Intracranial metastases in small cell carcinoma of the lung. Correlation of clinical and autopsy findings

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 neurooncologic 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. Radionucleide brain scan was negative in seven of 13 patients in spite of “positive” neuro‐oncological examination and 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.