Neurologic Complications in Patients With Cancer

Eudocia Q. Lee, MD, MPH Neuro-oncology p. 1629-1645 December 2020, Vol.26, No.6 doi: 10.1212/CON.0000000000000937
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PURPOSE OF REVIEW 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.

RECENT FINDINGS 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.

SUMMARY 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.

Address correspondence to Dr Eudocia Q. Lee, Center for Neuro-Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, D2-110, Boston, MA 02215, [email protected].

RELATIONSHIP DISCLOSURE: Dr Lee has served as a consultant for prIME Oncology and has received publishing royalties from Wolters Kluwer N.V. and an honorarium from Medlink Inc.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Lee discusses the unlabeled/investigational use of checkpoint inhibitors for the treatment of progressive multifocal leukoencephalopathy.

© 2020 American Academy of Neurology.