Early diagnosis of brain metastases in an unselected population of cancerous patients

Abstract

In a series of 50 unselected cases in whom brain metastases were later demonstrated by pathological examination, early clinical signs and symptoms, as well as paraclinical abnormalities were studied. These included electroencephalogram, brain scan, angiography, and analysis of cerebrospinal fluid. Two groups of patients could be distinguished. In the first group ( 22 patients) brain metastases were heralded by focal neurological symptoms. In these patients electroencephalogram, brain scan or angiography demonstrated focal lesions in 83%. In the second group ( 28 patients), diffuse symptoms of involvement of central nervous system were first observed. In these patients focal lesions were shown by the additional diagnostic procedures in only 42%. Determinations of proteins, LDH and GOT enzymes in the cerebrospinal fluid were of limited help. Neoplastic cells were found in only 10% of examined fluids. A striking increase of lipids was observed in 20% of the cerebrospinal fluids. This determination was not previously performed in a series of patients with brain metastases. The physiopathological signification of changes in lipid concentration of cerebrospinal fluid is discussed.