Manifestations of extrathoracic spread

brain metastases lung cancer is the foremost common
cause of brain metastases. 68 there are a few information to suggest
that with improved disease management in locally advanced disease
increased incidence of brain metastases is being observed. 69, 70
the manifestations of brain metastases are variable and depend
on the location of the lesion and therefore the quantity of associated
edema and/or hemorrhage. patients could present with
headache, nausea/emesis, focal weakness, seizures, confusion,
ataxia, or visual disturbances. leptomeningeal carcinomatosis
could present as cranial nerve palsies. patients with persistent
headaches while not any structural abnormalities on brain imaging
ought to endure spinal fluid analysis for leptomeningeal
carcinomatosis. a positive cytology is found on an initial lumbar
puncture in 50% to 70% of the patients. in patients with
clinical signs and symptoms suggestive of leptomeningeal metastases,
repeat lumbar puncture is needed if the primary cytology
analysis is negative.
magnetic resonance imaging (mri) is clearly the gold
commonplace for identifying brain metastases and that is additional sensitive
than ct scanning. 71, 72 mri is an elementicularly useful when
resection of solitary brain metastases is being contemplated because
an mri scan with gadolinium contrast could reveal other
smaller lesions missed on ct scans. mri might conjointly be useful
within the diagnosis of leptomeningeal involvement.
initial management of brain metastases consists of corticosteroids
given intravenously or orally, primarily based on the patient’s
condition. 73 patients with seizures ought to be treated with antiseizure
medications. but, prophylactic use of antiseizure
medications isn't essential and carries with it a high potential
for adverse effects. 74 subsequent management of brain metastases
depends on size, variety, location of the lesions moreover as
the standing of the extracranial disease, and therefore the general condition
of the patient. 75
leptomeningeal carcinomatosis is a districticularly difficult
challenge in lung cancer patients. it's poorly responsive to
therapy and typically occurs within the setting of progressive systemic
disease. in selected patients, intrathecal chemotherapy
will be beneficial, however in several patients, supportive care alone
is optima