Neurologic Aspects of Systemic Disease Part III PDF
Preview Neurologic Aspects of Systemic Disease Part III
HANDBOOK OF CLINICAL NEUROLOGY Series Editors MICHAEL J. AMINOFF, FRANC¸OIS BOLLER, AND DICK F. SWAAB VOLUME 121 EDINBURGH LONDON NEW YORK OXFORD PHILADELPHIA ST LOUIS SYDNEY TORONTO 2014 ELSEVIERB.V. Radarweg29,1043NX,Amsterdam,TheNetherlands ©2014,ElsevierB.V.Allrightsreserved. Nopartofthispublicationmaybereproducedortransmittedinanyformorbyanymeans,electronicor mechanical,includingphotocopying,recording,oranyinformationstorageandretrievalsystem,without permissioninwritingfromthepublisher.PermissionsmaybesoughtdirectlyfromElsevier’sRightsDepartment: phone:(þ1)2152393804(US)or(þ44)1865843830(UK);fax:(þ44)1865853333;e-mail: healthpermissions@elsevier.com.Youmayalsocompleteyourrequeston-lineviatheElsevierwebsiteat http://www.elsevier.com/permissions. ThisbookandtheindividualcontributionscontainedinitareprotectedundercopyrightbythePublisher(otherthan asmaybenotedherein). ISBN:9780702040887 BritishLibraryCataloguinginPublicationData AcataloguerecordforthisbookisavailablefromtheBritishLibrary LibraryofCongressCataloginginPublicationData AcatalogrecordforthisbookisavailablefromtheLibraryofCongress Notice Knowledgeandbestpracticeinthisfieldareconstantlychanging.Asnewresearchandexperiencebroadenour understanding,changesinresearchmethods,professionalpractices,ormedicaltreatmentmaybecomenecessary. Practitionersandresearchersmustalwaysrelyontheirownexperienceandknowledgeinevaluatingandusing anyinformation,methods,compounds,orexperimentsdescribedherein.Inusingsuchinformationormethodsthey shouldbemindfuloftheirownsafetyandthesafetyofothers,includingpartiesforwhomtheyhaveaprofessional responsibility. Withrespecttoanydrugorpharmaceuticalproductsidentified,readersareadvisedtocheckthemostcurrent informationprovided(i)onproceduresfeaturedor(ii)bythemanufacturerofeachproducttobeadministered,to verifytherecommendeddoseorformula,themethodanddurationofadministration,andcontraindications.Itisthe responsibilityofpractitioners,relyingontheirownexperienceandknowledgeoftheirpatients,tomakediagnoses, todeterminedosagesandthebesttreatmentforeachindividualpatient,andtotakeallappropriatesafety precautions. Tothefullestextentofthelaw,neitherthePublishernorthecontributorsoreditors,assumeanyliabilityforany injuryand/ordamagetopersonsorpropertyasamatterofproductsliability,negligenceorotherwise,orfromanyuse oroperationofanymethods,products,instructions,orideascontainedinthematerialherein. ThePublisher PrintedinChina The Publisher's CommissioningEditor:ThomasE.Stone policy is to use DevelopmentEditor:MichaelParkinson paper manufactured from sustainable forests ProjectManager:AnithaKittusamyRamasamy Designer/DesignDirection:AlanStudholme HandbookofClinicalNeurology3rdSeries Availabletitles Vol.79,Thehumanhypothalamus:basicandclinicalaspects,PartI,D.F.SwaabISBN9780444513571 Vol.80,Thehumanhypothalamus:basicandclinicalaspects,PartII,D.F.SwaabISBN9780444514905 Vol.81,Pain,F.CerveroandT.S.Jensen,eds.ISBN9780444519016 Vol.82,Motorneuronedisordersandrelateddiseases,A.A.EisenandP.J.Shaw,eds.ISBN9780444518941 Vol.83,Parkinson’sdiseaseandrelateddisorders,PartI,W.C.KollerandE.Melamed,eds.ISBN9780444519009 