WSO - April 2024 - 406

1217670
WSO
International Journal of StrokeNaftali et al.
Research
Lung cancer is associated with acute
ongoing cerebral ischemia:
A population-based study
Jonathan Naftali1*
, Rani Barnea1,2*, Ruth Eliahou2,3,
Keshet Pardo1, Assaf Tolkovsky1, Meital Adi4,
Vadim Hasminski2,3, Walid Saliba5,6, Sivan Bloch6,7,
Guy Raphaeli1,2, Avi Leader2,8 and Eitan Auriel1,2
International Journal of Stroke
2024, Vol. 19(4) 406 -413
© 2023 World Stroke Organization
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DOI: 10.1177/17474930231217670
journals.sagepub.com/home/wso
https://doi.org/10.1177/17474930231217670
Abstract
Background and Objectives: Cerebral microinfarcts (CMIs) are the most common type of brain ischemia; however,
they are extremely rare in the general population. CMIs can be detected by magnetic resonance diffusion-weighted imaging
(MRI-DWI) only for a very short period of approximately 2 weeks after their formation and are associated with an
increased stroke risk and cognitive impairment. We aimed to examine CMI detection rate in patients with lung cancer
(LC), which is strongly associated with ischemic stroke risk relative to other cancer types.
Methods: We used the Clalit Health Services record (representing more than 5 million patients) to identify adults with
LC and breast, pancreatic, or colon cancer (non-lung cancer, NLC) who underwent brain magnetic resonance diffusion
(MRI) scan within 5 years following cancer diagnosis. All brain MRI scans were reviewed, and CMIs were documented,
as well as cardiovascular risk factors.
Results: Our cohort contained a total of 2056 MRI scans of LC patients and 1598 of NLC patients. A total of 143 CMI
were found in 73/2056 (3.5%) MRI scans of LC group compared to a total of 29 CMI in 22/1598 (1.4%) MRI scans of
NLC (p < 0.01). Cancer type (e.g. LC vs NLC) was the only associated factor with CMI incidence on multivariate analysis.
After calculating accumulated risk, we found an incidence of 2.5 CMI per year in LC patients and 0.5 in NLC.
Discussion: CMIs are common findings in cancer patients, especially in LC patients and therefore might serve as a
marker for occult brain ischemia, cognitive decline, and cancer-related stroke (CRS) risk.
Keywords
Magnetic resonance diffusion-weighted imaging, antithrombotic, lesions, MRI, acute, cerebral infraction, ischemic stroke,
radiology, stroke subtypes
Received: 29 June 2023; accepted: 9 November 2023
1Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
2Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
3Department of Radiology, Rabin Medical Center, Petach Tikva, Israel
4Department of Radiology, Kaplan Medical Center, Rehovot, Israel
5Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
6Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
7Department of Neurology, Lady Davis Carmel Medical Center, Haifa, Israel
8Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
*Equal contribution.
Corresponding author:
Eitan Auriel, Department of Neurology, Rabin Medical Center, Zeev Jabotinsky Street 39, Petah Tikva 49100, Israel.
Email: eitanur@clalit.org.il
International Journal of Stroke, 19(4)
http://www.sagepub.com/journals-permissions https://www.doi.org/10.1177/17474930231217670 http://journals.sagepub.com/home/wso
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