[Metastatic neurological complications in patients with cancer]

The neurological complications of patients with cancer may be classified as metatatic or non-metastatic.

The development of cerebral metastases (CM) is not only one of the complications most feared by patients, but also often leads doctors to withdraw the systemic treatment of cancer, although early diagnosis and treatment usually alleviates or resolves the neurological deficits, and improves the quality of life and prolongs it. Most CM are originated by embolization of neoplastic cells to the brain. They are therefore found in the region where grey and white matter meet. The commonest symptoms of CM are headache, convulsive crises, altered mental functions, motor deficits, ataxia and speech disorders. Cerebral MR and CT are the most useful investigations in CM. The tumours most frequently involved in metastatic spinal compression are cancer of the lung, prostate, breast and kidney, and non-Hodgkin lymphoma. MR is the investigation of choice, but if this cannot be done, or is contraindicated, myelography or medullary CT using subarachnoid contrast material should be used.

In this article we review the diagnosis and management of metastatic neurological complications, specifically cerebral metastases and spinal compression.