vfumedВестник Северо-Восточного федерального университета имени М.К. Аммосова. Vestnik of North-Eastern Federal University. Серия «Медицинские науки. Medical Sciences»Vestnik of North-Eastern Federal University. Medical Sciences2587-5590Северо-Восточный федеральный университет имени М.К. Аммосова10.25587/SVFU.2023.50.87.001vfumed-247Research ArticleКЛИНИЧЕСКАЯ МЕДИЦИНАCLINICAL MEDICINEИШЕМИЧЕСКИЙ ИНСУЛЬТ И НАРУШЕНИЯ ГЕМОСТАЗА ПРИ ОНКОЛОГИЧЕСКИХ ПРОЦЕССАХ: ОБЗОР ЛИТЕРАТУРЫISCHEMIC STROKE AND HEMOSTASIS DISORDERS IN ONCOLOGICAL PROCESS: A LITERATURE REVIEWАммосоваЛ. В.AmmosovaL. V.

Аммосова Лия Васильевна – аспирант кафедры «Неврология и психиатрия» медицинского института

г. Якутск

Ammosova Liia Vasilievna – post-graduate student, Department of Neurology and Psychiatry, Institute of Medicine

Yakutsk

l_v_d@mail.ruЧугуноваС. А.ChugunovaS. A.

Чугунова Саргылана Афанасьевна – канд. мед. наук, доцент кафедры «Внутренние болезни и общеврачебная практика (семейная медицина)» ФПОВ

Якутск

Chugunova Sargylana Afanasievna – Candidate of Medical Sciences, Associate Professor, Department of Internal Medicine and General Medical Practice (Family Medicine), Faculty of Postgraduate Education of Doctors, Institute of Medicine

Yakutsk

 

sa.chugunova@mail.ruСВФУ им. М.К. АммосоваРоссияM. K. Ammosov North-Eastern Federal UniversityRussian Federation20231312202304516Copyright © Аммосова Л.В., Чугунова С.А., 20232023Аммосова Л.В., Чугунова С.А.Ammosova L.V., Chugunova S.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.smnsvfu.ru/jour/article/view/247

Злокачественные новообразования ассоциированы с повышенным риском развития острых нарушений мозгового кровообращения. В данной статье приведен обзор литературы о нарушениях гемостаза при онкологических процессах у пациентов с ишемическим инсультом. Рак-ассоцированный инсульт может развиваться по нескольким причинам, включая прямое воздействие опухоли, а также опосредованно через развитие нарушений коагуляции крови, сопутствующих инфекционных заболеваний или осложнений противоопухолевой терапии. Одним из наиболее распространенных патогенетических механизмов является ассоциированная с раком коагулопатия. Синдром Труссо является вариантом паранеопластического синдрома, характеризующийся состоянием гиперкоагуляции с развитием тромбозов, предшествующих диагностике злокачественного новообразования или развивающихся одновременно с ним. Для церебральной ишемии при синдроме Труссо характерен мультифокальный паттерн поражения по данным нейровизуализации. На сегодняшний день отсутствуют четкие диагностические критерии ракассоциированного инсульта, который нередко является одним из первых клинических проявлений онкологического процесса. По данным различных исследований, лабораторные маркеры гиперкоагуляции могут служить предикторами недиагностированного ранее злокачественного новообразования у пациентов с криптогенным ишемическим инсультом. В настоящее время предпринимается все больше попыток разработки диагностических шкал, основанных на клинических и нейровизуализационных характеристиках инсульта, для выявления скрытого онкологического процесса. Другой важной стороной вопроса остается отсутствие научно обоснованных рекомендаций по лечению ишемического инсульта, ассоциированного с раком. Учитывая распространенность инсульта у онкологических пациентов, потенциально неблагоприятные функциональные прогнозы, более высокие показатели постинсультной смертности и высокую частоту рецидивов, требуются дальнейшие исследования данной проблемы. 

Malignant neoplasms are associated with an increased risk of developing acute cerebrovascular accidents. This article provides a review of the literature on hemostatic disorders during oncological processes in patients with ischemic stroke. Cancer-associated stroke can develop for several reasons, including direct effects of the tumor, as well as indirectly through the development of blood coagulation disorders, concomitant infectious diseases, or complications of antitumor therapy. One of the most common pathogenetic mechanisms is cancer-associated coagulopathy. Trousseau syndrome is a variant of paraneoplastic syndrome, characterized by a state of hypercoagulability with the development of thrombosis that precedes the diagnosis of a malignant neoplasm or develops simultaneously with it. Cerebral ischemia in Trousseau’s syndrome is characterized by a multifocal pattern of lesions according to neuroimaging data. To date, there are no clear diagnostic criteria for cancer-associated stroke, which is often one of the first clinical manifestations of the oncological process. According to various studies, laboratory markers of hypercoagulability can serve as predictors of previously undiagnosed malignancy in patients with cryptogenic ischemic stroke. Currently, more and more attempts are being made to develop diagnostic scales based on clinical and neuroimaging characteristics of stroke to identify hidden oncological processes. Another important aspect of the issue remains the lack of evidence-based recommendations for the treatment of ischemic stroke associated with cancer. Given the prevalence of stroke in cancer patients, potentially poor functional prognosss, higher rates of post-stroke mortality and high relapse rates, further research into this issue is required.

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The authors declare that there are no conflicts of interest present.