Vol.84,Parkinson’sdiseaseandrelateddisorders,PartII,W.C.KollerandE.Melamed,eds.ISBN9780444528933 Vol.85,HIV/AIDSandthenervoussystem,P.PortegiesandJ.Berger,eds.ISBN9780444520104 Vol.86,Myopathies,F.L.MastagliaandD.HiltonJones,eds.ISBN9780444518996 Vol.87,Malformationsofthenervoussystem,H.B.SarnatandP.Curatolo,eds.ISBN9780444518965 Vol.88,Neuropsychologyandbehaviouralneurology,G.GoldenbergandB.C.Miller,eds.ISBN9780444518972 Vol.89,Dementias,C.DuyckaertsandI.Litvan,eds.ISBN9780444518989 Vol.90,Disordersofconsciousness,G.B.YoungandE.F.M.Wijdicks,eds.ISBN9780444518958 Vol.91,Neuromuscularjunctiondisorders,A.G.Engel,ed.ISBN9780444520081 Vol.92,Stroke–PartI:Basicandepidemiologicalaspects,M.Fisher,ed.ISBN9780444520036 Vol.93,Stroke–PartII:clinicalmanifestationsandpathogenesis,M.Fisher,ed.ISBN9780444520043 Vol.94,Stroke–PartIII:Investigationsandmanagement,M.Fisher,ed.ISBN9780444520050 Vol.95,Historyofneurology,S.Finger,F.BollerandK.L.Tyler,eds.ISBN9780444520081 Vol.96,Bacterialinfectionsofthecentralnervoussystem,K.L.RoosandA.R.Tunkel,eds.ISBN9780444520159 Vol.97,Headache,G.NappiandM.A.Moskowitz,eds.ISBN9780444521392 Vol.98,SleepdisordersPartI,P.MontagnaandS.Chokroverty,eds.ISBN9780444520067 Vol.99,SleepdisordersPartII,P.MontagnaandS.Chokroverty,eds.ISBN9780444520074 Vol.100,Hyperkineticmovementdisorders,W.J.WeinerandE.Tolosa,eds.ISBN9780444520142 Vol.101,Musculardystrophies,A.AmatoandR.C.Griggs,eds.ISBN9780080450315 Vol.102,Neuro-ophthalmology,C.KennardandR.J.Leigh,eds.ISBN9780444529039 Vol.103,Ataxicdisorders,S.H.SubramonyandA.Durr,eds.ISBN9780444518927 Vol.104,Neuro-oncologyPartI,W.GrisoldandR.Sofietti,eds.ISBN9780444521385 Vol.105,Neuro-oncologyPartII,W.GrisoldandR.Sofietti,eds.ISBN9780444535023 Vol.106,Neurobiologyofpsychiatricdisorders,T.SchlaepferandC.B.Nemeroff,eds.ISBN9780444520029 Vol.107,EpilepsyPartI,H.StefanandW.H.Theodore,eds.ISBN9780444528988 Vol.108,EpilepsyPartII,H.StefanandW.H.Theodore,eds.ISBN9780444528995 Vol.109,Spinalcordinjury,J.VerhaagenandJ.W.McDonaldIII,eds.ISBN9780444521378 Vol.110,Neurologicalrehabilitation,M.BarnesandD.C.Good,eds.ISBN9780444529015 Vol.111,PediatricneurologyPartI,O.Dulac,M.LassondeandH.B.Sarnat,eds.ISBN9780444528919 Vol.112,PediatricneurologyPartII,O.Dulac,M.LassondeandH.B.Sarnat,eds.ISBN9780444529107 Vol.113,PediatricneurologyPartIII,O.Dulac,M.LassondeandH.B.Sarnat,eds.ISBN9780444595652 Vol.114,Neuroparasitologyandtropicalneurology,H.H.Garcia,H.B.TanowitzandO.H.DelBrutto,eds. ISBN9780444534903 Vol.115,Peripheralnervedisorders,G.SaidandC.Krarup,eds.ISBN9780444529022 Vol.116,Brainstimulation,A.M.LozanoandM.Hallett,eds.ISBN9780444534972 Vol.117,Autonomicnervoussystem,R.M.BuijsandD.F.Swaab,eds.ISBN9780444534910 Vol.118,Ethicalandlegalissuesinneurology,J.L.BernatandH.R.Beresford,eds.ISBN9780444535016 Vol.119,NeurologicAspectsofSystemicDisease,J.BillerandJ.M.Ferro,eds.ISBN9780702040863 Vol.120,NeurologicAspectsofSystemicDisease,J.BillerandJ.M.Ferro,eds.ISBN9780702040870 Foreword Although neurology and psychiatry are closely linked specialties, many neurologists see their specialty as part of internalmedicine.Indeed,neurologydepartmentsintheUnitedStatesoftenbeganasdivisionswithindepartments ofinternalmedicine,attestingtotheirspecialrelationship.Withtheevolutionofneurologyasanindependentdisci- pline,ithasbecomeparticularlyimportantforitspractitionerstoremainfamiliarwiththeneurologicaspectsofsys- temic