Advertisement

Clinical Presentation of Brain Metastases

  • Annette Compter
  • Dieta BrandsmaEmail author
Chapter

Abstract

Brain metastases can result in a large variety of focal and nonfocal neurological symptoms. The clinical presentation of brain metastases is affected by the location, size and growth rate of the tumour. Any new neurological symptom or change in behaviour or cognition in a patient with cancer warrants further investigations for brain metastases. Focal neurological symptoms, like hemiparesis and dysphasia, can be caused by a direct effect of the brain metastasis or the surrounding oedema on the brain tissue or other neural structures. Most of these neurological symptoms occur within days to weeks, although an intratumoural haemorrhage can result in an acute onset of symptoms. Epileptic seizures occur in 10–20% of patients with brain metastases.

Keywords

Brain metastases Neurological symptoms Hydrocephalus Brain herniation Epilepsy 

References

  1. 1.
    Schiff D, Kesari S, Wen PY. Cancer neurology in clinical practice, vol. 2. New York: Humana Press; 2008.CrossRefGoogle Scholar
  2. 2.
    Lassman AB, DeAngelis LM. Brain metastases. Neurol Clin. 2003;21(1):1–23.. viiCrossRefGoogle Scholar
  3. 3.
    Christiaans MH, Kelder JC, Arnoldus EP, Tijssen CC. Prediction of intracranial metastases in cancer patients with headache. Cancer. 2002;94(7):2063–8.CrossRefGoogle Scholar
  4. 4.
    Argyriou AA, Chroni E, Polychronopoulos P, Argyriou K, Papapetropoulos S, Corcondilas M, et al. Headache characteristics and brain metastases prediction in cancer patients. Eur J Cancer Care. 2006;15(1):90–5.  https://doi.org/10.1111/j.1365-2354.2005.00621.x.CrossRefGoogle Scholar
  5. 5.
    Schagen SB, Klein M, Reijneveld JC, Brain E, Deprez S, Joly F, et al. Monitoring and optimising cognitive function in cancer patients: present knowledge and future directions. EJC Suppl. 2014;12(1):29–40.  https://doi.org/10.1016/j.ejcsup.2014.03.003.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Clouston PD, DeAngelis LM, Posner JB. The spectrum of neurological disease in patients with systemic cancer. Ann Neurol. 1992;31(3):268–73.  https://doi.org/10.1002/ana.410310307.CrossRefPubMedGoogle Scholar
  7. 7.
    Chang EL, Wefel JS, Maor MH, Hassenbusch SJ 3rd, Mahajan A, Lang FF, et al. A pilot study of neurocognitive function in patients with one to three new brain metastases initially treated with stereotactic radiosurgery alone. Neurosurgery. 2007;60(2):277–83.; ; discussion 283–4.  https://doi.org/10.1227/01.neu.0000249272.64439.b1.CrossRefPubMedGoogle Scholar
  8. 8.
    Mehta MP, Rodrigus P, Terhaard CH, Rao A, Suh J, Roa W, et al. Survival and neurologic outcomes in a randomized trial of motexafin gadolinium and whole-brain radiation therapy in brain metastases. J Clin Oncol. 2003;21(13):2529–36.  https://doi.org/10.1200/jco.2003.12.122.CrossRefPubMedGoogle Scholar
  9. 9.
    Meyers CA, Smith JA, Bezjak A, Mehta MP, Liebmann J, Illidge T, et al. Neurocognitive function and progression in patients with brain metastases treated with whole-brain radiation and motexafin gadolinium: results of a randomized phase III trial. J Clin Oncol. 2004;22(1):157–65.  https://doi.org/10.1200/jco.2004.05.128.CrossRefGoogle Scholar
  10. 10.
    Coia LR, Aaronson N, Linggood R, Loeffler J, Priestman TJ. A report of the consensus workshop panel on the treatment of brain metastases. Int J Radiat Oncol Biol Phys. 1992;23(1):223–7.CrossRefGoogle Scholar
  11. 11.
    Cohen N, Strauss G, Lew R, Silver D, Recht L. Should prophylactic anticonvulsants be administered to patients with newly-diagnosed cerebral metastases? A retrospective analysis. J Clin Oncol. 1988;6(10):1621–4.  https://doi.org/10.1200/jco.1988.6.10.1621.CrossRefPubMedGoogle Scholar
  12. 12.
    Glantz MJ, Cole BF, Friedberg MH, Lathi E, Choy H, Furie K, et al. A randomized, blinded, placebo-controlled trial of divalproex sodium prophylaxis in adults with newly diagnosed brain tumors. Neurology. 1996;46(4):985–91.CrossRefGoogle Scholar
  13. 13.
    Forsyth PA, Weaver S, Fulton D, Brasher PM, Sutherland G, Stewart D, et al. Prophylactic anticonvulsants in patients with brain tumour. Can J Neurol Sci. 2003;30(2):106–12.CrossRefGoogle Scholar
  14. 14.
    Herman ST. Epilepsy after brain insult: targeting epileptogenesis. Neurology. 2002;59(9 Suppl 5):S21–6.CrossRefGoogle Scholar
  15. 15.
    van Breemen MS, Wilms EB, Vecht CJ. Epilepsy in patients with brain tumours: epidemiology, mechanisms, and management. Lancet Neurol. 2007;6(5):421–30.  https://doi.org/10.1016/s1474-4422(07)70103-5.CrossRefPubMedGoogle Scholar
  16. 16.
    Weller M, Stupp R, Wick W. Epilepsy meets cancer: when, why, and what to do about it? Lancet Oncol. 2012;13(9):e375–82.  https://doi.org/10.1016/s1470-2045(12)70266-8.CrossRefPubMedGoogle Scholar
  17. 17.
    Sirven JI, Wingerchuk DM, Drazkowski JF, Lyons MK, Zimmerman RS. Seizure prophylaxis in patients with brain tumors: a meta-analysis. Mayo Clin Proc. 2004;79(12):1489–94.  https://doi.org/10.4065/79.12.1489.CrossRefPubMedGoogle Scholar
  18. 18.
    Oberndorfer S, Schmal T, Lahrmann H, Urbanits S, Lindner K, Grisold W. The frequency of seizures in patients with primary brain tumors or cerebral metastases. An evaluation from the Ludwig Boltzmann Institute of Neuro-Oncology and the Department of Neurology, Kaiser Franz Josef Hospital, Vienna. Wien Klin Wochenschr. 2002;114(21–22):911–6.PubMedGoogle Scholar
  19. 19.
    Riva M. Brain tumoral epilepsy: a review. Neurol Sci. 2005;26(Suppl 1):S40–2.  https://doi.org/10.1007/s10072-005-0404-y.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Neuro-oncologyNetherlands Cancer Institute—Antoni van LeeuwenhoekAmsterdamThe Netherlands

Personalised recommendations