Continuum (Minneap Minn). 2020 Dec;26(6):1629-1645. doi: 10.1212/CON.0000000000000937.
Neurologic complications in patients with cancer can significantly impact morbidity and mortality. Although these complications can be seen in patients without cancer as well, the purpose of this review is to highlight how the presentation, etiology, and management of delirium, seizures, cerebrovascular disease, and central nervous system infections may be different in patients with cancer.
Some of the newer anticancer therapies are associated with neurologic complications. Delirium and seizures have been described in patients receiving chimeric antigen receptor (CAR) T-cell therapy and other immune effector cell therapies. Angiogenesis inhibitors can increase the risk of bleeding and clotting, including intracranial hemorrhage and stroke. The risk of opportunistic fungal infections, including aspergillosis, is elevated with the Bruton tyrosine kinase inhibitor ibrutinib.
Providers should familiarize themselves with neurologic complications in patients with cancer because early diagnosis and intervention can improve outcomes. The differential diagnosis should be broad, including conventional causes as seen in patients who do not have cancer, with special consideration of etiologies specific to patients with cancer.
癌症患者的神经系统并发症会显著影响发病率和死亡率。尽管这些并发症在无癌症患者中也可见，但本篇综述的目的在于强调谵妄、癫痫、脑血管病和中枢神经系统感染的表现、病因和处理在癌症患者中可能存在差异。
一些新型抗癌疗法与神经系统并发症相关。嵌合抗原受体（CAR）T 细胞疗法和其他免疫效应细胞疗法的患者中已出现谵妄和癫痫。血管生成抑制剂会增加出血和血栓形成的风险，包括颅内出血和中风。布鲁顿酪氨酸激酶抑制剂伊布替尼会增加机会性真菌感染（包括曲霉菌病）的风险。
由于早期诊断和干预可以改善结局，因此临床医生应熟悉癌症患者的神经系统并发症。鉴别诊断应广泛，包括无癌症患者中常见的病因，同时要特别考虑癌症患者特有的病因。
