The spectrum of neurological disease in patients with systemic cancer

To ascertain the range of neurological problems in patients with systemic cancer, we prospectively evaluated neurological sysmptoms, neurological diagnoses, and primary tumors in all patients with a history of systemic cancer examined by the Department of Neurology at the Memorial Sloan–Kettering Ca...

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Veröffentlicht in:Annals of neurology 1992-03, Vol.31 (3), p.268-273
Hauptverfasser: Clouston, Paul D., DeAngelis, Lisa M., Posner, Jerome B.
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container_title Annals of neurology
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creator Clouston, Paul D.
DeAngelis, Lisa M.
Posner, Jerome B.
description To ascertain the range of neurological problems in patients with systemic cancer, we prospectively evaluated neurological sysmptoms, neurological diagnoses, and primary tumors in all patients with a history of systemic cancer examined by the Department of Neurology at the Memorial Sloan–Kettering Cancer Center, from Jul 1, 1990, to Dec 31, 1990. Of the 851 patients seen for neurological symptoms, less than half (45.2%) had metastatic involvement of the nervous system. The three most common symptoms were back pain (18.2%), altered mental status (17.1%), and headache (15.4%). The most common neurological diagnosis was brain metastasis (15.9%), followed by metabolic encephalopathy (10.2%), pain associated with bone metastases only (9.9%), and epidural extension or metastasis of tumor (8.4%). Of 133 patients with undiagnosed back or neck pain, 44 (33%) had epidural extension or metastases from tumor and 40 (30%) had pain associated with vertebral metastases only. In 15 (11%) the cause for the back pain was unrelated to metastatisc disease. Of 132 patients seen on initial consultation for altered mental status, metabolic encephalopathy was the major neurological diagnosis (80; 61%); 20 (15%) had intracranial metastases. Of 97 patients with undiagnosed headache, 59 (61%) had a nonstructural cause. Fifty‐three of these patients had either migraine, tension headache, or headache related to systemic illness (e.g., fever, sepsis). These results indicate that even in patients with systemic cancer, a group particularly prone to developing neurological disease that can be diagnosed radiologically, the role of clinicians remains important in helping distinguish noncancer‐related and nonmetastatisc neurological problems.
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Of the 851 patients seen for neurological symptoms, less than half (45.2%) had metastatic involvement of the nervous system. The three most common symptoms were back pain (18.2%), altered mental status (17.1%), and headache (15.4%). The most common neurological diagnosis was brain metastasis (15.9%), followed by metabolic encephalopathy (10.2%), pain associated with bone metastases only (9.9%), and epidural extension or metastasis of tumor (8.4%). Of 133 patients with undiagnosed back or neck pain, 44 (33%) had epidural extension or metastases from tumor and 40 (30%) had pain associated with vertebral metastases only. In 15 (11%) the cause for the back pain was unrelated to metastatisc disease. Of 132 patients seen on initial consultation for altered mental status, metabolic encephalopathy was the major neurological diagnosis (80; 61%); 20 (15%) had intracranial metastases. Of 97 patients with undiagnosed headache, 59 (61%) had a nonstructural cause. Fifty‐three of these patients had either migraine, tension headache, or headache related to systemic illness (e.g., fever, sepsis). 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Of the 851 patients seen for neurological symptoms, less than half (45.2%) had metastatic involvement of the nervous system. The three most common symptoms were back pain (18.2%), altered mental status (17.1%), and headache (15.4%). The most common neurological diagnosis was brain metastasis (15.9%), followed by metabolic encephalopathy (10.2%), pain associated with bone metastases only (9.9%), and epidural extension or metastasis of tumor (8.4%). Of 133 patients with undiagnosed back or neck pain, 44 (33%) had epidural extension or metastases from tumor and 40 (30%) had pain associated with vertebral metastases only. In 15 (11%) the cause for the back pain was unrelated to metastatisc disease. Of 132 patients seen on initial consultation for altered mental status, metabolic encephalopathy was the major neurological diagnosis (80; 61%); 20 (15%) had intracranial metastases. Of 97 patients with undiagnosed headache, 59 (61%) had a nonstructural cause. Fifty‐three of these patients had either migraine, tension headache, or headache related to systemic illness (e.g., fever, sepsis). These results indicate that even in patients with systemic cancer, a group particularly prone to developing neurological disease that can be diagnosed radiologically, the role of clinicians remains important in helping distinguish noncancer‐related and nonmetastatisc neurological problems.