diseases as well as with the systemic aspects of neurologic disorders. This has been recognized since the Handbook of Clinical Neurology was founded by Pierre Vinken and George Bruyn, with volume 1 appearing in December 1968. That first series concluded in 1982 and was followed by a second series, edited by them, that concluded—in turn—in 2002. We then took over as editors of the current third series, with volume 79 appearing inlate2003andseveralvolumesappearingannuallysincethen. Twovolumes(38and39)werepublishedinthefirstseriesoftheHandbook,focusingontheneurologicmanifes- tationsofsystemicdiseases.Thesecondseriesincludedafurtherthreevolumes(63,70,and71)onthesametopic, publishedin1993and1998,withoneofus(MJA)servingasaneditorofthosevolumes.Advancesinthefield,but especiallyinimmunology,genetics,imaging,pharmacotherapeutics,andintensivecare,sincethattimehaveneces- sitatedareappraisalofthefieldandthepublicationofthreenewvolumesonthetopic.Wearethereforeparticularly delightedatthepublicationofthisscholarlycontributiontothemedicalandneurologicliteratureandwelcomeitas partoftheHandbook.Webelievethatitwillappealnotonlytoneurologistsbuttophysiciansinallspecialties,helping intheirinteractionswitheachotherandwiththeirpatients. ProfessorsJose´ BillerandJose´ M.Ferrohavetogetherproducedanauthoritative,comprehensive,anduptodate accountofthetopicandhaveassembledatrulyinternationalgroupofauthorswithacknowledgedexpertisetocon- tributetotheseimportantmultifacetedvolumes.Wearegratefultothemandtoallthecontributorsfortheireffortsin creatingsuchaninvaluableresource.Weareconfidentthatcliniciansinmanydifferentdisciplineswillfindmuchin thesevolumestoappealtothem. Itisapleasure,also,tothankElsevier,ourpublishers–andinparticularTomStone,MichaelParkinson,andKristi Anderson–forunfailingandexpertassistanceinthedevelopmentandproductionofthesevolumes. MichaelJ.Aminoff Franc¸oisBoller DickF.Swaab Preface Medicinehasalwaysbeeninastateofevolutionandtoday,morethanever,withtheacceleratedgrowthofscientific knowledge,patientsareevaluatedandtreatedbyteamsofphysicians.Theextensivebodyofknowledgeandthemajor scientificandclinicaladvancesinneurologyandinternalmedicineareagaindrawingbothspecialtiesclosertogether. Whateverthesubspecialtyareaofinterest,thenatureofmodernclinicalmedicinecallsformultidisciplinarycollab- orativeeffortstobettermeettheneedsofindividualpatients.Theaimofthesethreevolumesofthethirdseriesofthe HandbookofClinicalNeurologyistointegrateandprovideathoroughframeworkofthecoreneurologicmanifes- tations ofawidearray ofsystemicdisorders. Each chapterprovides acritical appraisaland extensivebackground informationregardingthevarietyofpresentationsofeachdisorder,thecharacteristicclinicalcourse,thetypicalneu- rologic manifestations of each disease, and current therapeutic strategies. Comprehensive and updated references alsobringforthvaluableresourcesforfurthertopicalreadingandresearch.Ourintendedaudienceincludesexperi- encedpractitionersandresidentsinneurology,neurosurgery,andinternalmedicine,aswellasotherhealthcarepro- fessionalsindifferentsubspecialtiescaringforthesechallengingpatients. Wehavepurposelydividedthesethreevolumesintochaptersuniformlyorganizedbyorgansystem,whicharefur- therdividedbyspecificconditionsanddiseasecategories.VolumeIisdedicatedtotheneurologicaspectsofcardio- pulmonary