Neurologic complications occur frequently in patients with cancer. After ro
utine chemotherapy, these complications are the most common reason for hosp
italization of these patients. Brain metastases are the most prevalent comp
lication, affecting 20 to 40 percent of cancer patients and typically prese
nting as headache, altered mental status or focal weakness. Other common me
tastatic complications are epidural spinal cord compression and leptomening
eal metastases. Cord compression can be a medical emergency, and the rapid
institution of high-dose corticosteroid therapy, radiation therapy or surgi
cal decompression is often necessary to preserve neurologic function. Lepto
meningeal metastases should be suspected when a patient presents with neuro
logic dysfunction in more than one site. Metabolic encephalopathy is the co
mmon nonmetastatic cause of altered mental status in cancer patients. Cereb
rovascular complications such as stroke or hemorrhage can occur in a variet
y of tumor-related conditions, including direct invasion, coagulation disor
ders, chemotherapy side effects and nonbacterial thrombotic: endocarditis.
Radiation therapy is the most commonly employed palliative measure for meta
stases. Chemotherapy or surgical removal of tumors is used in selected pati
ents.