Intracerebral and subarachnoid hemorrhage in patients with cancer Journal Article
| Authors: | Navi, B. B.; Reichman, J. S.; Berlin, D.; Reiner, A. S.; Panageas, K. S.; Segal, A. Z.; Deangelis, L. M. |
| Article Title: | Intracerebral and subarachnoid hemorrhage in patients with cancer |
| Abstract: | Objective: To analyze the risk factors, presentation, etiologies, and outcomes of adult cancer patients with intracranial hemorrhage (IH). Methods: We analyzed 208 patients retrospectively with the diagnosis of IH from the Memorial Sloan-Kettering neurology database from January 2000 through December 2007. Charts were examined for clinical and radiographic data. Survival was calculated using the Kaplan-Meier method. Survival between groups was compared via the log-rank test. Logistic regression models were used to assess for prognostic indicators of 30-and 90-day mortality. Results: There were 181 intracerebral and 46 subarachnoid hemorrhages. Sixty-eight percent of patients had solid tumors, 16% had primary brain tumors, and 16% had hematopoietic tumors. Hemiparesis and headache were the most common symptoms. Intratumoral hemorrhage (61%) and coagulopathy (46%) accounted for the majority of hemorrhages, whereas hypertension (5%) was rare. Median survival was 3 months (95% confidence interval [CI] 2-4), and 30-day mortality was 31%. However, nearly one-half of patients were completely or partially independent at the time of discharge. Patients with primary brain tumors had the longest median survival (5.9 months, 95% CI 2.9-11.8, p = 0.05). Independent predictors of 30-day mortality were not having a primary brain tumor, impaired consciousness, multiple foci of hemorrhage, hydrocephalus, no ventriculostomy, and treatment of increased intracranial pressure. Conclusions: Intracranial hemorrhage in patients with cancer is often due to unique mechanisms. Prognosis is poor, but comparable to intracranial hemorrhage in the general population. Aggressive care is recommended despite high mortality, because many patients have good functional outcomes. © 2010 by AAN Enterprises, Inc. |
| Keywords: | adult; controlled study; treatment outcome; aged; aged, 80 and over; middle aged; survival rate; retrospective studies; young adult; major clinical study; clinical feature; mortality; pathogenesis; hypertension; cancer patient; brain tumor; neoplasm; neoplasms; risk factors; steroid; medical record review; risk factor; skull irradiation; kaplan-meiers estimate; craniotomy; multivariate analysis; headache; anticonvulsive agent; blood clotting disorder; anastomosis; brain hemorrhage; hemiparesis; cerebral hemorrhage; thrombocyte transfusion; vitamin k group; hydrocephalus; cryoprecipitate; subarachnoid hemorrhage; steroids; ventriculostomy; fresh frozen plasma; brain ventricle hemorrhage; epidural hematoma; intracranial hypertension; subdural hematoma |
| Journal Title: | Neurology |
| Volume: | 74 |
| Issue: | 6 |
| ISSN: | 0028-3878 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2010-02-09 |
| Start Page: | 494 |
| End Page: | 501 |
| Language: | English |
| DOI: | 10.1212/WNL.0b013e3181cef837 |
| PUBMED: | 20142616 |
| PROVIDER: | scopus |
| PMCID: | PMC2830918 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 2" - "Export Date: 20 April 2011" - "CODEN: NEURA" - "Source: Scopus" |
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