Encephalitic Form of Metastatic Carcinoma

Abstract

CARCINOMATOUS extension to the nervous system manifests itself in many fashions. Among these are solitary metastasis to the brain and multiple metastases of varying number and size. Less common, and not sufficiently recognized for either its pathological or its clinical features, is the encephalitic form of carcinomatous metastasis, which may closely simulate encephalitis of other types. It is to call attention to this form of metastatic carcinoma that the following cases are reported.REPORT OF CASES Case 1.\p=m-\J. A. (N.P. 42-154). Bronchiogenic carcinoma in a man aged 55, with an organic mental syndrome; later appearance of hemiparesis, aphasia, cerebellar signs and convulsive movements. Diffuse carcinomatous infiltration of the meninges, brain, brain stem, cerebellum and spinal cord.History.\p=m-\A white man aged 55 was first seen by one of us (B. J. A.) on July 26, 1942, at which time he stated that he was not as fit generally as he had been. His history was not very reliable, but his wife stated that he had begun to slow down 2l/2 years before examination. His gait became slow and careful, and, whereas he had formerly been a vig¬ orous, outgoing person, he had to urge himself to meet people. In addition, he had become irritable and sarcastic. The difficulty with the gait persisted, but he never lost his equilibrium. For six months he had noticed a shaking of both hands and had cut himself several times while shaving. He had observed that his scalp was sensitive over the top of his head, and he had a feeling of congestion in the frontal portion with tightness over both eyes. For three weeks he had noticed difficulty in finding words, and he had to remind his secretary to tell him what he wanted to discuss when calling on the telephone. His ability to concentrate was poor ; his speech had become less distinct, and he "mixed words," e. g., saying "potato" instead of "tomorrow." There was a past history of an operation for diverticulosis in November 1938, about 3 /2 years before examination. Two months prior to admission (May 1942) he fell from a bicycle and struck the left side of his head but seemed to have no definite injury. The positive neurological findings when he was first seen included pale, white optic nerve heads with blurred margins but no elevation of the disks. The retinal arteries were thin and moderately sclerotic. He had a coarse tremor of the lips ; a fine tremor on extension of the fingers increased in the finger to nose test, especially on the right side, and the deep reflexes were overactive. The abdominal reflexes were absent. In addition, there were impairment of intellectual functions, dysarthria and slight expressive aphasia.The aphasia increased, and the intellectual impairment became pronounced. There devel¬ oped weakness of the lower half of the right side of the face and a tendency to veer to the right in walking. Cerebellar signs became pronounced. Two months before examination, his eyes deviated to the right, and he was unable to move them to the left. There later developed right ...

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