</description><subject>Adult</subject><subject>Antineoplastic Agents - adverse effects</subject><subject>Biological and medical sciences</subject><subject>Cerebrovascular Disorders - complications</subject><subject>Cerebrovascular Disorders - epidemiology</subject><subject>Child</subject><subject>Comorbidity</subject><subject>Consciousness Disorders - epidemiology</subject><subject>Consciousness Disorders - etiology</subject><subject>Female</subject><subject>Humans</subject><subject>Incidence</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Mental Disorders - complications</subject><subject>Mental Disorders - epidemiology</subject><subject>Movement Disorders - epidemiology</subject><subject>Movement Disorders - etiology</subject><subject>Neoplasm Metastasis - physiopathology</subject><subject>Neoplasms - classification</subject><subject>Neoplasms - complications</subject><subject>Neoplasms - epidemiology</subject><subject>Nervous System Diseases - epidemiology</subject><subject>Nervous System Diseases - etiology</subject><subject>Neurology</subject><subject>Osteoarthritis - complications</subject><subject>Osteoarthritis - epidemiology</subject><subject>Pain - epidemiology</subject><subject>Pain - etiology</subject><subject>Prospective Studies</subject><subject>Radiotherapy - adverse effects</subject><subject>Tumors of the nervous system. 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Phacomatoses</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Clouston, Paul D.</creatorcontrib><creatorcontrib>DeAngelis, Lisa M.</creatorcontrib><creatorcontrib>Posner, Jerome B.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>Annals of neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Clouston, Paul D.</au><au>DeAngelis, Lisa M.</au><au>Posner, Jerome B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The spectrum of neurological disease in patients with systemic cancer</atitle><jtitle>Annals of neurology</jtitle><addtitle>Ann Neurol</addtitle><date>1992-03</date><risdate>1992</risdate><volume>31</volume><issue>3</issue><spage>268</spage><epage>273</epage><pages>268-273</pages><issn>0364-5134</issn><eissn>1531-8249</eissn><coden>ANNED3</coden><abstract>To ascertain the range of neurological problems in patients with systemic cancer, we prospectively evaluated neurological sysmptoms, neurological diagnoses, and primary tumors in all patients with a history of systemic cancer examined by the Department of Neurology at the Memorial Sloan–Kettering Cancer Center, from Jul 1, 1990, to Dec 31, 1990. Of the 851 patients seen for neurological symptoms, less than half (45.2%) had metastatic involvement of the nervous system. The three most common symptoms were back pain (18.2%), altered mental status (17.1%), and headache (15.4%). The most common neurological diagnosis was brain metastasis (15.9%), followed by metabolic encephalopathy (10.2%), pain associated with bone metastases only (9.9%), and epidural extension or metastasis of tumor (8.4%). Of 133 patients with undiagnosed back or neck pain, 44 (33%) had epidural extension or metastases from tumor and 40 (30%) had pain associated with vertebral metastases only. In 15 (11%) the cause for the back pain was unrelated to metastatisc disease. Of 132 patients seen on initial consultation for altered mental status, metabolic encephalopathy was the major neurological diagnosis (80; 61%); 20 (15%) had intracranial metastases. Of 97 patients with undiagnosed headache, 59 (61%) had a nonstructural cause. Fifty‐three of these patients had either migraine, tension headache, or headache related to systemic illness (e.g., fever, sepsis). These results indicate that even in patients with systemic cancer, a group particularly prone to developing neurological disease that can be diagnosed radiologically, the role of clinicians remains important in helping distinguish noncancer‐related and nonmetastatisc neurological problems.</abstract><cop>Hoboken</cop><pub>Wiley Subscription Services, Inc., A Wiley Company</pub><pmid>1637135</pmid><doi>10.1002/ana.410310307</doi><tpages>6</tpages></addata></record>
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subjects Adult
Antineoplastic Agents - adverse effects
Biological and medical sciences
Cerebrovascular Disorders - complications
Cerebrovascular Disorders - epidemiology
Child
Comorbidity
Consciousness Disorders - epidemiology
Consciousness Disorders - etiology
Female
Humans
Incidence
Male
Medical sciences
Mental Disorders - complications
Mental Disorders - epidemiology
Movement Disorders - epidemiology
Movement Disorders - etiology
Neoplasm Metastasis - physiopathology
Neoplasms - classification
Neoplasms - complications
Neoplasms - epidemiology
Nervous System Diseases - epidemiology
Nervous System Diseases - etiology
Neurology
Osteoarthritis - complications
Osteoarthritis - epidemiology
Pain - epidemiology
Pain - etiology
Prospective Studies
Radiotherapy - adverse effects
Tumors of the nervous system. Phacomatoses
title The spectrum of neurological disease in patients with systemic cancer
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