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[Cerebral metastasis]
R Massot-Punyet1, J Almajano, J M Camacho
1Sección de Neurología, Hospital Universitari Joan XXIII, Tarragona, España. massot@comt.es
Introduction:
Cancer and its metastatic complications are one of the most important types of disease due to their high morbidity and mortality (nearly 100%). In spite of the blood-brain barrier, the brain is one of the main targets. Paradoxically, the incidence of cerebral metastases (CM) has increased due to the progress of medical science. The clinical features of CM are particularly seen in otoneurophthalmology (ONO).
Objective:
To review the pathophysiology, etiology, prognosis, complementary tests and clinical features of the CM, particularly the findings of most importance in ONO.
Material And Methods:
Data on MC was obtained from MEDLINE and Cancerlit for the period 1991 to 2000. The cases of CM seen in three hospitals of different communities and levels of healthcare are also reviewed.
Results:
The CM are mainly situated in the cortical and juxtacortical zones, causing seizures which together with headache and mental and focal motor syndromes, make up the main clinical findings. Cancer of the lung and breast are the main causes of CM, whilst cancer of the prostate metastasizes more to the base of the skull and spinal coverings. Melanoma has the greatest tendency to metastasize. In spite of surgery, radiotherapy and chemotherapy the average survival with CM is three months.
Conclusions:
CM is a diagnosis which should be considered in patients of middle age or older. The lung is the most usual site of origin. In spite of the dreadful prognosis, the doctor plays a decisive part in both aggressive and palliative measures.