47 Table 47.1 Cancer-related systemic disorders producing CNS symptomatology Table 47.2 CNS infections particularly associated with lymphomas, leukemias, and myeloma Table 47.3 CNS side-effects of cancer treatment Radiotherapy Encephalopathy Delayed myelopathy Hypothalamic/pituitary disturbances Oncogenesis – mainly meningioma, sarcoma, glioma Chemotherapy Encephalopathy and/or myelopathy (particularly after BCNU, L-asparaginase, intrathecal methotrexate) Cerebellar disorder (cytosine arabinoside) Table 47.4 Immunogenic paraneoplastic disorders affecting the nervous system aAntibody predominantly associated with syndrome; an identical paraneoplastic syndrome may occur with other antibodies/no detectable antibody.
Paraneoplastic disorders
Spread of the neoplasm to the nervous system (see Chapter 46).
Systemic metabolic and hemodynamic disturbances (Table 47.1).
Metabolic/endocrine disorders
Potential etiology
Hepatic failure
Liver metastases
Hypoglycemia
Consumption of glucose by disseminated sarcoma
Hyponatremia
Syndrome of inappropriate ADH secretion
Hypercalcemia
Bone metastases/inappropriate parathyroid hormone production
Cushing syndrome
Inappropriate (ectopic) ACTH production
Wernicke–Korsakoff syndrome
Thiamine deficiency secondary to emesis
Vascular disorders
Potential etiology
Encephalopathy/infarction–hyperviscosity
Waldenstrom’s macroglobulinemia
Infarction–hypercoagulability state
Mucin-secreting adenocarcinomas
Infarction
Polycythemia rubra vera
Embolic infarction
Marantic endocarditis
Hemorrhage
Reduced coagulation factors in hepatic failure
Thrombocytopenia in bone marrow failure
Infections secondary to immunosuppression produced by lymphoreticular neoplasms (Table 47.2).
Organism
Particular clinical association
Varicella zoster virus encephalitis
Hodgkin’s disease
Herpes simplex virus encephalitis
Hodgkin’s disease
Cytomegalovirus encephalitis
Acute lymphoblastic leukemia
Progressive multifocal leukoencephalopathy (JC papovavirus)
Various
Listeria infection
Post-splenectomy
Streptococcal meningitis
Post-splenectomy
Toxoplasmosis
Lymphoma
Cryptococcal meningoencephalitis
Various
CNS aspergillosis
Various
Side-effects of cancer therapy (Table 47.3).
Production of antibodies that simultaneously target onconeural antigens on neurons and neoplastic cells (Table 47.4), which is the subject of this chapter.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
