Abstract:
:Brain metastases occur in 20-40% of patients with cancer and their frequency has increased over time. Lung, breast and skin (melanoma) are the commonest sources of brain metastases, and in up to 15% of patients the primary site remains unknown. After the introduction of MRI, multiple lesions have outnumbered single lesions. Contrast-enhanced MRI is the gold standard for the diagnosis. There are no pathognomonic features on CT or MRI that distinguish brain metastases from primary malignant brain tumors or nonneoplastic conditions: therefore a tissue diagnosis by biopsy should be always obtained in patients with unknown primary tumor before undergoing radiotherapy and/or chemotherapy. Some factors are prognostically important: a high Performance Status, a solitary brain metastasis, an absence of systemic metastases, a controlled primary tumor and a younger age. Based on these factors, subgroups of patients with different prognosis have been identified (RPA class I, II, III). Symptomatic therapy includes corticosteroids to reduce vasogenic cerebral edema and anticonvulsants to control seizures. In patients with newly diagnosed brain metastases prophylactic anticonvulsants should not be used routinely. The combination of surgery and whole-brain radiotherapy (WBRT) is superior to WBRT alone for the treatment of single brain metastasis in patients with limited or absent systemic disease and good neurological condition. Complete surgical resection allows a relief of intracranial hypertension, seizures and focal neurological deficits. Radiosurgery, alone or in conjunction with WBRT, yields results which are comparable to those reported after surgery followed by WBRT, provided that lesion's diameter does not exceed 3-3.5 cm. Radiosurgery offers the potential of treating patients with surgically inaccessible metastases. Still controversial is the need for WBRT after surgery or radiosurgery: local control seems better with the combined approach, but overall survival does not improve. Late neurotoxicity in long surviving patients after WBRT is not negligible; to avoid this complication patients with favorable prognostic factors must be treated with conventional schedules of RT, and monitoring of cognitive functions is important. WBRT alone is the treatment of choice in patients with single brain metastasis not amenable to surgery or radiosurgery, and with an active systemic disease, and in patients with multiple brain metastases. A small subgroup of these latter may benefit from surgery. The response rate of brain metastases to chemotherapy is similar to the response rate of the primary tumor and extracranial metastases, some tumor types being more chemosensitive (small cell lung carcinoma, breast carcinoma, germ cell tumors). New radiosensitizers and cytotoxic or cytostatic agents, and innovative technique of drug delivery are being investigated.
journal_name
J Neuroljournal_title
Journal of neurologyauthors
Soffietti R,Rudā R,Mutani Rdoi
10.1007/s00415-002-0870-6keywords:
subject
Has Abstractpub_date
2002-10-01 00:00:00pages
1357-69issue
10eissn
0340-5354issn
1432-1459journal_volume
249pub_type
杂志文章,评审abstract::Neuropsychological assessment is one of the main fields of activity of clinical neuropsychologists. Goals of this assessment are verification and description of cognitive and affective impairments as the consequence of brain damage. Included are examinations of basal and higher sensory functions, the intellectual prof...
journal_title:Journal of neurology
pub_type: 杂志文章
doi:10.1007/s00415-007-2004-7
更新日期:2007-05-01 00:00:00
abstract::The problem of making a decision in case of two clinical hypotheses is treated by the application of the Neyman-Pearson criterion. As an example, a pneumoencephalographic index (frontal horn width divided by septum-caudate distance) of two different diseases, Huntington's chorea and Parkinsonism, is analyzed. As the a...
journal_title:Journal of neurology
pub_type: 杂志文章
doi:10.1007/BF00314395
更新日期:1978-10-25 00:00:00
abstract::A patient with an infarct limited to the paramedian thalamus and upper mesencephalon on the right side suffered a conjugate upgaze palsy associated with a monocular paresis of downward gaze in the ipsilateral eye (vertical "one-and-a-half" syndrome). This paresis involved tonic and phasic components. Vertical oculocep...
