Stroke in adults with primary intracranial tumours.

Background: We investigated stroke in patients with either benign or malignant primary intracranial tumours to give insights into how malignant and non-malignant intracranial tumours affect stroke and to provide evidence for stroke guidelines for these patients.

Methods: We conducted a retrospective cohort study of patients with benign or malignant primary intracranial tumours admitted with stroke (2011-2022) to a single centre with regional stroke and neuro-oncology units. Data collected included: stroke aetiology, stroke timing relative to tumour diagnosis, pre-stroke disability, post-stroke disability, stroke recurrence and treatment.

Results: We identified 258 patients who had an index stroke (120 haemorrhagic, 135 ischaemic, three coincident haemorrhagic/ischaemic) at or after the diagnosis of their primary intracranial tumour (71% benign, 29% malignant). Stroke incidence spiked at tumour diagnosis and subsequent months. Symptomatic intracranial haemorrhage was more commonly associated with malignant primary intracranial tumours. In-hospital mortality and level of disability at hospital discharge (median modified Rankin scale score, 4) were similar for patients with benign or malignant primary intracranial tumours. Stroke recurrence was 22% at one year. Statins were associated with reduced stroke recurrence (HR = 0.35 [95% CI 0.13-0.96]). The probability of patients with malignant tumours receiving chemotherapy was inversely related to disability at hospital discharge (ratio OR per unit increase modified Rankin scale = 0.65 [95% CI 0.42-0.96]).

Conclusion: Stroke has wider consequences for patients with primary intracranial tumours than commonly recognised. Our data indicated that statins may help to prevent stroke recurrence. Despite concerns about intracranial haemorrhage, antiplatelet agents should be considered after ischaemic stroke.