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Intramedullary tumors are treated by decompression and surgical excision (when feasible) and by irradiation The prognosis depends on the cause and severity of cord compression before it is relieved Treatment of epidural spinal metastases consists of irradiation, irrespective of cell type Dexamethasone is also given in a high dosage (eg, 25 mg four times daily for 3 days, followed by rapid tapering of the dosage, depending on response) to reduce cord swelling and relieve pain Surgical decompression is reserved for patients with tumors that are unresponsive to irradiation or have previously been irradiated and for cases in which there is some uncertainty about the diagnosis The long-term outlook is poor, but radiation treatment may at least delay the onset of major disability

Kastrup O et al Neuroimaging of infections NeuroRx 2005 Apr;2(2):324 32 [PMID: 15897953]

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A variety of nonmetastatic neurologic complications of malignant disease (see Table 39 13) can be recognized Metabolic encephalopathy due to electrolyte abnormalities, infections, drug overdose, or the failure of some vital organ may be reflected by drowsiness, lethargy, restlessness, insomnia, agitation, confusion, stupor, or coma The mental changes are usually associated with tremor, asterixis, and multifocal myoclonus The electroencephalogram is generally diffusely slowed Laboratory studies are necessary to detect the cause of the encephalopathy, which must then be treated appropriately Immune suppression resulting from either the malignant disease or its treatment (eg, by chemotherapy) predisposes patients to brain abscess, progressive multifocal leukoencephalopathy, meningitis, herpes zoster infection, and other opportunistic infectious diseases Moreover, an overt or occult cerebrospinal fluid fistula, as occurs with some tumors, may also increase the risk of infection CT scanning aids in the early recognition of a brain abscess, but metastatic brain tumors may have a similar appearance Examination of the cerebrospinal fluid is essential in the evaluation of patients with meningitis but is of no help in the diagnosis of brain abscess Cerebrovascular disorders that cause neurologic complications in patients with systemic cancer include nonbacterial thrombotic endocarditis and septic embolization Cerebral, subarachnoid, or subdural hemorrhages may occur in patients with myelogenous leukemia and may be found in association with metastatic tumors, especially malignant melanoma Spinal subdural hemorrhage sometimes occurs after lumbar puncture in patients with marked thrombocytopenia Disseminated intravascular coagulation occurs most commonly in patients with acute promyelocytic leukemia or with some adenocarcinomas and is characterized by a fluctuating encephalopathy, often with associated seizures, that frequently progresses to coma or death There may be few accompanying neurologic signs Venous sinus thrombosis, which usually presents with convulsions and headaches, may also occur in patients with leukemia or lymphoma Examination commonly reveals papilledema and focal or diffuse neurologic signs Anticonvulsants, anticoagulants, and drugs to lower the intracranial pressure may be of value Paraneoplastic cerebellar degeneration occurs most commonly in association with carcinoma of the lung Symptoms may precede those due to the neoplasm itself, which may be undetected for several months or even longer Typically, there is a pancerebellar syndrome causing dysarthria, nystagmus, and ataxia of the trunk and limbs The disorder probably has an autoimmune basis Treatment is of the underlying malignant disease Encephalopathy, characterized by impaired recent memory, disturbed affect, hallucinations, and seizures, occurs in some patients with carcinomas The cerebrospinal fluid is often abnormal EEGs may show diffuse slow-wave activity, especially over the temporal regions Pathologic changes are.

most marked in the inferomedian portions of the temporal lobes There is no specific treatment Malignant disease may be associated with sensorimotor polyneuropathy and less commonly with pure sensory neuropathy (ie, dorsal root ganglionitis) or autonomic neuropathy A subacute motor neuronopathy may be associated with lymphomas Dermatomyositis or a myasthenic syndrome may be seen in patients with underlying carcinoma (see 20) The myasthenic syndrome may have an autoimmune basis and differs clinically from myasthenia gravis

Darnell RB et al Paraneoplastic syndromes affecting the nervous system Semin Oncol 2006 Jun;33(3):270 98 [PMID: 16769417]

PSEUDOTUMOR CEREBRI (BENIGN INTRACRANIAL HYPERTENSION)

Headache, worse on straining Visual obscurations or diplopia may occur Level of consciousness may be impaired Other deficits depend on cause of intracranial hypertension or on herniation syndrome Examination reveals papilledema

There are many causes of pseudotumor cerebri Thrombosis of the transverse venous sinus as a noninfectious complication of otitis media or chronic mastoiditis is one cause, and sagittal sinus thrombosis may lead to a clinically similar picture Other causes include chronic pulmonary disease, endocrine disturbances such as hypoparathyroidism or Addison s disease, vitamin A toxicity, and the use of tetracycline or oral contraceptives Cases have also followed withdrawal of corticosteroids after long-term use In many instances, however, no specific cause can be found, and the disorder remits spontaneously after several months

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Symptoms of pseudotumor cerebri consist of headache, diplopia, and other visual disturbances due to papilledema and abducens nerve dysfunction Examination reveals the papilledema and some enlargement of the blind spots, but patients otherwise look well

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