Approximately 90,000 people are affected by primary brain tumors and other central nervous system tumors each year in the United States. The good news is that many adults with brain tumors are living longer, but they do face the risk of a particularly serious complication: acute ischemic stroke (AIS).

Because there is still limited research to guide clinicians in AIS prevention and management in adults, a team of nurse researchers sought to build an evidence base for practice. The results of their scientific literature review were published in the Journal of Neuroscience Nursing.

Adults aged 65 years and older accounted for more than 70% of reported cases of AIS in the general population. People who smoke, live a sedentary lifestyle, have certain pre-existing medical conditions, and have a family history of AIS also experience a greater risk.  


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The risk of AIS is twice as high for patients with cancer than for the general population, and brain tumor survivors in particular have a seven-fold increased risk.  The potential increases with age, and people who were children when their brain tumor was diagnosed are at even greater risk.

Brain tumor treatment may increase the risk of AIS, although it varies by tumor location and the dose, extent, and type of radiation. For example, radiation-induced intracranial artery stenosis elevates AIS risk. Systemic treatments also are linked to an increased risk. An example is the increased risk associated with cisplatin chemotherapy to treat medulloblastoma as part of the Packer regimen.

The researchers noted that clinicians involved with the long-term care of brain tumor survivors should incorporate AIS prevention during surveillance visits. These visits are an excellent opportunity to screen patients for AIS risk, and referrals to a variety of services can then be made. Imaging may help with screening and prevention. Clinicians should also collaborate with primary care providers to coordinate screenings for other conditions that raise the risk of AIS, such as hypertension.

Nurses have an important role to play, as they are responsible for patient education. They are well-positioned to engage family members and caregivers about the possibility of AIS and discuss symptoms to watch for. “Advanced practice nurses should address evidence-based lifestyle prevention strategies (diet and exercise recommendations from American Heart Association/American Stroke Association guidelines) in patient, family member, and caregiver interactions,” the researchers added.

The researchers called for additional research to learn more about the frequency of AIS in brain tumor survivors, as well as more research into the effects of various efforts to prevent AIS.

Reference

Figuracion KCF, Jung W, Martha SM. Ischemic stroke risk among adult brain tumor survivors: evidence to guide practice. J Neurosci Nurs. Published online July 26, 2021.  doi:10.1097/JNN.0000000000000606