Considering the rising detection of asymptomatic brain metastases (BM) during screening and staging procedures over the last decades, we aimed to evaluate the incidence, clinical characteristics and the prognostic value of neurological symptoms in BM from breast cancer. Patients with newly diagnosed BM from breast cancer (BC) were identified from the Vienna Brain Metastasis Registry. Patients were grouped into the three main subtypes: hormone receptor-positive/HER2 (human epidermal growth factor receptor 2)-negative breast cancer (HR BC), HER2 overexpressing BC (HER2 BC) and triple-negative BC (TN BC). A retrospective chart review and statistical outcome analyses were performed. 968 patients with BM from breast cancer (34.4% HR BC; 28.9% HER2 BC; 21.8% TN BC; 14.9% unknown receptor status) were included in the analysis. 81.6% (790/968) of the patients presented with neurological symptoms at BM diagnosis including focal deficits (695/790;88.0%), signs of increased intracranial pressure (388/790;49.1%), epileptic seizures (126/790;15.9%) and neuropsychological symptoms (133/790;16.8%). Patients with HER2 BC (66/280;23.6%) were significantly more often diagnosed with BM in absence of neurological symptoms during screening procedures compared to HR BC (62/333;18.6%) and TN BC (31/211;14.7%; chi-square test; p=0.043). Among all BC subtypes, asymptomatic patients presented with a significant longer median overall survival (OS) from diagnosis of BM compared to symptomatic patients (p<0.05; log-rank test; HR BC 20 vs. 9 months; HER2 BC 20 vs. 11 months; TN 11 vs. 5 months). In multivariate analysis, the breast cancer-specific Graded Prognostic Assessment (Breast-GPA: HR:1.4; 95% CI, 1.27-1.49; p<0.001) and the presence of neurological symptoms (HR:1.6; 95% CI, 1.35-1.95; p<0.001) presented as independently associated with survival prognosis from time of BM diagnosis respectively. Neurological symptoms are independently associated with overall survival in patients with BM from breast cancer. Our results highlight the need to incorporate neurological symptoms into the prognostic assessment of patients with BM from breast cancer.

Abstract Background Glioblastoma is associated with a high risk of epileptic seizures ranging from 40% to 60%. Before the advent of modern imaging techniques, electroencephalography (EEG) was a critical component in evaluating patients with space-occupying lesions. In this retrospective single-center study, we aimed (1) to characterize a cohort of patients with glioblastoma with regards to EEG monitoring, seizure frequency and the frequency of prescribed anti-seizure medications (ASM) and (2) to assess the value of EEG as a localizing technique in patients with glioblastoma. Material and Methods We reviewed the charts of 179 patients with glioblastomas between January 1st, 2020 and January 1st, 2022, treated at the Medical University of Vienna. The diagnosis was based on MRI and/or confirmed by biopsy according to the 2016 World Health Organization Classification of Tumors of the Central Nervous System. Patients who received an in-house EEG as part of their diagnostic work-up were included if an MRI/CT scan was available (within an average time of +/-60 days). For localization, focal slowing (theta/delta activity) and/or epileptiform discharges were considered. EEG rating was performed by a board-certified electrophysiologist blinded for the diagnosis and MRI/biopsy findings. Results We included 52 patients (29.05% of screened cohort) with at least one EEG and MRI or CT scan performed before or after EEG, following inclusion criteria (median: 2 days; mean: 6 days; range: -29 to 52), in the final analysis. Clinical seizure activity and/or epileptiform discharges on EEG were detected in 46 patients (88.46%), and 48 patients (92.31%) were on ASM. An IDH-wildtype glioblastoma was diagnosed in 45 patients (86.54%), 4 had an IDH-mutant glioblastoma (7.69%), and in 3 patients, IDH-status was unknown (5.77%). In 22 patients (42.31%), biopsy revealed a positive MGMT promoter methylation status, while 28 were unmethylated (53.84%), and two patients had an unknown MGMT promoter methylation status (3.85%). Intermittent and/or continuous focal slow-wave activity was registered in 45 patients (86.54%). In comparison, epileptiform discharges could only be found in 13 patients (25%). When compared to MRI/CT scans, the hemispheric tumor localization could be determined in 42 cases (80.77%). Moreover, the affected brain lobe was accurately predicted in 35 patients (67.31%). Three patients had diffuse EEG changes (5.77%), and EEG was unremarkable in 7 patients (13.46%). Conclusion Overall, our presented data indicate that the hemispheric localization of glioblastoma can be reliably predicted by EEG recordings, while a precise (brain lobe-specific) localization was only possible in around two-thirds of cases.

