Skip to main content

Advertisement

SpringerLink
Log in

Imaging of central nervous system emergencies in oncology

  • Pictorial Essay
  • Published:
Emergency Radiology Aims and scope Submit manuscript

Abstract

Central nervous system (CNS) may be predisposed to devastating complications in cancer patients which may add to morbidity and mortality in this group. Majority of the complications are vascular in nature due to the altered coagulation profile and pro-inflammatory state in these patients. However, there are a host of other conditions which may affect the clinical course of these patients including metabolic and toxic encephalopathies, infections, and paraneoplastic syndromes. Moreover, multimodality management of these patients, which is often used in majority of the cancers, exposes them to treatment related complications. This pictorial review aims to enlighten the reader regarding the various complications affecting the CNS as seen at our tertiary cancer care institute. We aim to highlight the emergent nature of these complications and the need to identify them quickly and accurately on imaging which helps to institute early appropriate management and prevents further morbidity and mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13

Similar content being viewed by others

Data Availability

The authors confirm that the data supporting the findings of this study are available within the article [and/or] its supplementary materials.

References

  1. Ostrom QT, Cioffi G, Waite K, Kruchko C, Barnholtz-Sloan JS (2021) CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2014–2018. Neuro-oncology. 23(12 Suppl 2):iii1–iii105

    Article  PubMed  PubMed Central  Google Scholar 

  2. Katabathina VS, Restrepo CS, Betancourt Cuellar SL, Riascos RF, Menias CO (2013) Imaging of oncologic emergencies: what every radiologist should know. Radiographics 33(6):1533–53. https://doi.org/10.1148/rg.336135508

  3. Suarez-Meade P, Marenco-Hillembrand L, Sherman WJ (2022) Neuro-oncologic Emergencies. Curr Oncol Rep 24(8):975–984

    Article  PubMed  Google Scholar 

  4. Bang OY, Chung JW, Lee MJ, Seo WK, Kim GM, Ahn MJ (2020) Cancer-Related stroke: an emerging subtype of ischemic stroke with unique pathomechanisms. J Stroke 22(1):1–10

    Article  PubMed  PubMed Central  Google Scholar 

  5. Schwarzbach CJ, Schaefer A, Ebert A, Held V, Bolognese M, Kablau M et al (2012) Stroke and cancer: the importance of cancer-associated hypercoagulation as a possible stroke etiology. Stroke 43(11):3029–3034

    Article  PubMed  Google Scholar 

  6. Gon Y, Okazaki S, Terasaki Y, Sasaki T, Yoshimine T, Sakaguchi M et al (2016) Characteristics of cryptogenic stroke in cancer patients. Ann Clin Transl Neurol 3(4):280–287

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Keraliya AR, Krajewski KM, Giardino AA, Tirumani SH, Shinagare AB, Ramaiya NH et al (2015) Imaging of nervous system involvement in hematologic malignancies: what radiologists need to know. AJR Am J Roentgenol 205(3):604–617

    Article  PubMed  Google Scholar 

  8. Yang EH, Marmagkiolis K, Balanescu DV, Hakeem A, Donisan T, Finch W et al (2021) Radiation-induced vascular disease-a state-of-the-art review. Front Cardiovasc Med 8:652761

    Article  PubMed  PubMed Central  Google Scholar 

  9. Galli J, Greenlee J (2020) Paraneoplastic Diseases of the Central Nervous System. F1000 Res 9:F1000 Faculty Rev-167. https://doi.org/10.12688/f1000research.21309.1

  10. Bhargava R (2019) CT Imaging in Neurocritical Care. Indian J Crit Care Med 23(Suppl 2):S98-s103

    Article  PubMed  PubMed Central  Google Scholar 

  11. Raizer JJ, DeAngelis LM (2000) Cerebral sinus thrombosis diagnosed by MRI and MR venography in cancer patients. Neurology 54(6):1222–1226

    Article  CAS  PubMed  Google Scholar 

  12. Stefan O, Vera N, Otto B, Heinz L, Wolfgang G (2009) Stroke in cancer patients: a risk factor analysis. J Neurooncol 94(2):221–226

    Article  PubMed  Google Scholar 

  13. Cestari DM, Weine DM, Panageas KS, Segal AZ, DeAngelis LM (2004) Stroke in patients with cancer: incidence and etiology. Neurology 62(11):2025–2030

    Article  CAS  PubMed  Google Scholar 

  14. Zaorsky NG, Zhang Y, Tchelebi LT, Mackley HB, Chinchilli VM, Zacharia BE (2019) Stroke among cancer patients. Nature. Communications 10(1):5172

    Google Scholar 

  15. Navi BB, Reiner AS, Kamel H, Iadecola C, Elkind MS, Panageas KS et al (2015) Association between incident cancer and subsequent stroke. Ann Neurol 77(2):291–300

    Article  PubMed  PubMed Central  Google Scholar 

  16. Dardiotis E, Aloizou AM, Markoula S, Siokas V, Tsarouhas K, Tzanakakis G et al (2019) Cancer-associated stroke: Pathophysiology, detection and management (Review). Int J Oncol 54(3):779–796

    CAS  PubMed  PubMed Central  Google Scholar 

  17. Rogers LR (2010) Cerebrovascular complications in patients with cancer. Semin Neurol 30(3):311–319

    Article  PubMed  Google Scholar 

  18. Chu WC, Lee V, Howard RG, Roebuck DJ, Chik KW, Li CK (2003) Imaging findings of paediatric oncology patients presenting with acute neurological symptoms. Clin Radiol 58(8):589–603

