Metástasis cerebrales
*Correspondencia: Dr. Romà Massot i Punyet. Secció de Neurologia. Hos-pital Universitari Joan XXIII. Dr. Mallafrè, 4. E-43007 Tarragona. Fax:+34 9772 24011. E-mail: massot@comt.es
Introduction. Cancer and its metastatic complications are one of the most important types of disease due to their high morbidity and mortality (nearly 100%). In spite of the blood-brain barrier, the brain is one of the main targets. Paradoxically, the incidence of cerebral metastases (CM) has increased due to the progress of medical science. The clinical features of CM are particularly seen in otoneurophthalmology (ONO).
Objective. To review the pathophysiology, etiology, prognosis, complemen-tary tests and clinical features of the CM, particularly the findings of most importance in ONO. Material and methods. Data on MC was obtained from MEDLINE and Cancerlit for the period 1991 to 2000. The cases of CM seen in three hospitals of different communities and levels of healthcare are also reviewed. Results. The CM are mainly situated in the cortical and juxtacortical zones, causing seizures which together with headache and mental and focal motor syndromes, make up the main clinical findings. Cancer of the lung and breast are the main causes of CM, whilst cancer of the prostate metastasises more to the base of the skull and spinal coverings. Melanoma has the greatest tendency to metastasise. In spite of surgery, radiotherapy and chemotherapy the average survival with CM is three months.
Conclusions. CM is a diagnosis which should be considered in patients of middle age or older. The lung is the most usual site of origin. In spite of the dreadful prognosis, the doctor plays a decisive part in both aggressive and palliative measures.
Objetivo Revisar la fisiopatología, etiología, pronóstico, pruebas complementarias y clínica de las MC, en especial las manifestaciones de mayor interés en ONO. Material y métodos. Se han vaciado las bases de datos MEDLINE y CancerLit desde 1991 hasta el 2000 referentes a MC. Se ha revisado la casuística sobre MC de tres hospitales de diferentes comunidades y distintos niveles asistenciales.
Resultados Las MC se ubican con preferencia en la zona cortical o yuxtacortical, justificando las crisis convulsivas, que, unidas a la cefalea y a un síndrome mental y focal motor, constituyen la clínica predominante. El cáncer de pulmón y el de mama son las principales fuentes de MC, mientras el de próstata prefiere la base de cráneo y el estuche medular. El melanoma destaca por su mayor capacidad para metastatizar. A pesar de la cirugía, radio y quimioterapia, la supervivencia promedio tras el diagnóstico de MC es de tres meses.
Conclusiones Las MC son un diagnóstico a considerar a partir de la edad media de la vida. El pulmón es el origen en la mayoría de casos. A pesar del pésimo pronóstico, el papel del médico es decisivo tanto para las medidas agresivas como paliativas.
