Life-threatening Neurological Complications in Patients with Malignancies

  • S. Legriel
  • E. Azoulay


A growing number of patients with malignancies experience infectious and toxic complications related to their disease or to its treatment. The population of patients likely to require medical attention for malignant disease is expanding for three reasons: 1) The incidence of cancer is rising [1, 2], survival of patients with malignancies is improving as a result of new treatments and management strategies [2], and 3) life expectancy has increased in older individuals, patients infected with human immunodeficiency virus (HIV), and patients treated with anticancer medications or immunosuppressants [3, 4].


Brain Metastasis Disseminate Intravascular Coagulation Optic Neuritis Aseptic Meningitis Posterior Reversible Encephalopathy Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P (2007) Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol 18: 581–592CrossRefPubMedGoogle Scholar
  2. 2.
    Brenner H (2002) Long-term survival rates of cancer patients achieved by the end of the 20th century: a period analysis. Lancet 360: 1131–1135CrossRefPubMedGoogle Scholar
  3. 3.
    Patel P, Hanson DL, Sullivan PS, et al (2008) Incidence of types of cancer among HIVinfected persons compared with the general population in the United States, 1992–2003. Ann Intern Med 148: 728–736PubMedGoogle Scholar
  4. 4.
    Yabroff KR, Lamont EB, Mariotto A, et al (2008) Cost of care for elderly cancer patients in the United States. J Natl Cancer Inst 100: 630–641CrossRefPubMedGoogle Scholar
  5. 5.
    Azoulay E, Schlemmer B (2006) Diagnostic strategy in cancer patients with acute respiratory failure. Intensive Care Med 32: 808–822CrossRefPubMedGoogle Scholar
  6. 6.
    Azoulay E, Thiery G, Chevret S, et al (2004) The prognosis of acute respiratory failure in critically ill cancer patients. Medicine (Baltimore) 83: 360–370CrossRefGoogle Scholar
  7. 7.
    Larche J, Azoulay E, Fieux F, et al (2003) Improved survival of critically ill cancer patients with septic shock. Intensive Care Med 29: 1688–1695CrossRefPubMedGoogle Scholar
  8. 8.
    Pene F, Percheron S, Lemiale V, et al (2008) Temporal changes in management and outcome of septic shock in patients with malignancies in the intensive care unit. Crit Care Med 36: 690–696CrossRefPubMedGoogle Scholar
  9. 9.
    Darmon M, Thiery G, Ciroldi M, Porcher R, Schlemmer B, Azoulay E (2007) Should dialysis be offered to cancer patients with acute kidney injury? Intensive Care Med 33: 765–772CrossRefPubMedGoogle Scholar
  10. 10.
    Soares M, Salluh JI, Carvalho MS, Darmon M, Rocco JR, Spector N (2006) Prognosis of critically ill patients with cancer and acute renal dysfunction. J Clin Oncol 24: 4003–4010CrossRefPubMedGoogle Scholar
  11. 11.
    Darmon M, Ciroldi M, Thiery G, Schlemmer B, Azoulay E (2006) Clinical review: specific aspects of acute renal failure in cancer patients. Crit Care 10: 211CrossRefPubMedGoogle Scholar
  12. 12.
    Plotkin SR, Wen PY (2003) Neurologic complications of cancer therapy. Neurol Clin 21: 279–318CrossRefPubMedGoogle Scholar
  13. 13.
    Recht L, Mrugala M (2003) Neurologic complications of hematologic neoplasms. Neurol Clin 21: 87–105CrossRefPubMedGoogle Scholar
  14. 14.
    Sul JK, Deangelis LM (2006) Neurologic complications of cancer chemotherapy. Semin Oncol 33: 324–332CrossRefPubMedGoogle Scholar
  15. 15.
    Wen PY, Schiff D (2003) Neurologic complications of solid tumors. Neurol Clin 21: 107–140CrossRefPubMedGoogle Scholar
  16. 16.
    Denier C, Bourhis JH, Lacroix C, et al (2006) Spectrum and prognosis of neurologic complications after hematopoietic transplantation. Neurology 67: 1990–1997CrossRefPubMedGoogle Scholar