diseases, renal disorders, and selective rheumatologic and musculoskeletal disorders. Volume II encompasses core neurologic aspects of gastrointestinal and hepatobiliary disorders, endocrinologic diseases, and agamutofmetabolic,nutritionalandenvironmentalconditions.VolumeIIIconcentratesontheneurologicaspects of hematologic and oncologic disorders, organ transplantation, infectious diseases, and tropical neurology. It also includesamiscellaneousgroupofdisordersincludingneurodermatology,neurologicalcomplicationsofpregnancy, iatrogenicneurology,neuromusculardisordersintheintensivecaresetting,posteriorreversibleleukoencephalopathy and reversible cerebral vasoconstriction syndromes, neuro-Behcet’s, complications of neuroimaging, neuro- traumatology,andobservationspertainingtoneurologyinthedevelopingworld.Thesevolumesgobeyondthescope of classic neurology and examine the neurologic manifestations of a wide range of medical conditions, spanning mostareasofmedicine,thatneurologists,neurosurgeons,internists, andotherspecialistsmustdiagnoseandtreat ineverydaypractice. Wearehopefulthatthesethreevolumeswillcontributetothebestpossiblecareofpatientswiththesedisorders,and thatthereadershipwillfindthematerialinformative,authoritative,reliable,andstimulating Weareextremelygratefultoallthecontributorsfromacrosstheglobe,whobysharingtheirknowledgeandexper- tisemadethesevolumespossible.Tobringtofruitionaworkofthismagnituderequiresahighlyprofessionaleditorial effort,andforthiswethankLindaTurnerforherwonderfulorganizationalskillsandadministrativeexpertise,and MikeParkinsonandtheeditorialstaffatElsevierfortheirunfailingdedication,professionalism,andexpertassistance inthedevelopmentandproductionofthesethreevolumes. Jose´ Biller,MD Jose´ M.Ferro,MD Contributors H.M.Ahmed D.Dean DepartmentofNeurologicalSurgery,LoyolaUniversity DepartmentofInternalMedicine,IndianaUniversity, MedicalCenter,Maywood,IL,USA Indianapolis,IN,USA G.Akman-Demir O.H.DelBrutto DepartmentofNeurology,SchoolofMedicine,Istanbul SchoolofMedicine,UniversidaddeEspecialidades BilimUniversity,Istanbul,Turkey EspirituSantoandDepartmentofNeurological Sciences,HospitalClinicaKennedy,Guayaquil, Z.Argov Ecuador DepartmentofNeurology,Hadassah–Hebrew UniversityMedicalCenter,Jerusalem,Israel A.Didelot CentredeRe´fe´rence,deDiagnosticetdeTraitementdes J.F.Bale,Jr. SyndromesNeurologiquesParane´oplasiquesand DepartmentsofPediatricsandNeurology,Universityof INSERMU842,UMR-S842,Lyon,France UtahSchoolofMedicine,SaltLakeCity,UT,USA A.Ducros J.R.Berger DepartmentofNeurology,HoˆpitalGuideChauliac, DepartmentofNeurology,UniversityofKentucky Montpellier,France CollegeofMedicine,Lexington,KY,USA S.Edelstein M.Bilgrami DepartmentofAnesthesiology,LoyolaUniversity DepartmentofMedicine,LoyolaUniversityMedical MedicalCenter,Maywood,IL,USA Center,Maywood,IL,USA O.Fustinoni J.Biller INEBAInstituteofNeurosciencesandFacultyof DepartmentofNeurology,LoyolaUniversityChicago, Medicine,UniversityofBuenosAires,BuenosAires, StritchSchoolofMedicine,Maywood,IL,USA Argentina H.S.Block J.C.Garcia-Monco DepartmentofNeurology,LoyolaUniversityChicago, ServiceofNeurology,HospitaldeGaldacano, StritchSchoolofMedicine,Maywood,IL,USA