Vascular Disorders

Central nervous system vascular disease is a common complication of cancer. It may result from the direct or indirect effects of cancer and cancer treatment on blood vessels, from cancer and cancer treatment-related coagulopathies, or from infection. Tumor-related infarction occurs in the setting of cerebral tumor embolization from systemic cancer, intravascular lymphomatosis, or venous sinus compression from adjacent skull or dural tumor. Parenchymal intratumoral hemorrhage occurs in a wide variety of primary and metastatic tumor histologies. Subdural hemorrhage is a well-recognized sequela to dural metastasis of solid or hematological tumors. Treatment-related vascular toxicity includes the posterior reversible encephalopathy syndrome described in a large number of chemotherapy, immunotherapy, and targeted agents. The delayed effects of radiation on cervical carotid arteries are increasingly recognized as a cause of cerebral ischemia in patients radiated for head and neck tumors. Thrombotic coagulopathies may result in arterial thrombosis, notably in patients with solid tumors who develop nonbacterial thrombotic endocarditis. Thrombotic coagulopathy also underlies most cases of venous sinus thrombosis, most commonly in pediatric patients treated with l-asparaginase for acute leukemia. Hemorrhagic coagulopathies, including acute disseminated intravascular coagulation, may result in parenchymal, subdural, or subarachnoid hemorrhage. Cerebral infarction or hemorrhage due to infection is uncommon and is typically related to fungal infections associated with host immunosuppression.