Metastatic brain tumors

- Case report -
Metastatic brain tumors - overview
• Brain metastases are the most common brain tumors, comprising over
50% of all brain tumors.

• At the time of the onset of neurological symptoms caused by brain

metastases, in over 70% of cases multiple tumors are found on brain MRI.
Metastatic brain tumors – overview (2)
• The route of dissemination in the case of brain metastases is generally hematogenous.

• If a single brain tumor is identified in a patient with a history of neoplasia, a biopsy

should be performed to rule out a diagnosis of the primary tumor.

• In the case of brain metastases, the average survival even with specialized treatment is
8 months
5 neoplasms that cause most brain metastases:

• Lung cancer
• Breast cancer
• Renal cell cancer
• Melanoma
• Gastro-intenstinal cancer
Metastatic brain tumor - presentation
• Symptoms that occur in brain metastases are common with other
intracranial expansive processes:
- Headache;
- Nausea and vomiting;
- Paresis;
- Seizures;
- Mental status changes (depression, apathy, confusion).
Metastatic brain tumor – imagistic evaluation
• CT: metastases may be hypointense, isointense, or hyperintense with surrounding
vasogenic edema.
Metastatic brain tumor – imagistic evaluation
• MRI:
- T1 (c+): the contrast can be captured evenly, dotted or in the form of a halo.
- T2 nativ: hyperintense typically occur.

T1 (c+)

T2 nativ
Treatment
• Drug treatment with Dexamethasone and Mannitol to reduce
intracranial pressure
• Chemotherapy, radiation therapy

• Surgical remove of metastases - palliative

Case report
• The 76-year-old patient presents with vertigo, temporo-spatial
disorientation started 2 months ago.

• In recent weeks he has felt a decrease in muscle strength in his

right side.
Neurological status :

• Conscious, confused, dizzy syndrome, right hemiparesis

4 / 5 MRC, no pyramidal signs.
Personal pathological history:

• Lung cancer treated surgically 5 years ago

• High blood pressure

• Diabetes
Imagistic evaluation IRM cerebral C+

Axial T1 (c+) Sagital T1 (c+)

Imagistic evaluation IRM cerebral C+

Axial T2 Sagital T2
Imagistic evaluation IRM cerebral C+

Coronal T1 (c+) Coronal T2

Surgical treatment
• Surgery is performed to ablate the left occipital tumor.
Postoperative CT aspect

sagital coronal
axial
Outcome

• The postoperative neurological status is similar to the preoperative one.

• The patient is referred to the oncology department.

Bibliografie:
• 1. Greenberg MS. Handbook of Neurosurgery. Ninth Edition; 2020
• 2. Stephen J. Haines. Evidence-Based Neurosurgery
• 3. Francesco Signorelli. Explicative cases of controversial issues in neurosurgery
• 4. E. Sander Connoly . Fundamental of Operative Techniques in Neurosurgery
• 5. Michael Sabel. Getting ready for brain tumor surgery