Brain Tumors and the Risk of Stroke

Though rare, brain cancer-related strokes are extremely serious

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An uncommon complication of brain cancer is bleeding within the brain (called an intracranial hemorrhage) which can lead to a hemorrhagic stroke. This is a relatively rare situation but one that is more likely to occur in people over 60 who have certain types of brain cancer or who have undergone radiation treatments to the head or neck.

Symptoms

The symptoms of a stroke caused by an intracerebral hemorrhage are different from a typical stroke. This is because most strokes, known as ischemic strokes, occur suddenly when a blood vessel in the brain is blocked.

Since brain tumors grow slowly, stroke symptoms tend to develop over the course of days, weeks, or months rather than hours or minutes. If the rupture of a vessel in the brain leads to a stroke, it is called a hemorrhagic stroke. The most common symptoms of a hemorrhagic stroke include:

  • A severe headache
  • Double vision
  • Weakness on one side of the body
  • Paralysis or numbness on one side of the body
  • Inability to speak
  • Inability to understand spoken language
  • Difficulty writing or reading
  • Changes in vision or vision loss
  • Seizures or convulsions

Both the amount of bleeding and the location of the hemorrhage will determine whether the symptoms are mild or severe.

Studies suggest that people who develop stroke as a result of a brain tumor are highly vulnerable to a second stroke, usually within 2.2 years.

Causes

There are two main types of brain tumors, either one of which can develop bleeding:

  • Primary brain tumors originate within brain tissue. Examples include pituitary tumors, gliomas (generally fast-growing), and meningiomas (generally slow-growing and benign).
  • Metastatic brain tumors start in one area of the body (such as the lungs, breast, or kidneys) and spread to another part of the body.

Bleeding from a primary brain tumor is a relatively rare event. A brain tumor's tendency to bleed depends on the tumor's characteristics. For instance, meningiomas (which develop in the membrane surrounding the brain and spinal cord) rarely cause bleeding.

Although brain metastases from lung or breast cancer are less likely to bleed, those associated with melanoma are highly vulnerable to bleeding. Studies suggest that up to 50% of intracranial hemorrhages caused by metastasis are related to melanoma.

By contrast, gliomas (which develops in sticky cells surrounding nerve cells) are more vulnerable to bleeding, in part because they are fast-growing. Pituitary tumors are also prone to bleeding.

According to a 2017 study in the journal Stroke, 72% of strokes caused by a brain tumor are the result of a glioma. Prior radiation to the head and neck is also a major risk factor, occurring in no less than 71% of cases.

Diagnosis

Bleeding from a brain tumor ca usually be diagnosed with computed tomography (CT). With a CT scan of the brain, the area of bleeding typically appears as a bright white area, in contrast to the grayish appearance of the normal brain tissue. In addition, the blood in the brain is typically surrounded by a darker area, which represents brain swelling.

Most injuries to the brain, including strokes and brain tumors, cause swelling. The shape and size of the swelling help doctors determine whether the bleeding is caused by a brain tumor or another condition (such as head trauma).

If there is any suspicion that a brain tumor is involved, the next test will be to order a magnetic resonance imaging (MRI) scan of the brain along with an injection of a contrast agent known as gadolinium. Gadolinium helps delineate areas of healthy brain tissue, blood, and cancerous tissue.

It is not uncommon for intracranial bleeding caused by a glioma to be misdiagnosed as a hypertensive crisis. Unless an MRI with a contrast agent is ordered, the glioma may be entirely missed and allowed to grow unchecked.

Treatment

The treatment of intracranial bleeding depends on the symptoms and the volume of blood involved. The standard treatment is to remove the blood and tumor at the same time. However, if the volume of blood is small, and the symptoms are mild, surgery may not be needed.

If it is safe to delay surgery, other tests will be performed to help confirm the location of the brain tumor and whether it is primary or metastatic). An oncologist can then decide what other cancer treatments are needed, such as radiation and chemotherapy.

Generally speaking, the prognosis is poor if a stroke occurs as a result of brain cancer. Although 85% of people can achieve disease-free survival for a year, recurrence will typically occur before the second year. All told, the median survival time is 11.7 months from the time of surgery.

With that said, survival times can increase to five years and even more if the stroke was mild and the cancer is diagnosed in an earlier stage.

A Word From Verywell

If you or a loved one has had a brain hemorrhage caused by a tumor, you will need to follow very closely with a medical team, including an oncologist, a neurologist, and a neurosurgeon. While recovery may be slow and exhausting, both physically and mentally, with strong support from loved ones and your healthcare team, you can get through it.

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