title: The spectrum of neurological disease in patients with systemic cancer.
abstract: To ascertain the range of neurological problems in patients with systemic cancer, we prospectively evaluated neurological symptoms, 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 815 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 metastatic 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 nonmetastatic neurological problems.
authors.affiliation: Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
authors.forename: P D
authors.initials: PD
authors.lastname: Clouston
authors.forename: L M
authors.initials: LM
authors.lastname: DeAngelis
authors.forename: J B
authors.initials: JB
authors.lastname: Posner
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects; D002561:Cerebrovascular Disorders / Q000150:complications / Q000453:epidemiology; D002648:Child; D015897:Comorbidity; D003244:Consciousness Disorders / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000453:epidemiology; D009069:Movement Disorders / Q000453:epidemiology / Q000209:etiology; D009362:Neoplasm Metastasis / Q000503:physiopathology; D009369:Neoplasms / Q000145:classification / Q000150:complications / Q000453:epidemiology*; D009422:Nervous System Diseases / Q000453:epidemiology* / Q000209:etiology; D010003:Osteoarthritis / Q000150:complications / Q000453:epidemiology; D010146:Pain / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D011878:Radiotherapy / Q000009:adverse effects
chemical_list: D000970:Antineoplastic Agents