Chapter 8 The role of surgery for brain metastases from solid tumors
Publication date: 2018 Source:Handbook of Clinical Neurology, Volume 149 Author(s): Niklas Thon, Friedrich-Wilhelm Kreth, Joerg-Christian Tonn Surgery, stereotactic radiosurgery, radiotherapy, and chemotherapy including novel targeted therapy strategies and any combination thereof as well as supportive care are the key elements for treatment of brain metastases. Goals of microsurgery are to obtain tissue samples for histologic diagnosis (particularly in case of uncertainty about the unknown primary tumor but also in the context of future targeted therapies), to relieve burden from space-occupying effects, to improve l...
Source: Handbook of Clinical Neurology - January 5, 2018 Category: Neurology Source Type: research
Chapter 7 Brain metastases: neuroimaging
Publication date: 2018 Source:Handbook of Clinical Neurology, Volume 149 Author(s): Whitney B. Pope Magnetic resonance imaging (MRI) is the cornerstone for evaluating patients with brain masses such as primary and metastatic tumors. Important challenges in effectively detecting and diagnosing brain metastases and in accurately characterizing their subsequent response to treatment remain. These difficulties include discriminating metastases from potential mimics such as primary brain tumors and infection, detecting small metastases, and differentiating treatment response from tumor recurrence and progression. Optimal pat...
Source: Handbook of Clinical Neurology - January 5, 2018 Category: Neurology Source Type: research
Chapter 6 Brain metastasis: clinical manifestations, symptom management, and palliative care
Publication date: 2018 Source:Handbook of Clinical Neurology, Volume 149 Author(s): Thomas Noh, Tobias Walbert Patients who have brain metastases can suffer from a medley of symptoms, including headaches, seizures, cognitive impairment, fatigue, and focal deficits. As therapies have evolved, so has the management of these symptoms as patients survive longer. This chapter focuses on the clinical presentation of brain metastases, the treatment of those symptoms, and palliation in end-of-life management. Brain metastases are the most common cerebral malignancy. They can present with various symptoms, which can have signif...
Source: Handbook of Clinical Neurology - January 5, 2018 Category: Neurology Source Type: research
Chapter 5 Metastatic diseases of the central nervous system – neuropathologic aspects
Publication date: 2018 Source:Handbook of Clinical Neurology, Volume 149 Author(s): M. Beatriz S. Lopes A large percentage of patients with cancer will develop brain metastases, and many of them will die within a few months following diagnosis of intracranial metastasis. Although the majority of the central nervous system metastases are derived from a well-known primary neoplasm, about 5–10% of brain metastases are from an unknown source, making the tissue diagnosis a first step in the search for a primary malignancy. The pathologist utilizes several immunohistochemical and molecular diagnostic tools for such investig...
Source: Handbook of Clinical Neurology - January 5, 2018 Category: Neurology Source Type: research
Chapter 4 Role of the blood –brain barrier in metastatic disease of the central nervous system
Publication date: 2018 Source:Handbook of Clinical Neurology, Volume 149 Author(s): Anna S. Berghoff, Matthias Preusser Systemic therapy is an important backbone in the multimodal treatment approach of brain metastases. However, the blood–brain barrier or, more correctly, the blood–tumor barrier, as the properties of tumor-associated vessels differ from the physiologic state, potentially limits the passage of systemic drugs. Indeed, several preclinical and clinical investigations showed that the distribution of drugs is very heterogeneous within a given brain metastasis, despite the contrast enhancement in magnetic...
Source: Handbook of Clinical Neurology - January 5, 2018 Category: Neurology Source Type: research
Chapter 3 Pathogenesis and biology
Publication date: 2018 Source:Handbook of Clinical Neurology, Volume 149 Author(s): Frank Winkler Metastasis to the brain is an increasing complication of solid cancers. Fortunately, our understanding of its pathogenesis has greatly increased in the last decade, with crucial insights into the molecular and cellular determinants of successful brain colonization; some aspects remain less well understood. The latter include the exact features of brain metastasis-initiating cancer cells, and a potential premetastatic niche. It is clear that a brain-arrested cancer cell has to master a sequence of steps to eventually grow to...
Source: Handbook of Clinical Neurology - January 5, 2018 Category: Neurology Source Type: research
Chapter 2 Brain metastases: epidemiology
Publication date: 2018 Source:Handbook of Clinical Neurology, Volume 149 Author(s): Quinn T. Ostrom, Christina Huang Wright, Jill S. Barnholtz-Sloan Brain metastases (BM) are the most commonly diagnosed type of central nervous system tumor in the United States. Estimates of the frequency of BM vary significantly, as there is no nationwide reporting system for metastases. BM may be the first sign of a previously undiagnosed cancer, or occur years or decades after the primary cancer was diagnosed. Incidence of BM varies significantly by primary cancer site. Lung, breast, and melanoma continue to be the leading cause of ...
Source: Handbook of Clinical Neurology - January 5, 2018 Category: Neurology Source Type: research
Chapter 1 Overview of metastatic disease of the central nervous system
Publication date: 2018 Source:Handbook of Clinical Neurology, Volume 149 Author(s): Craig Nolan, Lisa M. Deangelis In 2016, the American Society of Clinical Oncology reported that 1.7 million Americans were diagnosed with cancer; this number will rise to 2.3 million in the United States and 22 million worldwide in 2030. This rising need is being met by an explosion of new cancer therapies, including: immune checkpoint inhibitors, T-cell therapies, tumor vaccines, antiangiogenic therapies, and various targeted therapies. This armamentarium of targeted therapies has led to better systemic control of disease and longer pa...
