 groups on the basis of infarct pattern: embolic infarction, large artery disease, and lacunar infarction. Medical records were reviewed in detail for demographic data, cancer information, vascular risk factors, and prognosis. RESULTS: Two thirds of cancer patients had multiple infarcts, and 30% of infarcts were located infratentorially. Embolic infarction, large artery disease, and lacunar infarction occurred in 60, 31, and 9% of cancer patients, respectively. Gastrointestinal (GI) cancer was significantly related to embolic infarction (odds ratio 4.64, p = 0.04). The 3-month mortality rates were higher in patients with rather than without cancer metastasis (68 vs. 8%; p < 0.001). CONCLUSIONS: Cerebral infarcts in cancer patients tended to be embolic and multiple. Patients with GI cancer were particularly susceptible to embolic infarction.