    Article  CAS  PubMed  Google Scholar 

  19. Singer S, Grommes C, Reiner AS, Rosenblum MK, DeAngelis LM (2015) Posterior reversible encephalopathy syndrome in patients with cancer. Oncologist 20(7):806–811

    Article  PubMed  PubMed Central  Google Scholar 

  20. Parasher A, Jhamb R (2020) Posterior reversible encephalopathy syndrome (PRES): presentation, diagnosis and treatment. Postgrad Med J 96(1140):623–628. https://doi.org/10.1136/postgradmedj-2020-137706

  21. Shah S, Flanagan EP, Paul P, Smith CY, Bryant SC, Devine MF, Lennon VA, McKeon A, Pittock SJ, Dubey D (2021) Population-based epidemiology study of paraneoplastic neurologic syndromes. Neurol Neuroimmunol Neuroinflamm 9(2):e1124. https://doi.org/10.1212/NXI.0000000000001124

  22. Rosenfeld MR, Dalmau J (2013) Diagnosis and management of paraneoplastic neurologic disorders. Curr Treat Options Oncol 14(4):528–538

    Article  PubMed  Google Scholar 

  23. Pruitt AA (2010) Central nervous system infections in cancer patients. Semin Neurol 30(3):296–310

    Article  PubMed  Google Scholar 

  24. Safdieh JE, Mead PA, Sepkowitz KA, Kiehn TE, Abrey LE (2008) Bacterial and fungal meningitis in patients with cancer. Neurology 70(12):943–947

    Article  CAS  PubMed  Google Scholar 

  25. Fugate JE, Lyons JL, Thakur KT, Smith BR, Hedley-Whyte ET, Mateen FJ (2014) Infectious causes of stroke. Lancet Infect Dis 14(9):869–880

    Article  PubMed  Google Scholar 

  26. Hersh N, Steiner I, Siegal T, Benninger F (2021) Herpes simplex encephalitis in patients receiving chemotherapy and whole-brain radiation therapy. J Neurovirol 27(5):774–781

    Article  CAS  PubMed  Google Scholar 

  27. Riveros Gilardi B, Muñoz López JI, Hernández Villegas AC, Garay Mora JA, Rico Rodríguez OC, Chávez Appendini R, De la Mora Malváez M, Higuera Calleja JA (2019) Types of Cerebral Herniation and Their Imaging Features. Radiographics 39(6):1598–1610. https://doi.org/10.1148/rg.2019190018

  28. Tranvinh E, Lanzman B, Provenzale J, Wintermark M (2019) Imaging Evaluation of the Adult Presenting With New-Onset Seizure. AJR Am J Roentgenol 212(1):15–25

    Article  PubMed  Google Scholar 

  29. Turnquist C, Harris BT, Harris CC (2020) Radiation-induced brain injury: current concepts and therapeutic strategies targeting neuroinflammation. Neurooncol Adv. 2(1):vdaa057

    PubMed  PubMed Central  Google Scholar 

  30. Rahmathulla G, Marko NF, Weil RJ (2013) Cerebral radiation necrosis: a review of the pathobiology, diagnosis and management considerations. J Clin Neurosci 20(4):485–502

    Article  PubMed  Google Scholar 

  31. Ali FS, Arevalo O, Zorofchian S, Patrizz A, Riascos R, Tandon N et al (2019) Cerebral radiation necrosis: incidence, pathogenesis, diagnostic challenges, and future opportunities. Curr Oncol Rep 21(8):66

    Article  PubMed  Google Scholar 

  32. Khan M, Ambady P, Kimbrough D, Shoemaker T, Terezakis S, Blakeley J et al (2018) Radiation-induced myelitis: initial and follow-up MRI and Clinical features in patients at a single tertiary care institution during 20 years. AJNR Am J Neuroradiol 39(8):1576–1581

    CAS  PubMed  PubMed Central  Google Scholar 

  33. Sindhwani G, Arora M, Thakker VD, Jain A (2017) MRI in Chemotherapy induced Leukoencephalopathy: report of two cases and radiologis’s perspective. J Clin Diagn Res : JCDR. 11(7):Td08-td9

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Tata Memorial Centre, Mumbai, India

    Kajari Bhattacharya, Kunal Nigam, Amit Kumar J. Choudhari, Nitin Sudhakar Shetty, Kunal Gala, Daksh Chandra & Suyash Kulkarni

  2. Homi Bhabha National Institute, Mumbai, India

    Kajari Bhattacharya, Amit Kumar J. Choudhari, Nitin Sudhakar Shetty, Kunal Gala, Daksh Chandra & Suyash Kulkarni

Authors
  1. Kajari Bhattacharya
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kunal Nigam
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Amit Kumar J. Choudhari
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nitin Sudhakar Shetty
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kunal Gala
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daksh Chandra
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Suyash Kulkarni
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kajari Bhattacharya.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bhattacharya, K., Nigam, K., Choudhari, A.K.J. et al. Imaging of central nervous system emergencies in oncology. Emerg Radiol 30, 499–512 (2023). https://doi.org/10.1007/s10140-023-02139-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10140-023-02139-4

Keywords

Search

Navigation