journal_title:Journal of neurology
pub_type: 杂志文章
doi:10.1007/BF00313651
更新日期:1984-01-01 00:00:00
abstract::The seasonal occurrence of relapses was analysed retrospectively in a group of 53 patients with treated dermatomyositis (DM) or polymyositis (PM). In DM, the incidence of both myositic and cutaneous relapses was highest in summer whereas in the PM group relapses was more evenly distributed throughout the seasons but l...
journal_title:Journal of neurology
pub_type: 杂志文章
doi:10.1007/s004150200036
更新日期:2002-04-01 00:00:00
abstract:OBJECTIVE:Crossed aphasia (CA), usually referred to as an acquired language disturbance, is caused by a lesion in the cerebral hemisphere ipsilateral to the dominant hand, and the exact mechanism is not clear. The development of handedness is influenced by education and training and the impact of habitualization, while...
journal_title:Journal of neurology
pub_type: 杂志文章
doi:10.1007/s00415-018-8901-0
更新日期:2018-07-01 00:00:00
abstract::An 18-year-old man suffered from acute Sydenham chorea appearing coincidently with beta-haemolytic streptococcal throat infection. Imaging techniques documented lesions of basal ganglia and substantia nigra. In the early course of the disease vascular lesions may be important pathogenetic mechanisms of this acquired m...
journal_title:Journal of neurology
pub_type: 杂志文章
doi:10.1007/BF00858729
更新日期:1993-02-01 00:00:00
abstract:BACKGROUND:Delayed ischaemic neurological deficit (DID) following subarachnoid haemorrhage from aneurysm rupture (aSAH) is a serious complication and a major cause of mortality and morbidity. No empirical estimates of resource use and costs of patients with delayed ischaemic deficit compared to those without have been ...
journal_title:Journal of neurology
pub_type: 杂志文章
doi:10.1007/s00415-009-0034-z
更新日期:2009-03-01 00:00:00
abstract::Differentiation of herpes simplex virus (HSV) types 1 and 2 in cerebrospinal fluid of 17 patients with serologically diagnosed HSV encephalitis and meningitis or acute limbic encephalitis was determined by stringent hybridization of polymerase chain reaction--amplified DNAs. Ten of 17 patients were positive; six with ...
journal_title:Journal of neurology
pub_type: 杂志文章
doi:10.1007/BF00873514
更新日期:1994-08-01 00:00:00
abstract::The highest risk of subsequent stroke after a TIA occurs within the first week after the index event. However, the risk of stroke recurrence (SR) remains high during the first year of follow-up. We studied the temporal pattern and predictors of SR (at 7 days and from 7 days to 1-year follow-up). Between April 2008 and...
journal_title:Journal of neurology
pub_type: 杂志文章
doi:10.1007/s00415-014-7390-z
更新日期:2014-08-01 00:00:00
abstract:OBJECTIVE:Amyotrophic lateral sclerosis type 8 (ALS8) is a familial form of motor neuron disease, with predominance of lower motor neuron degeneration, and is caused by mutation of the vesicle-associated membrane protein-associated protein B (VAPB). We aimed to compare the cognitive profile of patients with ALS8 and he...
journal_title:Journal of neurology
pub_type: 杂志文章
doi:10.1007/s00415-019-09369-y
更新日期:2019-08-01 00:00:00
abstract::Patients in a minimally conscious state (MCS) show restricted signs of awareness but are unable to communicate. We assessed cerebral glucose metabolism in MCS patients and tested the hypothesis that this entity can be subcategorized into MCS- (i.e., patients only showing nonreflex behavior such as visual pursuit, loca...
journal_title:Journal of neurology
pub_type: 杂志文章
doi:10.1007/s00415-011-6303-7
更新日期:2012-06-01 00:00:00
abstract::Anti-N-Methyl-D-Aspartate receptor (NMDAR) encephalitis is an acute neurological disorder affecting children and adults. We aimed to compare the clinical characteristics, treatments, and outcomes between children and adults with anti-NMDAR encephalitis and to assess the probable risk factors. In this observational stu...
