Early diagnosis of brain metastases in an unselected population of cancerous patients

In a series of 50 unselected cases in whom brain metastasis was later demonstrated by pathological examination, early clinical signs and symptoms, as well as paraclinical abnormalities were studied. These included EEG, brain scan, angiography and analysis of CSF. Two groups of patients could be distinguished. In the first group (22 patients) brain metastasis was heralded by focal neurological symptoms. In these patients EEG, brain scan or angiography demonstrated focal lesions in 83%. In the second group (28 patients), diffuse symptoms of involvement of CNS were first observed. In these patients focal lesions were shown by the additional diagnostic procedures in only 42%. Determinations of proteins, LDH and GOT enzymes in the CSF were of limited help. Neoplastic cells were found in only 10% of examined fluids. A striking increase of lipids was observed in 20% of the CSF. This determination was not previously performed in a series of patients with brain metastasis. The physiopathological signification of changes in lipid concentration of CSF is discussed.SCOPUS: ar.j