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Continuum,
October 2005,
Volume 11,
Issue 5
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faculty.
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editor's preface.
- Miller, Aaron
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brain metastases.
- Burri, Stuart, Asher, Anthony
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Show/Hide Abstract
Brain metastases are the most common problem in neuro-oncology. The overall survival of patients with brain metastases is generally poor, but based upon various prognostic factors some patients have relatively long survivals. Whole brain radiation therapy for 2 to 4 weeks is the mainstay of treatment of brain metastases. Aggressive local therapies with open surgical resection or stereotactic radiosurgery have been shown to improve overall survival in some patients with solitary brain metastases. Optimal management of brain metastases is best accomplished with a multidisciplinary team.(C) 2005 American Academy of Neurology
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metastatic spinal cord disease.
- Schiff, David
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Show/Hide Abstract
Spinal cord dysfunction from neoplastic compression is a devastating complication of cancer. This chapter covers the most common causes of spinal cord compression: epidural metastases and intramedullary spinal cord metastases. Less common causes of spinal cord dysfunction associated with cancer, including radiation myelopathy, paraneoplasia, and carcinomatous meningitis, are reviewed elsewhere in this issue. Improvements in neuroimaging, surgical, and radiation techniques have occurred and will continue to improve the outcome from spinal cord compression, but early diagnosis remains the cornerstone of preserved neurological function.(C) 2005 American Academy of Neurology
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leptomeningeal and peripheral nerve metastases.
- Drappatz, Jan, Batchelor, Tracy
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Show/Hide Abstract
Leptomeningeal metastasis (LM) occurs when cancer cells enter cerebrospinal fluid (CSF) pathways, causing either multifocal or diffuse infiltration of the subarachnoid space of the brain and spinal cord. The terms leptomeningeal carcinomatosis or carcinomatous meningitis are used if the primary tumor is a carcinoma, whereas lymphomatous or leukemic meningitis applies to patients with hematologic malignancies. LM has become an increasingly important late complication of cancer, as survival from systemic disease increases and newer chemotherapies fail to penetrate the blood-brain barrier. The hallmark of clinical presentation is a cancer patient with multifocal neurological dysfunction. The clinical course is relentlessly progressive, with most individuals surviving for only a few months. Occasionally, patients respond well to treatment, resulting in prolonged survival and improvement of their neurological function. Progress in diagnostic modalities and the development of more effective therapeutics may decrease neurological morbidity and improve quality of life and survival. Neoplastic involvement of the peripheral nervous system is much less common. The mechanisms are diverse and include local invasion or compression, eg, of the brachial plexus in breast carcinoma. Direct infiltration of nerves, perineurial spread, and intraneural metastasis causing painful neuropathies are rare.(C) 2005 American Academy of Neurology
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paraneoplastic disorders of the nervous system.
- Bataller, Luis, Dalmau, Josep
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Show/Hide Abstract
Evidence indicates that many paraneoplastic neurological disorders (PNDs) are immune mediated. These disorders can affect any part of the nervous system and usually develop before the presence of a cancer is known, complicating their recognition and resulting in diagnostic delays. The diagnosis of PND is usually based on the recognition of the neurological syndrome, the demonstration of the associated cancer, and the detection of serum or cerebrospinal fluid (CSF) paraneoplastic antibodies. Despite the utility of these antibodies, they do not supersede the importance of the clinical assessment because some antibodies can be detected in cancer patients without PNDs and, conversely, many patients with PNDs do not have detectable antibodies. This chapter focuses on the comprehensive diagnostic approach to PNDs, emphasizing the importance of the clinical assessment, and reviews the most frequent syndromes and treatment strategies.(C) 2005 American Academy of Neurology
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neurological effects of therapeutic irradiation.
- Taphoorn, Martin, Bromberg, Jacoline
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Show/Hide Abstract
Apart from beneficial effects, therapeutic irradiation may have side effects on various parts of the nervous system: although neurons are resistant to radiation, glial tissue and blood vessels are not. Adverse effects may occur during radiotherapy or may be delayed from several weeks to many years. In addition, indirect adverse effects may occur due to damage to the hypothalamic-pituitary axis or large blood vessels or be caused by induction of secondary tumors. Most early complications are self-limiting, whereas delayed adverse effects are irreversible and difficult to treat. Increasing knowledge on the pathogenesis of and risk factors for these side effects, in combination with new radiation techniques, will help to decrease their incidence.(C) 2005 American Academy of Neurology
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neurological complications of chemotherapeutic and biological agents.
- New, Pamela
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Show/Hide Abstract
Treatment-related neurotoxicity is an important issue in neuro-oncology. Neurological side effects are common to many chemotherapeutic agents, and all levels of the nervous system are susceptible. Often neurotoxicity of these medications is dose-limiting, and even when this is not the case the side effects may compromise quality of life. Differentiating the complications of chemotherapy from other neurological complications of cancer is at times difficult. The incidence of neurotoxicity will increase as patients are surviving longer and being treated more aggressively with higher-dose regimens and combinations of treatment modalities. In this chapter the more common toxicities of chemotherapeutic and biological response modifiers are reviewed. Recognizing these complications and addressing them will become a more frequent and challenging clinical problem for practicing neurologists.(C) 2005 American Academy of Neurology
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appendix a: chemotherapy agents associated with neurotoxicity/ocular toxicity reported in 5% or greater of patients.
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index.
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multiple-choice questions.
- Lewis, Steven, Lynn, D.
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patient management problem.
- Chamberlain, Marc
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preferred responses.
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list of abbreviations.
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Managing Editor, Continuum and Quintessentials
aweiss@aan.com
(651) 695-2742
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