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21 Cards in this Set
- Front
- Back
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What are four neurologic complications of metastatic cancer?
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1. Brain Metastases
2. Spinal Cord Metastases 3. Leptomeningeal Metastases 4. Brachial/Lumbosacral Plexopathy |
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What are five non-metastatic neurologic complications of cancer?
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1. Metabolic Encephalopathy
2. Side Efx of Chemo 3. Radiation Injury 4. Cerebrovascular Disorders 5. CNS Infections 6. Paraneoplastic syndromes |
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What is the common etiology of most metastatic brain tumors?
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Embolization of tumor cells that arrest in the white matter just below the white/grey junction.
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What are the most common metastatic neurologic complications of cancer?
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Metastasis to cranial/intracranial contents. Parenchymal lesions being the most common.
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What are some complications of brain metastases?
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1. Hemorrhage (associated with melanoma, choriocarcinoma)
2. Mass effect resulting in displacement of normal infiltrating 3. Vasogenic/extracellular edema- due to absence of BBB in tumor epithelium allowing proteinacious infiltration |
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Characterize spinal cord metastasis and their common etiology.
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Commonly arise from bone metastasis resulting in extramedullary/extradural lesions.
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What is ESCC?
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Epidural Spinal Cord Compression (ESCC) complication arising from metastatic spinal cord mets that if untreated will result in ablation of the intraspinal space and damage to spinal nerve roots
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Characterize the pathophysiology of leptomeningeal metastasis (carcinomatous meningitis)?
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Diffuse infiltration of systemic/primary CNS tumor through blood stream into the subarachnoid space commonly secondary to adenocarcinoma from lung or breast origin.
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Describe typical findings of LP in patient carcinomatous meningitis.
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Elevated opening pressure, protein
Low glucose with primarily monocytes/lymphocytes...mltpl taps may be neccessary to establish a Dx. |
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Discuss Brachial/Lumbosacral Plexopathy.
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Tumor infiltration of a plexus presenting with pain following dermatomal patterns
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What is Pancoast's Syndrome?
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Superior pulmonary sulcus tumor is infiltration of the brachial plexus secondary to tumor in the apex of the lung.
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What is the primary neurological side effect of side effect of chemotherapy?
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1. Treatment induced neurotoxicity
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What are some side effects induced by vincristine?
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Peripheral, cranial and autonomic neuropathy affecting small fibers (anterolateral spinothalamic tract), pain and temperature impairment
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What are some side effects of anti-neoplastic glucocorticoids?
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Myopathy (msl weakness), psychosis, visual blurring, tremor, pseudotumor (steroids increase ICP)
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What is a major concern for patients taking methotrexate?
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MTX can induce Aspetic meningits
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What is the most common non-metastatic neurological complication of cancer.
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Metabolic encephalopathy (pts confused, disoriented and lethargic)
1. Electrolyte imabalance (hyper/hypocalcemia) 2. organ dysfunction (hyperammonemia, azotemia) 3. hormone production (SIADH, ectopic ACTH) |
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What is the pathophysiology of radiation injury?
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Radiation toxicity to normal tissues surrounding lesion such as increased ICP, radionecrosis, radiation induced neoplasms, plexopathy
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What is the most frequent cause of stroke in patients with solid tumors?
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Arterial thrombosis due to non bacterial thrombotic endocarditis
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What are paraneoplastic syndromes?
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Disorders of organ function occuring in association with cancer but not as a direct result of tumor mass or metastatic effect on tissue often preceding dx of cancer. Pathology is thought to be autoimmune reaction mounted against cancer to which target neurological tissue reacts.
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Why is it important to check platelet levels before performing an LP?
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Thrombocytopenic patients may be at risk for and epidural hematoma.
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What are side effects of cisplatin?
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Effects the large fiber system (dorsal column) impairing vibration/position sense. Hearing problems are irreversible!!!
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