  17. 17.
    Louis DN, Ohgaki H, Wiestler OD, et al (2007) The 2007 WHO Classification of Tumours of the Central Nervous System. Acta Neuropathol (Berl) 114: 97–109CrossRefGoogle Scholar
  18. 18.
    De Angelis LM (2001) Brain tumors. N Engl J Med 344: 114–123CrossRefGoogle Scholar
  19. 19.
    Morgenstern LB, Frankowski RF (1999) Brain tumor masquerading as stroke. J Neurooncol 44: 47–52CrossRefPubMedGoogle Scholar
  20. 20.
    Metcalfe SE, Grant R (2001) Biopsy versus resection for malignant glioma. Cochrane Database Syst Rev CD002034Google Scholar
  21. 21.
    Bataille B, Delwail V, Menet E, et al (2000) Primary intracerebral malignant lymphoma: report of 248 cases. J Neurosurg 92: 261–266CrossRefPubMedGoogle Scholar
  22. 22.
    Lassman AB, DeAngelis LM (2003) Brain metastases. Neurol Clin 21: 1–23CrossRefPubMedGoogle Scholar
  23. 23.
    Posner JB, Chernik NL (1978) Intracranial metastases from systemic cancer. Adv Neurol 19: 579–592PubMedGoogle Scholar
  24. 24.
    Demir H, Berk F, Raderer M, et al (2004) The role of nuclear medicine in the diagnosis of cancer of unknown origin. Q J Nucl Med Mol Imaging 48: 164–173PubMedGoogle Scholar
  25. 25.
    Lassen U, Daugaard G, Eigtved A, Damgaard K, Friberg L (1999) 18F-FDG whole body positron emission tomography (PET) in patients with unknown primary tumours (UPT). Eur J Cancer 35: 1076–1082CrossRefPubMedGoogle Scholar
  26. 27.
    Andrews DW (2008) Current neurosurgical management of brain metastases. Semin Oncol 35: 100–107CrossRefPubMedGoogle Scholar
  27. 28.
    Byrne TN, Borges LF, Loeffler JS (2006) Metastatic epidural spinal cord compression: update on management. Semin Oncol 33: 307–311CrossRefPubMedGoogle Scholar
  28. 29.
    Pavlidis N (2004) The diagnostic and therapeutic management of leptomeningeal carcinomatosis. Ann Oncol 15 (Suppl 4): iv285–291Google Scholar
  29. 30.
    Chamberlain MC (2005) Neoplastic meningitis. J Clin Oncol 23: 3605–3613CrossRefPubMedGoogle Scholar
  30. 31.
    Gleissner B, Chamberlain MC (2006) Neoplastic meningitis. Lancet Neurol 5: 443–452CrossRefPubMedGoogle Scholar
  31. 32.
    Nieuwenhuizen L, Biesma DH (2008) Central nervous system myelomatosis: review of the literature. Eur J Haematol 80: 1–9CrossRefPubMedGoogle Scholar
  32. 33.
    Jaeckle KA (2006) Neoplastic meningitis from systemic malignancies: diagnosis, prognosis and treatment. Semin Oncol 33: 312–323CrossRefPubMedGoogle Scholar
  33. 34.
    Ramchandren S, Dalmau J (2005) Metastases to the peripheral nervous system. J Neurooncol 75: 101–110CrossRefPubMedGoogle Scholar
  34. 35.
    Antoine JC, Camdessanche JP (2007) [Paraneoplastic neurological syndromes]. Presse Med 36: 1418–1426CrossRefPubMedGoogle Scholar
  35. 36.
    Pruitt AA (2004) Central nervous system infections in cancer patients. Semin Neurol 24: 435–452CrossRefPubMedGoogle Scholar
  36. 37.
    Safdieh JE, Mead PA, Sepkowitz KA, Kiehn TE, Abrey LE (2008) Bacterial and fungal meningitis in patients with cancer. Neurology 70: 943–947CrossRefPubMedGoogle Scholar
  37. 38.
    van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M (2004) Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 351: 1849–1859CrossRefPubMedGoogle Scholar
  38. 39.
    Klastersky J, Aoun M (2004) Opportunistic infections in patients with cancer. Ann Oncol 15 (Suppl 4): iv329–iv335PubMedGoogle Scholar
  39. 40.
    Dougan C, Ormerod I (2004) A neurologist’s approach to the immunosuppressed patient. J Neurol Neurosurg Psychiatry 75 (Suppl 1): i43–49CrossRefGoogle Scholar
  40. 41.
    Segal BH, Freifeld AG, Baden LR, et al (2008) Prevention and treatment of cancer-related infections. J Natl Compr Canc Netw 6: 122–174PubMedGoogle Scholar
  41. 42.
