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Altered Mental Status in Cancer.

John Y Rhee1,2,3, Vihang Nakhate1,3,4, Christy Soares5

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Altered mental status (AMS) in cancer patients has many causes, including cancer spread and treatment side effects. This review outlines a clinical approach and cancer-specific causes of AMS.

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Area of Science:

  • Oncology
  • Neurology
  • Internal Medicine

Background:

  • Cancer patients frequently exhibit altered mental status (AMS).
  • Multiple factors contribute to AMS in cancer, including direct CNS invasion, leptomeningeal spread, and tumor-associated complications.
  • Cancer treatments and their sequelae, such as neurotoxicity, infections, and metabolic disturbances, can also precipitate AMS.

Purpose of the Study:

  • To describe a clinical approach for evaluating cancer patients with AMS.
  • To discuss the diverse etiologies of AMS in the cancer population.
  • To highlight cancer-specific differential diagnoses for AMS.

Main Methods:

  • Literature review focusing on altered mental status in cancer patients.
  • Discussion of common and cancer-specific causes of AMS.
  • Presentation of a clinical framework for diagnosis and management.

Main Results:

  • AMS in cancer patients stems from direct tumor effects, treatment toxicity, and systemic complications.
  • Common causes like toxic-metabolic encephalopathy and delirium are relevant, but cancer-specific factors require distinct consideration.
  • A systematic approach is crucial for identifying the underlying cause of AMS.

Conclusions:

  • Altered mental status in cancer patients is a complex issue with multifactorial origins.
  • A comprehensive differential diagnosis, including cancer-specific etiologies, is essential for effective management.
  • Clinical evaluation should integrate general neurological principles with cancer-specific considerations.