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CNS Metastasis

Metastatic Neoplasm to the Central Nervous System


Presentation

  • Most patients initially presented with advanced FIGO stage: 9 stage IVB, 4 stage IIIC, 4 stage IIIA, 2 stage IB, and 1 stage IA.[ncbi.nlm.nih.gov]
  • She presented with headaches, obtundation, and brain herniation, and suffered sudden death 12 months after completing high-dose chemotherapy.[ncbi.nlm.nih.gov]
  • Abstract We present the case of a woman affected by ovarian cancer metastatic to multiple lymph node and the CNS.[ncbi.nlm.nih.gov]
  • Reported cases demonstrating ECMGBM are reviewed providing a summary of presentations for the entity. Special attention is placed on transmission of GBM through organ transplantation.[ncbi.nlm.nih.gov]
  • Tumor models are also presented, which utilize expression data, pathway sensitivity, and genetic abnormalities, representing targets in cancer.[books.google.es]
Fatigue
  • It’s weakness, not fatigue or pain, that you’re looking for.” 4. Balance problems Many cancers that spread to the brain occur in the back of the brain (cerebellum), which controls balance.[cityofhope.org]
  • In the AURA3 trial, the most common ( 20%) adverse reactions observed in osimertinib-treated patients were diarrhea (41%), rash (34%), dry skin (23%), nail toxicity (22%), and fatigue (22%). Dr.[astrazeneca-us.com]
  • Common side effects of many targeted therapy drugs include flu-like symptoms and fatigue. Most side effects go away on their own or can be treated.[cancer.ca]
  • The most common adverse events in the apalutamide group were fatigue, hypertension, rash, and diarrhea.[ascopost.com]
  • Nineteen months after completion of radiation therapy for the parotid carcinoma ex PA, he presented to the emergency department with a 3-week history of malaise, fever, gait imbalance, and fatigue. He was diagnosed with and treated for pneumonia.[ajnr.org]
Headache
  • She presented with headaches, obtundation, and brain herniation, and suffered sudden death 12 months after completing high-dose chemotherapy.[ncbi.nlm.nih.gov]
  • Suzanne ; Fenech, Thomas ; Debono, Patricia Date: 2015 Abstract: A fifty-eight year old male patient presented to the ophthalmic department with a 3 day history of reduced visual acuity, blurred vision and floaters, associated with recent lethargy, headaches[um.edu.mt]
  • Headaches are the most common symptom of cerebral disease. Diplopia is the most common cranial nerve symptom. Imaging Gadolinium-enhanced MRI is the modality of choice for both cranial and spinal sites.[rtnotes.wikidot.com]
  • "Progressive headaches are not a typical headache or migraine that we are accustomed to. These types of headaches get worse, continue for days and won’t go away.[cityofhope.org]
  • This was accompanied by headache and sudden onset weakness in the left upper limb and lower limb. He also had a history of sudden collapse, 1 month prior to admission. He was a non-smoker and non-alcoholic.[casereports.in]
Dizziness
  • Patients may experience hearing loss on one side, ringing in the ears, dizziness, facial numbness, tingling or headaches.[uchospitals.edu]
  • Other effects from use and misuse can include: slurred speech poor concentration confusion headache light-headedness dizziness dry mouth problems with movement and memory lowered blood pressure slowed breathing If a person takes CNS depressants long term[drugabuse.gov]
  • Some side effects of these drugs are nausea and vomiting, skin problems (such as a rash), sleepiness, dizziness, problems with memory, problems with speech and liver damage.[cancer.ca]
  • Neurological toxicities were predominantly grade 1–2, such as seizures, headache and dizziness, and did not result in treatment cessation.[tlcr.amegroups.com]
Limb Weakness
  • Exam revelaed bilateral optic atrophy, mild left facial weakness, severe left limb weakness, confusion and agitation.[neurology.org]
  • Limb weakness with paresthesias and pain occur in the affected limb. Headaches are the most common symptom of cerebral disease. Diplopia is the most common cranial nerve symptom.[rtnotes.wikidot.com]

Workup

  • A systemic workup including bone marrow biopsy and cerebrospinal fluid (CSF) analysis was done. Bone marrow was positive for tumor deposits of malignant round cells.[ijo.in]
  • Full blood cell count and workup for infectious diseases yielded negative results. Magnetic resonance imaging of the brain and orbit showed diffuse thickening and enhancement of the right optic nerve and meninges ( Figure 1 A and B).[jamanetwork.com]
  • As part of the initial workup for the trial, she received a chest x-ray which showed small nodular opacities in the bilateral lungs.[omicsonline.org]
Mediastinal Mass
  • CT thorax showed mediastinal mass while hypodense mass was seen in right parietal convexity of brain in CT brain.[casereports.in]

