Solitary brainstem metastasis

Progressive cranial nerve palsies and long-tract signs without increased intracranial pressure developed in three patients. All had a history of cancer, but two had been in remission for more than 5 years and were thought to be cured of the malignancy. The patients were treated with cranial irradiation and glucocorticoids, following which one patient made a dramatic neurologic recovery. In each case, postmortem examination showed a brainstem metastasis with no metastatic lesions elsewhere in the nervous system. An occult metastasis should be considered when signs or symptoms suggest brainstem tumor in an adult.