    Rogers LR (2003) Cerebrovascular complications in cancer patients. Neurol Clin 21: 167–192CrossRefPubMedGoogle Scholar
  42. 43.
    Graus F, Rogers LR, Posner JB (1985) Cerebrovascular complications in patients with cancer. Medicine (Baltimore) 64: 16–35Google Scholar
  43. 44.
    Cestari DM, Weine DM, Panageas KS, Segal AZ, DeAngelis LM (2004) Stroke in patients with cancer: incidence and etiology. Neurology 62: 2025–2030PubMedGoogle Scholar
  44. 45.
    Coplin WM, Cochran MS, Levine SR, Crawford SW (2001) Stroke after bone marrow transplantation: frequency, aetiology and outcome. Brain 124: 1043–1051CrossRefPubMedGoogle Scholar
  45. 46.
    Darnell RB, Posner JB (2003) Paraneoplastic syndromes involving the nervous system. N Engl J Med 349: 1543–1554CrossRefPubMedGoogle Scholar
  46. 47.
    Dalmau J, Rosenfeld MR (2008) Paraneoplastic syndromes of the CNS. Lancet Neurol 7: 327–340CrossRefPubMedGoogle Scholar
  47. 48.
    Darnell RB, Posner JB (2006) Paraneoplastic syndromes affecting the nervous system. Semin Oncol 33: 270–298CrossRefPubMedGoogle Scholar
  48. 49.
    Honnorat J, Antoine JC (2007) Paraneoplastic neurological syndromes. Orphanet J Rare Dis 2: 22CrossRefPubMedGoogle Scholar
  49. 50.
    de Beukelaar JW, Sillevis Smitt PA (2006) Managing paraneoplastic neurological disorders. Oncologist 11: 292–305CrossRefPubMedGoogle Scholar
  50. 51.
    Vedeler CA, Antoine JC, Giometto B, et al (2006) Management of paraneoplastic neurological syndromes: report of an EFNS Task Force. Eur J Neurol 13: 682–690CrossRefPubMedGoogle Scholar
  51. 52.
    Verstappen CC, Heimans JJ, Hoekman K, Postma TJ (2003) Neurotoxic complications of chemotherapy in patients with cancer: clinical signs and optimal management. Drugs 63: 1549–1563CrossRefPubMedGoogle Scholar
  52. 53.
    Kozak OS, Wijdicks EF, Manno EM, Miley JT, Rabinstein AA (2007) Status epilepticus as initial manifestation of posterior reversible encephalopathy syndrome. Neurology 69: 894–897CrossRefPubMedGoogle Scholar
  53. 54.
    Hinchey J, Chaves C, Appignani B, et al (1996) A reversible posterior leukoencephalopathy syndrome. N Engl J Med 334: 494–500CrossRefPubMedGoogle Scholar
  54. 55.
    Lamy C, Oppenheim C, Meder JF, Mas JL (2004) Neuroimaging in posterior reversible encephalopathy syndrome. J Neuroimaging 14: 89–96PubMedGoogle Scholar
  55. 56.
    Legriel S, Bruneel F, Spreux-Varoquaux O, et al (2008) Lysergic acid amide-induced posterior reversible encephalopathy syndrome with status epilepticus. Neurocrit Care 9: 247–252CrossRefPubMedGoogle Scholar
  56. 57.
    Laack NN, Brown PD (2004) Cognitive sequelae of brain radiation in adults. Semin Oncol 31: 702–713CrossRefPubMedGoogle Scholar
  57. 58.
    Cross NE, Glantz MJ (2003) Neurologic complications of radiation therapy. Neurol Clin 21: 249–277CrossRefPubMedGoogle Scholar
  58. 59.
    Soffietti R, Cornu P, Delattre JY, et al (2006) EFNS Guidelines on diagnosis and treatment of brain metastases: report of an EFNS Task Force. Eur J Neurol 13: 674–681CrossRefPubMedGoogle Scholar
  59. 60.
    Delaney A, Fleetwood-Walker SM, Colvin LA, Fallon M (2008) Translational medicine: cancer pain mechanisms and management. Br J Anaesth 101: 87–94CrossRefPubMedGoogle Scholar
  60. 61.
    Miovic M, Block S (2007) Psychiatric disorders in advanced cancer. Cancer 110: 1665–1676CrossRefPubMedGoogle Scholar
  61. 62.
    Spinazze S, Schrijvers D (2006) Metabolic emergencies. Crit Rev Oncol Hematol 58: 79–89CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2009

Authors and Affiliations

  • S. Legriel
    • 1
  • E. Azoulay
    • 2
  1. 1.Department of Intensive CareHôpital André MignotLe ChesnayFrance
  2. 2.Department of Intensive CareHôpital Saint-LouisParisFrance

Personalised recommendations