Neurological Emergencies in Cancer Patients

Posted by e-Medical PPT Tuesday, October 23, 2012
Neurologic Emergencies in Cancer Patients
Neurologic sx’s present in 38% of oncology-related ED visits
Most common neurologic dx’s among cancer patients @ Memorial Sloan-Kettering Cancer Center:
    Brain mets 16%
    Metabolic encephalopathy 10%
    Bone mets 10%
    Epidural tumor 8%

Neurologic Emergencies in Cancer Patients
Brain tumors
Epidural spinal cord compression (ESCC)
Leptomeningeal metastasis (LMM)
Stroke
Acute neurologic complications of cancer treatment
Paraneoplastic syndromes

Brain Tumors: epidemiology
Each year:
    17,500 dx’d with primary brain tumors
    66,000 dx’d with symptomatic brain metastases
        lung, breast, skin, GU, GI account for majority
Incidence is increasing:
    - improved diagnostic methodology
    - better access to health care among the elderly
    - improved survival among cancer patients

Brain Tumors: mechanism
Direct tissue destruction
Displacement of brain tissues (tumor/edema)
Compression of vasculature (ischemia)
Compression of CSF pathways (hydrocephalus)

Brain Tumors: clinical features
Headache
    - presenting sx in 35% of patients
    - 70% of patients will have a headache at some point
    - “classic”: mild @ onset, worse in morning, improves after rising
    - usually: dull, non-throbbing headache, gradually increases, chronic
    - accompanied by impaired MS, nausea/vomiting
Focal deficits
Cognitive disturbances
    - presenting sx in 30% of patients
Seizure
    - presenting sx in 33% of pts with gliomas
    - presenting sx in 15-20% of pts with brain mets
    - postictal deficits or Todd’s paralysis
Papilledema
    - older studies: present in 70%
    - now: 8%
Acute presentations: hydrocephalus, intratumoral hemorrhage, seizures
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