title: Neurological symptoms from a brain metastasis as the first presentation of colorectal cancer.
abstract: A 63-year-old man, a wheelchair user, from primary progressive multiple sclerosis (MS), presented with an episode of expressive dysphasia and confusion. Cerebral imaging revealed a solitary cerebral mass that was radiologically felt to be a primary brain tumour, but a brain biopsy demonstrated an adenocarcinoma in keeping with brain metastasis. Further immunohistochemistry suggested a probable colorectal primary. Subsequent staging confirmed a primary cancer within the caecum/terminal ileum, with extensive bilobar unresectable liver metastases. Unfortunately, as a consequence of the heavy tumour burden and rapid disease progression, the patient deteriorated rapidly and, due to his poor performance status, palliative chemotherapy was not deemed suitable. He was offered palliative whole brain radiotherapy to help control his symptoms, but he declined. He subsequently died at home a few weeks later, as per his wishes.
authors.affiliation: Department of Oncology, Royal Free London NHS Foundation Trust, London, UK.
authors.forename: Christina
authors.initials: C
authors.lastname: Chu
authors.affiliation: Department of Nuclear Medicine, Royal Free London NHS Foundation Trust, London, UK.
authors.forename: Shaunak
authors.initials: S
authors.lastname: Navalkissoor
authors.affiliation: Department of Oncology, Royal Free London NHS Foundation Trust, London, UK.
authors.forename: Roopinder
authors.initials: R
authors.lastname: Gillmore
mesh_terms: D001932:Brain Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000556:secondary*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology*; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000556:secondary; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis; D014057:Tomography, X-Ray Computed / Q000379:methods