Related Subjects:
| Hypercalcaemia
| Neutropenic Sepsis
| Pulmonary Embolism
| Superior vena caval obstruction syndrome
| Cerebral Metastases
| Metastatic bone disease
| Oncological emergencies
Whole brain radiation treatment is the primary treatment
About
- Lung cancer is the commonest
Aetiology
- Found at the junction between grey and white matter
- Increased at Border zone between MCA and PCA
- Most commonly involves carcinomas and malignant melanomas
- 80% in the cerebral hemispheres, 20% subtentorial
Common to brain
- Lung, Breast (intraductal tends to go to cerebellum)
- Testicular, Renal, Malignant melanoma
- Colon, Ovary, Prostate, Thyroid
Rarely to brain
- Prostate, Ovary and Hodgkin's disease
Location
- Breast/Prostate and Myeloma can go to skull and dura
- Pelvic and colonic tumours tend to favour the posterior fossa
Haemorrhagic metastases
- Melanoma, Chorioepithelioma
- Lung, Thyroid, Kidney
Clinical
- Seizures, headache, weakness - see Brain tumours topic
- Cerebellar lesions with ataxia
- Stroke like presentations - hypodensity or haemorrhagic
Investigations
- CT/MRI - circumscribed solid or ring-shaped lesion with vasogenic oedema.
- CT +/- contrast should show all lesions > 1 cm. MRI more sensitive especially to the posterior fossa. Solitary lesions should be considered primary brain first.
 | Day 1: admitted suspected stroke but some atypical features.
Patient improved and discharged home |
 | Day 15: clinical worsening |
 | Day 18: clinical worsening |
 | Day 21 |
 | Day 21 |
 | Day 21 |
 | Day 21 with contrast |
Finding a Primary
- Skin exam for melanoma
- Thyroid exam for mass
- Breast exam for mass
- CT chest, Abdomen and Pelvis
- Tumour markers - CEA, LFTs
- Bone scan
- Mammograpy
- Upper/Lower GI endoscopy
Management
- Options depend on the extent of other diseases and comorbidities, presence and extent of tumours elsewhere.
- In some cases solitary metastases may be resected and/or radiation or other treatments are given.
- Steroids - Dexamethasone is given to most patients especially those showing oedema with sometimes dramatic short term benefits.
- Anticonvulsants such as Levetiracetam may be considered if seizure or at high risk of seizure
- After CT scan or MRI discuss each case individually with neurosurgeons who may wish to biopsy for a tissue diagnosis and decision on whether to do more.
- Surgery, Chemotherapy or Whole brain irradiation