Treatment

  • The standard treatment for multiple brain lesions remains whole-brain radiation for symptom control, with no improvement in survival.[ncbi.nlm.nih.gov]
  • Information regarding symptoms, treatment, and survival was collected. The Kaplan-Meier method was used to compare survival data. RESULTS: The incidence of CNS metastasis was 0.97%.[ncbi.nlm.nih.gov]
  • Treatment Goals “Our treatment goals are to prolong survival, palliate neurologic symptoms, and prevent symptom progression.[ascopost.com]
  • Treatment Radiation therapy should be given to symptomatic areas and to sites of bulky disease. Radiation is the best treatment for focal leptomeningeal nodules.[rtnotes.wikidot.com]
  • Articles will include: Posterior Fossa Tumors in Adult Patients; Lymphomas and Adult Brain Tumors; Pre-Treatment Evaluation of Gliomas; Post Treatment Evaluation of Gliomas; Metastasis in Adult Brain Tumors; Extraparenchymal Lesions in Adult Brain Tumors[books.google.es]

Prognosis

  • Other risk factors related to CNSL prognosis were also analyzed. sVCAM-1Serum and CCL2Serum/CSF were significantly higher in the CNSL group than in the non-CNSL group and the controls (p 0.05).[ncbi.nlm.nih.gov]
  • This volume mainly contains information on the diagnosis, therapy, and prognosis of brain tumors. Insights on the understanding of molecular pathways involved in tumor biology are explained, which should lead to the development of effective drugs.[books.google.es]
  • Patients with brain metastases of solid tumors have a poor prognosis, despite improvements in survival achieved with modern neurosurgical and radiation techniques.[clinicaltrials.gov]
  • In addition to clinical improvements in the treatment of early-stage breast cancer, the prognosis of patients with HER-2–positive metastatic breast cancer in the post-trastuzumab era has also improved ( 11 ).[clincancerres.aacrjournals.org]

Etiology

  • The clinical presentation and the patient’s history of extrapulmonary tuberculosis involving the genitourinary tract suggested the possibility of disseminated tuberculosis as the etiology for the patient’s brain and spinal cord lesions; however, in light[ajnr.org]
  • The min PSR was helpful in differentiating metastases from glioblastoma and lymphoma, with an optimum cutoff of 136% and min PSR of Table 4: Decision thresholds Discussion An intracranial contrast-enhancing lesion can have many different etiologies, including[ajnr.org]

Epidemiology

  • Epidemiologic considerations". Neurology. 22 (1): 40–8. doi : 10.1212/WNL.22.1.40. PMID 5061838. Walker AE, Robins M, Weinfeld FD (February 1985). "Epidemiology of brain tumors: the national survey of intracranial neoplasms".[en.wikipedia.org]
  • The descriptive epidemiology of obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2006 ; 30 ( 3 ): 327 – 337. Epub ahead of print Jan 18. 3. American Psychiatric Association.[cambridge.org]
  • Performance of specific immunohistochemical, molecular, or other assays will be determined using clinical and epidemiologic information provided by the submitter and the histopathologic features identified in the submitted tissue specimens.[cdc.gov]
  • Cutaneous malignant melanoma - Clinical epidemiology and survival. J Indian Med Assoc 1998;96:19-20, 28. 15. Srodon M, Westra WH.[ijpmonline.org]
  • The epidemiological challenge of the most frequent eye cancer: retinoblastoma, an issue of birth and death. Br J Ophthalmol. 2009;93:1129–31. View Article PubMed Google Scholar Abramson DH, Schefler AC. Update on retinoblastoma.[bmcophthalmol.biomedcentral.com]
Sex distribution
Age distribution

Pathophysiology

  • Much needs to be learned about the pathophysiology of CNS metastasis at a molecular level.[clincancerres.aacrjournals.org]
  • This would include: A nationally recognized population based examination or some other system of certification; Adoption of CNS curriculum that contains three core graduate-level courses: advanced physiology/pathophysiology, physical/health assessment[nacns.org]

Prevention

  • Areas for future research include the need for an understanding of site-specific metastasis, effective anticancer strategies for sanctuary sites, assays to detect drug accumulation in sanctuary sites, prevention of CNS metastasis, improving the therapeutic[ncbi.nlm.nih.gov]
  • This led to the use of prophylactic cranial irradiation, which was effective in preventing CNS relapse in ALL.[clincancerres.aacrjournals.org]
  • If the drug seems to be working for a subject's tumor, subject will have the option to continue to receive it as part of a continuation study looking at the drug effect on preventing the tumor from recurring.[centerwatch.com]
  • Prause 1 , S Heegaard 1 1 Eye Pathology Section, Department of Neuroscience and Pharmacology, University of Copenhagen, Denmark 2 Department of Experimental Clinical Oncology, Aarhus University Hospital, Centre for Cancer Documentation, Department of Prevention[bjo.bmj.com]
  • […] metastatic disease 4 The blood-barrier is reinforced by P-gp, a drug-efflux-transporter protein, which actively removes a broad range of P-gp substrates from the endothelial cell cytoplasm before they cross into the CNS 4 Certain transporter proteins may prevent[biooncology.com]

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