[Brain metastases as primary manifestation of non-small cell bronchogenic carcinomas]

While brain metastases from small cell lung cancer are a familiar problem, the incidence of brain metastases from non-small cell lung cancer, and their significance as the first tumor manifestation, has been underestimated. At the University Hospital, Basle, over one year, 7 (approximately 7%) of 102 patients with newly diagnosed non-small cell lung cancer had brain metastases as the first manifestation of systemic cancer. Three of the 7 patients were women with a mean age of 48 years. Initial symptoms were headaches, vertigo and vomiting, which prompted the diagnosis of brain metastases. In only 3 patients was the primary lung cancer diagnosed immediately after diagnosis of the brain metastases, while in the remaining 4 a period of up to 6 months elapsed. Bronchogenic cancer is the most frequent primary in patients presenting with brain metastases. Accordingly, in a patient with brain metastases from an unknown primary, bronchogenic cancer should be considered first and diagnostic tests aimed in that direction. This may obviate an extended and expensive diagnostic workup.