ARRS 2022 Abstracts

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E1523. Neurological Emergencies in Patients with Cancer: Pearls for the Imager
Authors
  1. Eric Fromke; University of North Carolina at Chapel Hill
  2. Carlos Zamora; University of North Carolina at Chapel Hill
Background
Advances in therapies over recent decades have allowed cancer patients to live longer; however, the frequency of direct and indirect neurological emergencies has also increased. Patients with cancer are also subject to the secondary effects of continued chronic therapy. Neurological sequelae of cancer often present acutely and require an immediate diagnosis. Patients with cancer are at increased risk of neurological emergencies of various etiologies, with unique risk factors, presentations, imaging features, and treatments. Imaging plays a critical role in the management of these patients, which varies widely depending on etiology and prompt diagnosis. The purpose of this exhibit will be to review common and uncommon neurological emergencies in the patient with cancer and review the relevant clinical and imaging features associated with each.

Educational Goals / Teaching Points
The goal of this exhibit is to review causes of neurological emergencies in patients with cancer and their imaging features. We will present a case-based exhibit with illustrative examples on CT as well as routine and advanced MRI. We will emphasize key findings and tools to help build a differential diagnosis. Finally, we will discuss the biomolecular mechanisms by which these processes can disrupt CNS structures. After participating in this exhibit, the radiologist will be equipped to discern various neuro-oncological on the basis of imaging and clinical history.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Imaging often plays an early role in the diagnosis and management plans of patients with neurological symptoms. We will discuss CT and MRI findings of several neurological emergencies related to cancer, including: complications relating to physical features of the tumor; complications of immunosuppressive therapy and opportunistic infection; stroke and hemorrhage; metabolic disorders; conditions secondary to chemo- and radio-therapy; and spinal cord emergencies.

Conclusion
The oncology patient is subject to a wide number of neurological emergencies that are associated with increased morbidity and mortality. They may present with complications that are directly tumor-related, secondary to immunosuppression or other systemic effects, or iatrogenic. A prompt and accurate diagnosis is critical for adequate patient management.