Sims Karilyn, Saliba Natalie, Goldhagen Michele
Medical School, Edward Via College of Osteopathic Medicine, Auburn, USA.
Hospital Medicine, Russell Medical Center, Alexander City, USA.
Cureus. 2025 Feb 27;17(2):e79794. doi: 10.7759/cureus.79794. eCollection 2025 Feb.
Metastasis is one of the most significant contributors to mortality and treatment-related morbidity in patients with advanced-stage lung cancer, as it is often considered incurable once discovered. Accordingly, a significant challenge with metastasis is identifying its progression early, as initial imaging may be negative while metastasis propagates undetected. Hence, there is a growing consensus that determining the optimal frequency and improving screening protocols for brain metastasis in patients with lung cancer are essential areas of research, as earlier detection could allow for prompt adjustments in treatment and/or prophylactic interventions, thereby potentially improving outcomes and reducing risks associated with more invasive procedures. Moreover, another difficulty in the diagnosis of brain metastasis can arise from its symptom overlap with strokes, often necessitating methods such as the use of the visual-aphasia-neglect assessment scale, as well as accounting for patient history and timeline of symptoms, with definitive diagnosis established through a head CT/MRI. This report presents a patient with a history of a tobacco use disorder, upper esophageal stricture, and a one-year history of advanced stage III non-small-cell lung carcinoma who reported to the emergency department (ED) with concerns of neurological weakness where multiple lesions with vasogenic edema were discovered on head CT, suggestive of brain metastasis. The patient was admitted to the hospital, where he was treated with dexamethasone and subsequent MRI confirmed the diagnosis of brain metastasis. He was discharged home to begin whole brain radiation therapy with orders to temporarily hold his chemotherapy medication. The patient initially responded well, but most recent CT scans have indicated progression of metastasis to bone and gastrointestinal organs. Thus, earlier recognition of impending brain metastasis, especially in advanced-stage lung carcinoma, is a significant area of research, as timely detection can have decisive impacts on patient outcomes and possible interventions.
转移是晚期肺癌患者死亡和治疗相关发病率的最重要因素之一，因为一旦发现往往被认为无法治愈。因此，转移的一个重大挑战是早期识别其进展，因为在转移扩散未被发现时，初始影像学检查可能呈阴性。因此，越来越多的人达成共识，即确定肺癌患者脑转移的最佳筛查频率并改进筛查方案是重要的研究领域，因为早期检测可以及时调整治疗和/或预防性干预措施，从而有可能改善预后并降低与更具侵入性手术相关的风险。此外，脑转移诊断的另一个困难可能源于其症状与中风的重叠，这通常需要使用视觉失语忽视评估量表等方法，并考虑患者病史和症状出现的时间线，最终通过头部CT/MRI确诊。本报告介绍了一名有烟草使用障碍、食管上段狭窄病史以及晚期III期非小细胞肺癌一年病史的患者，该患者因担心神经功能衰弱前往急诊科就诊，头部CT发现多个伴有血管源性水肿的病灶，提示脑转移。患者入院后接受了地塞米松治疗，随后的MRI证实了脑转移的诊断。他出院回家开始全脑放射治疗，并被要求暂时停用化疗药物。患者最初反应良好，但最近的CT扫描显示转移已进展至骨骼和胃肠道器官。因此，尽早识别即将发生的脑转移，尤其是在晚期肺癌患者中，是一个重要的研究领域，因为及时检测对患者的预后和可能的干预措施具有决定性影响。
