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Year : 2019  |  Volume : 8  |  Issue : 11  |  Page : 3726-3735

The spectrum of malignancies presenting with neurological manifestations: A prospective observational study

1 Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
2 Department of Pathology, RML Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
3 Department of Radiation Oncology, King George Medical University, Lucknow, Uttar Pradesh, India

Correspondence Address:
Dr. Ravindra K Garg
Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh - 226 003
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jfmpc.jfmpc_506_19

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Introduction: A neurological consultation is needed in nearly 45% of patients suffering from cancer. The present study was planned to evaluate the clinical, radiological and histopathological spectrum of patients with an underlying malignancy and presenting with a neurological complaint. Materials and Methods: We prospectively evaluated all patients provisionally diagnosed either with a primary or secondary malignancy of the brain on the basis of clinical, radiological and/or histopathological features. Results: A total of 155 patients were enrolled from a total of 4893 admissions done from January 2015 to July 2016. The common presenting symptoms were headache, back pain and paraparesis. Around 26% of patients presented with an altered sensorium, 19.4% with seizures and 21% had at least one cranial nerve involvement. The most common site of involvement was the brain noted in 49.7% of patients. Primary malignancies constituted 78 cases (50.7%) while secondary malignancies included 77 cases (49.3%). Magnetic resonance imaging (MRI) revealed 92 (59.4%) intra-axial lesions and 59 (38.1%) extra-axial lesions, with five cases having both. The most common diagnoses were intra-cerebral metastases and glioblastoma (intra-axial), and vertebral metastases and meningioma (extra-axial). Histopathological confirmation was obtained in 59 patients (38.1%) with 12 primary and 47 secondary lesions. Ten (6.45%) patients had an unknown primary with secondary metastases. The three most common histopathologically confirmed diagnoses were adenocarcinoma lung, plasma cell dyscrasia and adenocarcinoma prostate. Conclusion: Primary neurological consultations with an unknown primary are common hence a high index of suspicion can prevent an inadvertent delay in the diagnosis and appropriate treatment of a malignant lesion. Developing a neuro-oncology register may help us in gaining more insight into such situations.

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