The spectrum of neurological complications in Pakistani patients with malignancies

To evaluate the incidence and nature of neurological complications related to malignancy in a tertiary care hospital in Pakistan.

A retrospective chart review was performed of patients with malignancy, having neurological symptoms, admitted to The Aga Khan University Hospital, Karachi, Pakistan.

There were a total of 178 admissions among 152 patients, with more than half (50.5%) of them above the age of 50, with a male to female ratio of 1.34:1. Most admissions (60%) occurred within the first year of diagnosis of the malignancy. Neurological problems were the second commonest cause for admission (20%) in our study group following admissions for chemotherapy/transfusions (52%). The most common primary tumour was Non-Hodgkin's Lymphoma (16.3%), followed by breast (15.7%), Acute Myeloid Leukemia (AML), (12.9%) and carcinoma of unknown primary site (9%). The 3 most common symptoms were altered mental status (45.3%), lower-limb weakness (27.9%) and seizures (17.3%). Fifteen percent of admissions were secondary to a neurological symptom as an initial presentation of the primary tumour. The commonest neurological diagnoses were brain metastasis (27%), followed by spinal cord compression (16.9%), intracerebral haemorrhage (11.2%) and metabolic encephalopathy (9%). Head imaging revealed abnormalities in 77% of patients. The most common neurological diagnosis for mortality (25.8%) was intracerebral haemorrhage (34.8%), followed by brain metastasis (26.1%).

This descriptive study on neurological complications amongst cancer patients from Pakistan, defines the various neurological symptoms and diagnoses in patients with malignant disorders, highlights the common tumour types, the associated characteristics and determinants of mortality in this Asian population.