Etiology of tumor-related intracranial hemorrhage
Carcinoma, Non-Small-Cell Lung
© J. R. Carhuapoma, S. A. Mayer, and D. F. Hanley 2010.Introduction Cancer-related intracerebral bleeding is an uncommon cause of hemorrhage and represents only a fraction of all non-traumatic intracranial hemorrhages (ICHs) . In the literature, the incidence of tumoral hemorrhages has been estimated at 0.8–4.4% of all ICHs [2–5]. One study of 144 patients found that tumor-related hemorrhages accounted for 9% of hemorrhages; however, there was an overrepresentation of metastatic brain tumors in this population that explained the majority of their neoplastic ICHs . Intracerebral hemorrhage is relatively common in cancer patients and can be demonstrated in 3–14.6% at autopsy [2,7–11]. The causes of hemorrhage in cancer patients are multiple and include intratumoral bleeding, cerebral metastasis, coagulation disorders, and complications of anticancer treatment (Table 3.1). In addition to metastases, primary brain tumors can also present with or develop an ICH. Recognizing that a neoplasm may be the source of an ICH is of cardinal importance, particularly when it is the presenting manifestation . Tumor-related hemorrhages occur in any part of the central nervous system (CNS) . In most patients, the site of hemorrhage is the brain parenchyma. Subarachnoid (SAH) and subdural hemorrhages are less commonly caused by a neoplasm . Only 0.4% of all SAHs can be attributed to intracranial neoplasms with roughly half linked to primary CNS tumors and half linked to metastatic disease . Subdural hemorrhages secondary to neoplasm occur almost exclusively in patients with metastatic disease and are rarely associated with primary brain tumors [11,12].
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