[Analysis of the neurologic consultations in an oncologic hospital: contributions of neuro-oncology].

OBJECTIVE

To determine the reasons for consultation to the neurology service in a cancer center.

METHODS

A retrospective examination of all neurology consultations over a 3-month period.

RESULTS

A total of 247 patients were examined. The most frequent symptoms included, pain (34%), motor weakness (25%) and altered mental status (22%). The most frequent diagnoses were spinal cord compression (18%), brain metastases (15%), metabolic and/or toxic encephalopathies (14%) and stroke (7%). Spinal cord compression was demonstrated in 50% of patients with back pain or radiculopathy. Pain and motor weakness resulted from metastatic complications in 75% and 69% of the cases, respectively; however, only 18% of the cases of altered mental functions resulted from metastatic complications. At the time of the neurology consultation, 41% of the patients were receiving corticosteroids and 43% suffered from one or more of its adverse effects. The diagnostic test most frequently requested by the neurologist was the MRI. In 101 patients the neurological symptoms were followed for at least 5 days; when the cause of the neurological deficit was a metastatic complication, the effect of the treatment was evaluated one month later. Overall, 64% of the patients with metastatic complications improved with treatment, 19% remained stable, and 17% worsened or died.

CONCLUSIONS

In a cancer center, the three symptoms that most frequently resulted in neurologic consultation were pain, motor weakness, and altered mental status. These were most commonly due to brain or epidural metastases, toxic and/or metabolic encephalopathy, and stroke. The use of neuroimaging does not appear to replace the need for neurologic consultation. The neurologist assists in establishing the diagnosis and initiating the appropriate treatment. In this study, two out of three patients improved after treatment of the neurologic deficit.