Galdacano,Vizcaya,Spain M.C.Brouwer G.Godeneche DepartmentofNeurology,AcademicMedicalCenter, DepartmentofNeurology,CHULaMile´trie,Poitiers, Amsterdam,TheNetherlands France F.D.Dastur W.Grisold DepartmentofMedicine,P.D.HindujaNational DepartmentofNeurology,KaiserFranzJosepHospital, Hospital,Mumbai,India Vienna,Austria xii CONTRIBUTORS M.Guarino W.S.Jellish NeurologyUnit,S.Orsola-MalpighiUniversityHospital, DepartmentofAnesthesiology,LoyolaUniversity Bologna,Italy MedicalCenter,Maywood,IL,USA G.Guillet S.V.Khadilkar DepartmentofDermatology,CHULaMile´trie,Poitiers, DepartmentofNeurology,GrantMedicalCollegeand France SirJ.J.GroupofHospitalsandBombayHospital InstituteofMedicalSciences,Mumbai,India J.J.Halperin DepartmentofNeurosciences,OverlookMedical D.K.Kochar Center,Summit,NJ,USA MedicalResearch,RajasthanUniversityofHealth Sciences,Jaipur,India S.G.B.Heckenberg DepartmentofNeurology,KennemerGasthuis, C.Lamy Haarlem,TheNetherlands DepartmentofNeurology,Universite´ ParisDescartes, HoˆpitalSainte-Anne,Paris,France R.Helbok DepartmentofNeurology,MedicalUniversityHospital N.Latronico Innsbruck,Innsbruck,Austria DepartmentofAnesthesiaIntensiveCareand PostoperativeCare,DivisionofNeuroanaesthesiaand A.Heroux NeurocriticalCare,UniversityofBrescia,SpedaliCivili, HeartFailureandHeartTransplantProgram, Brescia,Italy LoyolaUniversityMedicalCenter,Maywood, IL,USA R.B.Love DepartmentofCardiothoracicSurgery,MedicalCollege { J.Hildebrand ofWisconsin,Milwaulkee,WI,USA Fe´de´rationdeNeurologieMazarin,GroupeHospitalier Pitie´-Salpeˆtrie`re,Paris,France C.R.Marino DepartmentofMedicine,UniversityofTennessee S.E.Hocker HealthScienceCenter,Memphis,TN,USA DivisionofCriticalCareNeurology,Collegeof Medicine,MayoClinic,Rochester,MN,USA J.L.Mas DepartmentofNeurology,Universite´ ParisDescartes, D.Holt HoˆpitalSainte-Anne,Paris,France DepartmentofSurgery,LoyolaUniversityMedical Center,Maywood,IL,USA S.Mathis DepartmentofNeurology,CHULaMile´trie,Poitiers, J.Honnorat France CentredeRe´fe´rence,deDiagnosticetde TraitementdesSyndromesNeurologiques E.Melian Parane´oplasiquesandINSERMU842,UMR-S842, DepartmentofRadiationOncology,LoyolaUniversity Lyon,France Chicago,StritchSchoolofMedicine,Maywood,IL, USA S.Hou DepartmentofMedicine,DivisionofNephrologyand A.A.Miravalle Hypertension,LoyolaUniversityMedicalCenter, DepartmentofNeurology,UniversityofColorado Maywood,IL,USA SchoolofMedicine,Aurora,CO,USA M.Jacewicz M.T.Mitchell DepartmentofNeurology,UniversityofTennessee DepartmentofRadiology,AdvocateChristHospital, HealthScienceCenter,Memphis,TN,USA OakLawn,IL,USA {(deceased) CONTRIBUTORS xiii J.M.K.Murthy G.C.Roma´n ContinentalInstituteofNeurosciences&Rehabilitation, DepartmentofNeurology,WeillCornellMedical ContinentalHospitals,IT&FinancialDistrict, College,MethodistNeurologicalInstitute,Houston, Gachibowli,Hyderabad,India TX,USA J-P.Neau K.L.Roos DepartmentofNeurology,CHULaMile´trie,Poitiers, DepartmentofNeurology,IndianaUniversitySchoolof France Medicine,Indianapolis,IN,USA P.O’Keefe J.D.Rosenblum DepartmentofMedicine,LoyolaUniversityMedical DepartmentofRadiology,LoyolaUniversity Center,Maywood,IL,USA Chicago,StritchSchoolofMedicine,Chicago, IL,USA C.Oppenheim DepartmentofNeurology,Universite´ ParisDescartes, R.Ruda` HoˆpitalSainte-Anne,Paris,France DivisionofNeuro-Oncology,Departmentof Neuroscience,UniversityandSanGiovanniBattista T.C.Origitano Hospital,Turin,Italy DepartmentofNeurologicalSurgery,LoyolaUniversity MedicalCenter,Maywood,IL,USA S.Saip DepartmentofNeurology,CerrahpasaSchoolof S.V.Pamboukian Medicine,IstanbulUniversity,Istanbul,Turkey SectionofAdvancedHeartFailure,CardiacTransplant, MechanicalCirculatorySupportandPulmonary V.Sanghi VascularDisease,UniversityofAlabamaat DivisionofNeurology,BombayHospitalandMedical Birmingham,Birmingham,AL,USA ResearchCentre,KEMHospitalandSethG.S.Medical College,Mumbai,India O.Pasternak DepartmentofRadiology,LoyolaUniversityChicago, E.Schmutzhard StritchSchoolofMedicine,Chicago,IL,USA DepartmentofNeurology,MedicalUniversityHospital Innsbruck,Innsbruck,Austria J.Ga´llegoPe´rez-Larraya DepartmentofNeurologyandNeurosurgery,Clinicof T.Schreiner theUniversityofNavarra,UniversityofNavarra, DepartmentofNeurology,Children’sHospital,Aurora, Pamplona,SpainandFe´de´rationdeNeurologie CO,USA Mazarin,GroupeHospitalierPitie´-Salpeˆtrie`re,Paris, France B.S.Singhal E.C.PerryIII DepartmentofNeurology,BombayHospitalInstituteof DepartmentofNeurologicalSurgery,LoyolaUniversity MedicalSciences.Mumbai,India MedicalCenter,Maywood,IL,USA A.Siva K.Potluri DepartmentofNeurology,CerrahpasaSchoolof DepartmentofMedicine,DivisionofNephrologyand Medicine,IstanbulUniversity,Istanbul,Turkey Hypertension,LoyolaUniversityMedicalCenter, Maywood,IL,USA E.M.Sizoo DepartmentofNeurology,VUUniversityMedical T.E.Rodriguez Center,Amsterdam,TheNetherlands Bone Marrow Transplantation Program, Loyola University Medical Center and Department of R.Soffietti Medicine, Loyola University Chicago, DivisionofNeuro-Oncology,Departmentof Stritch School of Medicine, Chicago, Neuroscience,UniversityandSanGiovanniBattista IL, USA Hospital,Turin,Italy xiv CONTRIBUTORS L.A.Sposato D.vandeBeek DepartmentofClinicalNeurologicalSciences,London DepartmentofNeurology,AcademicMedicalCenter, HealthSciencesCentre,UniversityofWesternOntario, Amsterdam,TheNetherlands London,Ontario,Canada E.F.M.Wijdicks A.Stracciari DivisionofCriticalCareNeurology,Collegeof NeurologyUnit,S.Orsola-MalpighiUniversityHospital, Medicine,MayoClinic,Rochester,MN,USA Bologna,Italy C.H.Wigfield C.Sundaram Department of Surgery, Section of Cardiac & DepartmentofPathologyNizam’sInstituteofMedical Thoracic Surgery, University of Chicago, Chicago, Sciences,Panjagutta,Hyderabad,India IL, USA M.J.B.Taphoorn S.A.Zˇivkovic´ DepartmentofNeurology,MedicalCenterHaaglanden, NeurologyService,DepartmentofVeteransAffairsand TheHague,Netherlands DepartmentofNeurology,UniversityofPittsburgh SchoolofMedicine,Pittsburgh,PA,USA E.Trevisan DivisionofNeuro-Oncology,Departmentof Neuroscience,UniversityandSanGiovanniBattista Hospital,Turin,Italy HandbookofClinicalNeurology,Vol.121(3rdseries) NeurologicAspectsofSystemicDiseasePartIII JoseBillerandJoseM.Ferro,Editors ©2014ElsevierB.V.Allrightsreserved Chapter77 { Brain metastases JAIMEGA´LLEGOPE´REZ-LARRAYA1,2*ANDJERZYHILDEBRAND2(deceased) 1DepartmentofNeurologyandNeurosurgery,ClinicoftheUniversityofNavarra,UniversityofNavarra,Pamplona,Spain 2F(cid:2)d(cid:2)rationdeNeurologieMazarin,GroupeHospitalierPiti(cid:2)-Salp(cid:3)tri(cid:4)re,Paris,France