Source: Handbook of Clinical Neurology - January 5, 2018 Category: Neurology Source Type: research
Chapter 17 Psychiatric syndromes other than dementia
Publication date: 2017 Source:Handbook of Clinical Neurology, Volume 146 Author(s): Karl Bechter, Florian Deisenhammer There is wide variability in how psychiatry guidelines and textbooks address the question of cerebrospinal fluid (CSF) diagnostics in the screening of psychiatric disorders. A United States-based textbook confirms that there is no consensus about which laboratory investigation should be routinely performed in psychiatric patients, but with respect to CSF diagnostics, the differences are even more striking. A survey among European experts showed a wide variety of opinions regarding clinical use and crit...
Source: Handbook of Clinical Neurology - October 28, 2017 Category: Neurology Source Type: research
Chapter 16 Primary headaches
Publication date: 2017 Source:Handbook of Clinical Neurology, Volume 146 Author(s): Gerrit L.J. Onderwater, Robin M. Van Dongen, Ronald Zielman, Gisela M. Terwindt, Michel D. Ferrari Headache disorders, characterized by recurrent headache, are among the most common disorders of the nervous system. Primary headache disorders are by definition not the result of any other underlying disease or process. In this chapter the current status of cerebrospinal fluid (CSF) research and applications for clinical practice for the three main primary headaches – migraine, cluster headache, and tension-type headache – will be d...
Source: Handbook of Clinical Neurology - October 28, 2017 Category: Neurology Source Type: research
Chapter 15 Epilepsy
Publication date: 2017 Source:Handbook of Clinical Neurology, Volume 146 Author(s): Susanne Fauser, Hayrettin Tumani Epilepsy is worldwide one of the most common neurologic diseases (prevalence 0.5–1%). The diagnostic procedure following a first epileptic seizure includes cerebral imaging, blood examinations, electroencephalography, and an investigation of the cerebrospinal fluid (CSF) in patients seen soon after a seizure in order to exclude dangerous causes which require immediate treatment. Basic CSF investigation comprises the determination of cell counts, glucose, and lactate levels in serum and CSF and of album...
Source: Handbook of Clinical Neurology - October 28, 2017 Category: Neurology Source Type: research
Chapter 14 Cerebrospinal fluid and brain extracellular fluid in severe brain trauma
Publication date: 2017 Source:Handbook of Clinical Neurology, Volume 146 Author(s): Raimund Helbok, Ronny Beer Traumatic brain injury is a major cause of morbidity and mortality worldwide. Pathophysiologic mechanisms of secondary brain injury are complex and still not fully understood. Cerebrospinal fluid deserves attention to detect infectious complications and to identify biomarkers of disease severity and impending secondary brain injury. As an adjunct, cerebral microdialysis (CMD) allows online measurements of biomarkers derived directly from brain extracellular fluid. We critically review relevant literature relat...
Source: Handbook of Clinical Neurology - October 28, 2017 Category: Neurology Source Type: research
Chapter 13 Vascular diseases and bleedings
Publication date: 2017 Source:Handbook of Clinical Neurology, Volume 146 Author(s): Harald Hegen, Michael Auer, Florian Deisenhammer Diseases of the central nervous system that are caused by an underlying vascular pathology typically result in either hemorrhage or ischemia. Most prominent entities include spontaneous subarachnoid hemorrhage, spontaneous intracerebral hemorrhage, and ischemic stroke. For anatomic reasons, cerebrospinal fluid (CSF) qualifies as body fluid for the exploration of biomarkers in these disorders. Even though in subarachnoid hemorrhage a few CSF parameters have been established for routine di...
Source: Handbook of Clinical Neurology - October 28, 2017 Category: Neurology Source Type: research
Chapter 12 CSF in acute and chronic infectious diseases
Publication date: 2017 Source:Handbook of Clinical Neurology, Volume 146 Author(s): Felix Benninger, Israel Steiner Infections of the nervous system are an important and challenging aspect of clinical neurology. Immediate correct diagnosis enables to introduce effective therapy, in conditions that without diagnosis may leave the patient with severe neurological incapacitation and sometimes even death. The cerebrospinal fluid (CSF) is a mirror that reflects nervous system pathology and can promote early diagnosis and therapy. The present chapter focuses on the CSF findings in neuro-infections, mainly viral and bacterial...
Source: Handbook of Clinical Neurology - October 28, 2017 Category: Neurology Source Type: research
Chapter 11 Impaired cerebrospinal fluid pressure
Publication date: 2017 Source:Handbook of Clinical Neurology, Volume 146 Author(s): Jan Hoffmann Abnormalities of cerebrospinal fluid (CSF) pressure are relatively common and may lead to a variety of symptoms, with headache usually being the most prominent one. The clinical presentation of alterations in CSF pressure may vary significantly and show a striking similitude to several primary headache syndromes. While an increase in CSF pressure may be of primary or secondary origin, a pathologic decrease of CSF pressure is usually the result of a meningeal rupture with a resulting leakage of CSF. The pathophysiologic mecha...
Source: Handbook of Clinical Neurology - October 28, 2017 Category: Neurology Source Type: research
