Snapshot A 67-year-old woman presents to the emergency department by her daughter due to an observed seizure-like event. The daughter states that this is the first time she has ever had a seizure. The daughter also reports that for the past few weeks she has had progressively worsening diffuse headaches, which are more severe in the morning, and accompanied by nausea. Medical history is significant for breast cancer. On physical exam, there is right-sided weakness in both upper and lower extremities. A head CT was obtained which showed hyperdense lesions with surrounding vasogenic edema. Introduction Most common intracranial malignancy in adults most commonly carcinomas such as lung breast kidney colorectal melanomas In children, most common sources are sarcomas neuroblastomas germ cell tumors Pathogenesis hematogenous spread (most commonly) usually found at gray-white matter junction Epidemiology > 50% of all intracranial tumors Presentation Highly variable clinical presentation must be suspected in patients with a history of malignancy who present with neurologic symptoms or behavioral abnormalities Symptoms headache morning headache is highly suggestive although it is uncommon nausea and vomiting cognitive dysfunction e.g., personality changes and altered mental status seizure of new onset stroke patients with malignancy are at risk of being hypercoagulable may hemorrhage into the metastasis tumor may compress artery Physical exam focal neurologic deficit e.g., hemiparesis location dependent papilledema Evaluation Contrast-enhanced MRI preferred for diagnosing brain metastasis features suggestive of metastasis multiple lesions lesions at grey-white matter junction vasogenic edema large when compared to lesion size Brain biopsy when diagnosis is unclear Differential Primary brain tumor Intracranial abscess Progressive multifocal leukoencephalopathy (PML) Cerebral infarction or hemorrhage Treatment Increased intracranial pressure dexamethasone Seizures phenytoin Radiation therapy Surgery stereotactic radiosurgery surgical resection neurosurgical resection is the standard for a single or limited number of metastases in a surgically accessible location Prognosis, Prevention, and Complications Prognosis if untreated, the median survival from solid tumors of brain metastases is ~ 1-2 months
QUESTIONS 1 of 2 1 2 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M2.ON.15.41) A 45-year-old female is admitted to the hospital after worsening headaches for the past month. She has noticed that the headaches are usually generalized, and frequently occur during sleep. She does not have a history of migraines or other types of headaches. Her past medical history is significant for breast cancer, which was diagnosed a year ago and treated with mastectomy. She recovered fully and returned to work shortly thereafter. CT scan of the brain now shows a solitary cortical 5cm mass surrounded by edema in the left hemisphere of the brain at the grey-white matter junction. She is admitted to the hospital for further management. What is the most appropriate next step in management for this patient? QID: 106285 Type & Select Correct Answer 1 Chemotherapy 10% (2/20) 2 Seizure prophylaxis and palliative pain therapy 5% (1/20) 3 Irradiation to the breasts 0% (0/20) 4 Irradiation to the brain mass 20% (4/20) 5 Surgical resection of the mass 60% (12/20) M 7 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept