Hirsch F R, Paulson O B, Hansen H H, Vraa-Jensen J
Cancer. 1982 Dec 1;50(11):2433-7. doi: 10.1002/1097-0142(19821201)50:11<2433::aid-cncr2820501131>3.0.co;2-e.
Two hundred-twelve consecutive patients with small cell carcinoma of the lung were included in an evaluation of clinical and diagnostic neurologic findings of intracranial metastases. A correlation of premortem findings to postmortem examination of the brain was obtained in 87 of the patients. Clinical intracranial metastases were diagnosed in 21.2% on the basis of symptoms and signs. At autopsy 44 of the 87 patients (50%) had metastases. Lesions located to the posterior cranial fossa were demonstrated in 53% of the positive autopsies. A correlation of 96% existed between significant premortem clinical findings and positive autopsy, while 33% had clinically "silent" metastases at autopsy. A neuro-oncologic examination was performed in 49 patients at the time of presentation of neurologic symptoms. Twenty-eight patients were considered to have intracranial metastases. Gait disturbances were the presenting signs in more than 50% of the patients. Brain metastases were demonstrated at autopsy in 14 of 15 patients considered to have intracranial metastases by the neuro-oncologist, and clinically "silent" metastases were observed in one out of 10 patients. Radionuclide brain scan was negative in seven of 13 patients in spite of "positive" neuro-oncological examination had a subsequent positive autopsy. Cerebrospinal fluid examination was of no value in the diagnosis of brain metastases. It is concluded that a careful clinical examination by a neuro-oncologist is of great value in early detection of brain metastases, especially in diagnosing metastases to the posterior cranial fossa.
212例连续性肺小细胞癌患者纳入颅内转移临床及诊断性神经学表现评估。87例患者获得生前检查结果与脑尸检结果的相关性。根据症状和体征，临床诊断颅内转移的比例为21.2%。尸检时，87例患者中有44例（50%）发生转移。阳性尸检病例中53%的病变位于后颅窝。生前显著临床检查结果与阳性尸检结果的相关性为96%，而33%的患者尸检时有临床“隐匿性”转移。49例患者在出现神经学症状时接受了神经肿瘤学检查。28例患者被认为有颅内转移。超过50%的患者以步态障碍为首发症状。神经肿瘤学家认为有颅内转移的15例患者中，14例尸检发现脑转移，10例中有1例观察到临床“隐匿性”转移。13例患者中7例放射性核素脑扫描为阴性，尽管神经肿瘤学检查“阳性”，随后尸检结果为阳性。脑脊液检查对脑转移的诊断无价值。结论是，神经肿瘤学家进行仔细的临床检查对早期发现脑转移具有重要价值，尤其是在后颅窝转移的诊断中。