INTRODUCTION and the most common type of brain tumor in adults. Theyexceedthenumberofprimarybraintumorsatleast Despite better prevention and treatment advances fourfold. achievedduringthelastdecades,cancerisstillamajor Theincidenceofbrainmetastasesisthoughttoberis- public health concern and remains one of the leading inginthelastfewdecadesduetoacombinationoffac- causesofdeathworldwide(Lopezetal.,2006).Thecen- torsotherthanpopulationaging.First,improvementsin tralnervoussystem(CNS)isafrequenttargetformetas- and wider use of neuroimaging have resulted in an tasesfromsystemiccancer.Themostcommonlocation increasedandearlierdetectionofclinicallysilentmetas- ofCNSmetastasesisthebrainparenchyma,followedby tases. For example, routine brain scans are performed theleptomeningealspace. during the staging evaluation in neurologically asymp- Parenchymalmetastasesdifferfromleptomeningeal tomaticpatientswithnewlydiagnosedlungcancer(Shi disease in clinical presentation, treatment modalities, et al., 2006) or metastatic melanoma (Gavrilovic and andprognosis.However,theircombinationiscommon: Posner, 2005). Second, more effective treatments for on one hand, superficial brain lesions may invade the systemic disease have extended survival of cancer subarachnoidspace,andontheotherhand,primarylep- patients,leadingtoalargerpopulationatriskforbrain tomeningeal carcinomatosis often invades the brain metastases. Third, some highly effective anticancer parenchymaviaperivascularVirchow–Robinspaces. agentspoorlycrosstheblood–brainbarrier(BBB),and Thischapterdealsonlywithmetastasesrestrictedto are thereby unable to eradicate dormant micrometas- thebrainparenchyma. tasesinpatientswithcontrolledsystemicdisease. Everymalignanttumorisabletometastasizetothe INCIDENCEANDPRIMARYTUMORS brain.However,onlyalimitednumberaccountforthe The exact incidence of metastatic brain tumors is vast majority of brain metastases. In adults, three unknown. Most epidemiologic studies may underesti- tumors, lung and breast carcinomas and malignant mate their true incidence, in part because some brain melanoma,accountforupto75%ofbrainmetastases metastases remain asymptomatic, in part because even (Nussbaum et al., 1996; DeAngelis and Posner, 2009). symptomatic lesions are often ignored in severely ill Inchildrenandveryyoungadults,theprimarytumors patients with advanced primary disease (Gavrilovic most likely to metastasize to the brain are sarcomas andPosner,2005).Autopsyandclinicalstudiessuggest (osteogenic sarcoma, rhabdomyosarcoma, and thatbrainmetastasesoccurin10–30%ofadultpatients Ewing’s sarcoma) and germ cell tumors (Kebudi with systemic malignancies (Posner and Chernik, 1978; et al., 2005). Schoutenetal.,2002),thusrepresentingbyfarthemost Lung cancers arethemostcommonsourceofbrain frequent neurologic complication of systemic cancer metastases,accountingforatleastonehalfofthecases *Correspondence to: Jaime Ga´llego Pe´rez de Larraya, M.D., Ph.D., Department of Neurology and Neurosurgery, Clı´nica UniversidaddeNavarra,UniversidaddeNavarra,Avd.Pı´oXII,36,Pamplona31008,Spain.Tel:þ34-948-255400,Fax:þ34-948- 296500,E-mail:[email protected] {ThischapterisdedicatedtothememoryofProfessorJerzyHildebrand
The list of books you might like
