Cancer and paraneoplastic strokes

© Cambridge University Press 2008 and 2009. Paraneoplastic syndromes are a variety of disorders that accompany the clinical evolution of tumors that are not produced directly by the primary neoplasm, by its metastasis, or as a result of diagnostic or therapeutic procedures. These syndromes may evolve in parallel with the development of the tumor, but may also be independent of it and even precede the initial diagnosis of neoplasm. Paraneoplastic syndromes are detected in about 7~-10~ of patients at the time the tumor is diagnosed, although almost all patients with a malignant tumor develop a paraneoplastic syndrome during the course of its evolution (Nathanson and Hall, 1997). Paraneoplastic syndromes can affect any part of the central nervous system (CNS). Occasionally, paraneoplastic syndromes arise from causal lesions in the CNS or peripheral nervous system, but neurological manifestations are more commonly due to lesions in organs outside of the CNS. The classic paraneoplastic neurological syndromes fall into the first group, whereas in the second group, the neurological manifestations are the result of blood vessel changes, blood-forming elements, hemostasis and coagulation disorders, metabolic changes, and infections (Table 50.1). Cerebrovascular paraneoplastic manifestations are included in the second group of neurological paraneoplastic syndromes.