journal_title:Journal of neurology
pub_type: 杂志文章
doi:10.1007/s00415-016-8282-1
更新日期:2016-12-01 00:00:00
abstract::Auto-oxidation of levodopa generates toxic metabolites, such as free radicals, semiquinones and quinones. In vitro, levodopa is a powerful toxin that is lethal to cultures of neurones. This raises the concern that levodopa may also be toxic in vivo, and that chronic treatment with levodopa could induce further damage ...
journal_title:Journal of neurology
pub_type: 杂志文章,评审
doi:10.1007/pl00022914
更新日期:2000-04-01 00:00:00
abstract::This observational study examined the outcome of two different therapeutic strategies in the treatment of chronic neuropathic pain by including pregabalin (PGB) as mono- or add-on therapy in one of two treatment options. Patients with a pain score of > or =4, refractory to usual care for neuropathic pain for at least ...
journal_title:Journal of neurology
pub_type: 杂志文章
doi:10.1007/s00415-010-5504-9
更新日期:2010-08-01 00:00:00
abstract::The SOX10 transcription factor is involved in development of neural crest derivatives and fate determination in glial cells. SOX10 mutations have been found in patients with intestinal aganglionosis and depigmentation with deafness (Waardenburg-Hirschsprung). Associated neurological signs have been reported in some ca...
journal_title:Journal of neurology
pub_type: 杂志文章
doi:10.1007/s004150170159
更新日期:2001-06-01 00:00:00
abstract::We report the case of a 17.5-year old girl with generalized myasthenia gravis (MG). When she was 13, she started to complain of episodic diplopia, ptosis and mild fatigability of upper and lower extremity muscles. She was diagnosed with MG 3 years later, after exacerbation of her limb muscle weakness. Acetylcholine re...
journal_title:Journal of neurology
pub_type: 信件
doi:10.1007/s00415-009-5215-2
更新日期:2009-10-01 00:00:00
abstract:BACKGROUND:Late-onset Pompe disease (LOPD) is a rare, metabolic disease primarily affecting the musculoskeletal and respiratory systems. Forced vital capacity (FVC) is commonly used to measure pulmonary function; however, associations between FVC and other LOPD outcomes remain unclear. METHODS:A systematic literature ...
journal_title:Journal of neurology
pub_type: 杂志文章,meta分析
doi:10.1007/s00415-019-09401-1
更新日期:2019-09-01 00:00:00
abstract::The effect of local cooling was studied in 28 patients with myastenia gravis. We stimulated the ulnar nerve with single stimuli and trains at 3/s for 2s and at 50/s for 1.5 s. The compound muscle action potential (MAP), the muscle twitch and the isometric tetanic force of the adductor pollicis were registered. 1. At 3...
journal_title:Journal of neurology
pub_type: 杂志文章
doi:10.1007/BF00314051
更新日期:1977-11-01 00:00:00
abstract::18FDG-positron emission tomography performed at different stages in the course of subacute sclerosing panencephalitis revealed a changing pattern of metabolic disturbance. In clinical stage II patients the inflammation in the basal ganglia appeared to lead to neuronal excitation accompanied by hypermetabolism. Widespr...
journal_title:Journal of neurology
pub_type: 杂志文章
doi:10.1007/BF00833917
更新日期:1992-03-01 00:00:00
abstract::Functional changes in the organisation of neuronal circuitries are generally used to explain parkinsonian motor symptoms and levodopa-induced dyskinesias. Based on information from histology and neurophysiological microrecordings of specific basal ganglia nuclei, the most widely accepted scheme is based on a central l...
journal_title:Journal of neurology
pub_type: 杂志文章,评审
doi:10.1007/pl00007765
更新日期:2000-04-01 00:00:00
abstract::Cerebellar ataxia can have many genetic causes among which are the congenital disorders of glycosylation type I (CDG-I). In this group of disorders, a multisystem phenotype is generally observed including the involvement of many organs, the endocrine, hematologic and central nervous systems. A few cases of CDG-Ia have...
