Cerebral infarction as a result of tumor emboli

Autopsy records at Mayo Clinic were reviewed to determine the pattern of cerebral infarction occurring as a consequence of nonmyxomatous tumor emboli. Between 1951 and 1984, there were seven adult patients who fulfilled the criteria: (1) focal or multifocal neurologic disease of abrupt onset; (2) systemic cancer; and (3) pathologic demonstration of tumor emboli in appropriate vessels. Tumors originated from the lung in four patients and from the colon and hypopharynx in one each; in one patient the primary source was unknown. Five patients had carotid and two had vertebrobasilar system strokes. Two patients had at least one antecedent transient ischemic attack (TIA). Three patients presented with cerebral infarction as the initial manifestation of their cancer. In two patients, it occurred immediately after pneumonectomy. In four patients, cerebral infarction occurred in a setting of widespread systemic, including pulmonary, metastases. At postmortem examination, one patient had a single large basilar artery tumor embolus. The others had multiple large and small vessel tumor embolic occlusions. The anterior circulation was affected in three patients, the posterior circulation in two, and both circulations were affected in two. Four patients had additional brain parenchymal metastases including one with diffuse leptomeningeal spread.