journal_title:Journal of neurology
pub_type: 杂志文章
doi:10.1007/s00415-007-0546-3
更新日期:2007-10-01 00:00:00
abstract::The APOE*4 allele of the apolipoprotein E gene increases the risk of Alzheimer's disease (AD), but whether it also affects the course of the disease is controversial. However, all studies on this issue until now have been based on patients at various stages of disease. In the present population-based study, 97 patient...
journal_title:Journal of neurology
pub_type: 杂志文章
doi:10.1007/s004150050351
更新日期:1999-04-01 00:00:00
abstract::Disturbances of balance, gait and posture are a hallmark of parkinsonian syndromes. Recognition of these axial features can provide important and often early clues to the nature of the underlying disorder, and, therefore, help to disentangle Parkinson's disease from vascular parkinsonism and various forms of atypical ...
journal_title:Journal of neurology
pub_type: 杂志文章,评审
doi:10.1007/s00415-019-09382-1
更新日期:2020-11-01 00:00:00
abstract::The management of high-grade glioma (HGG) has evolved significantly over the last decade. Patients are managed in a multidisciplinary team setting in order to ensure their care is guided by the most current evidenced based treatments. The outcome in patients with HGG, while still poor, has improved in terms of both su...
journal_title:Journal of neurology
pub_type: 杂志文章,评审
doi:10.1007/s00415-013-7032-x
更新日期:2014-04-01 00:00:00
abstract:BACKGROUND:Cerebral venous thrombosis (CVT) is associated with intracranial hemorrhage. AIM:To identify clinical and imaging features of CVT-associated intracranial hemorrhage. We hypothesized that higher clot burden would be associated with a higher risk of intracranial hemorrhage. METHODS:We performed a retrospecti...
journal_title:Journal of neurology
pub_type: 杂志文章
doi:10.1007/s00415-020-10008-0
更新日期:2020-11-01 00:00:00
abstract::The effect of furosemide (Lasix) therapy on a standardized experimental cerebral edema, induced in rats by applying a cooling stamp to the right side of the skull over the right coronal suture by means of a stereotactic instrument, was examined. The hemispherically separated water and electrolyte contents of the brain...
journal_title:Journal of neurology
pub_type: 杂志文章
doi:10.1007/BF00705536
更新日期:1979-05-02 00:00:00
abstract::Multi-modality evoked potentials and computed cranial tomography (CT) were performed in ten patients with Wilson's disease to determine if any of these studies would correlate reliably with neurologic status. While all four patients with CT abnormality had neurologic signs, two additional patients with neurologic find...
journal_title:Journal of neurology
pub_type: 杂志文章
doi:10.1007/BF00314035
更新日期:1985-01-01 00:00:00
abstract::Atrial fibrillation (AF) is a strong risk factor for first-ever stroke and stroke recurrence. The detection rate is low and detection is often costly and time-consuming. We evaluated the diagnostic yield of an external loop recorder (ELR) in patients with acute ischemic stroke or TIA, and assessed factors that are ass...
journal_title:Journal of neurology
pub_type: 杂志文章
doi:10.1007/s00415-014-7621-3
更新日期:2015-03-01 00:00:00
abstract::A woman affected by chronic progressive external ophthalmoplegia and muscle mitochondrial DNA deletion was studied by phosphorus magnetic resonance spectroscopy (31P-MRS) prior to and after 1 and 7 months of treatment with oral lipoic acid. Before treatment a decreased phosphocreatine (PCr) content was found in the oc...
journal_title:Journal of neurology
pub_type: 杂志文章
doi:10.1007/BF00873552
更新日期:1995-07-01 00:00:00
abstract::The concentration of neopterin was measured in serum samples taken from individuals infected with HTLV-I: 5 from asymptomatic individuals, 1 from a patient with adult T-cell leukaemia and 30 from patients with tropical spastic paraparesis (TSP). In addition, cerebrospinal fluid (CSF) was available from 22 of the TSP p...
journal_title:Journal of neurology
pub_type: 杂志文章
doi:10.1007/BF00810351
更新日期:1992-05-01 00:00:00