Background and purpose Next‐generation sequencing has greatly improved the diagnostic success rates for genetic neuromuscular disorders ( NMD s). Nevertheless, most patients still remain undiagnosed, and there is a need to maximize the diagnostic yield. Methods A retrospective study was conducted on 72 patients with NMD s who underwent exome sequencing ( ES ), partly followed by genotype‐guided diagnostic reassessment and secondary investigations. The diagnostic yields that would have been achieved by appropriately chosen narrow and comprehensive gene panels were also analysed. Results The initial diagnostic yield of ES was 30.6% ( n = 22/72 patients). In an additional 15.3% of patients ( n = 11/72) ES results were of unknown clinical significance. After genotype‐guided diagnostic reassessment and complementary investigations, the yield was increased to 37.5% ( n = 27/72). Compared to ES , targeted gene panels (<25 kilobases) reached a diagnostic yield of 22.2% ( n = 16/72), whereas comprehensive gene panels achieved 34.7% ( n = 25/72). Conclusion Exome sequencing allows the detection of pathogenic variants missed by (narrowly) targeted gene panel approaches. Diagnostic reassessment after genetic testing further enhances the diagnostic outcomes for NMD s.

Managing patients with brain tumors can involve behavioral and psychiatric phenomena, occurring at different time points. Review of the literature. Five causes were identified. 1. Focal and diffuse brain damage by the tumor Symptoms of anger, loss of emotional control, indifference and changes in behavior and personality appear. The extent to which tumor location impacts on psychopathology is not clear. Clinically, also apathy and loss of executive function can occur. In lesions of the paralimbic structures mood swings are dominant. Neuropsychological symptoms are related to focal pathology. 2. Psychiatric causes Manifestations can present as anxiety, depression, mania and psychosis. Few recent publications are available. It is useful to make a distinction between a,,psychiatric reaction (towards the disease)” and an organic psychosis. 3. Influence of seizures on behavior Brain tumors are one of the main causes of acquired epilepsies and are associated with 3–6% of all new cases of epilepsy. Rapidly growing tumors, as glioblastomas (GBM), are frequently associated with seizures. In patients with primary brain tumors with epilepsy cognitive impairment, abnormal scores in the anxiety scale and depression were noted. Brain tumors can cause status epilepticus, including the non-convulsive type. 4. Tumor treatment Treatment-induced effects may occur at any stage of the disease. Radiation can induce acute, or delayed effects, which are important in low grade glioma (LGG), and less frequent in GBM. Steroids can have psychotropic effects, ranging from unspecific excitatory state, towards psychosis and depression. Also, rapid discontinuation of prolonged steroid therapy causes mood swings. The issue of “chemobrain” has been attracting attention in the treatment of LGG. The clinical correlation is slowing of mentation and cognition and is also termed,,chemofog”. Most antineoplastic drugs used for the treatment of GBM, as temozolomide (TMZ) do not have psychotropic effects. Older drugs as procarbazine can cause psychiatric symptoms. VEGF inhibitors, can induce “posterior reversible encephalopathy syndrome” resulting in mental changes. Benzodiazepines, antidepressants and rarely anti-dementia drugs can cumulate and cause delirium as well as anticonvulsants. 5. Overlap of several causes Practically, often several causes can overlap. The identification of the most prevalent cause is important, followed by symptomatic therapy. Psychiatric alterations can be part of the management of patients with brain tumors. Symptom-oriented treatment of psychiatric manifestations, including psychotherapy, drug treatment and individual care is warranted. Communication with patients, caregivers and the involved health care professionals is essential.

Zusammenfassung Bei unklaren Schmerzzuständen im Becken-Bein-Bereich ist die Frage nach der Beteiligung des neuromuskulären Systems ein wichtiger Beitrag zur Feststellung der Ursache. Häufig werden Erkrankungen der Wirbelsäule oder bandscheibenbedingte Läsionen der Nervenwurzeln vermutet. Neben den radikulären und intermittierend auftretenden Ursachen kommen lokale Prozesse der Wirbelsäule und des Beckens, Schmerzausstrahlungen und -projektionen, Läsionen der Nervengeflechte und Einzelnerven sowie selten zentrale Ursachen in Betracht. Die Definition und Abgrenzung neuropathischer Schmerzsyndrome sind diagnostisch wichtig und bilden die Grundlage der Therapie.

Bei unklaren Schmerzzuständen im Becken-Bein-Bereich ist die Frage nach der Beteiligung des neuromuskulären Systems ein wichtiger Beitrag zur Feststellung der Ursache. Häufig werden Erkrankungen der Wirbelsäule oder bandscheibenbedingte Läsionen der Nervenwurzeln vermutet. Neben den radikulären und intermittierend auftretenden Ursachen kommen lokale Prozesse der Wirbelsäule und des Beckens, Schmerzausstrahlungen und -projektionen, Läsionen der Nervengeflechte und Einzelnerven sowie selten zentrale Ursachen in Betracht. Die Definition und Abgrenzung neuropathischer Schmerzsyndrome sind diagnostisch wichtig und bilden die Grundlage der Therapie.

Background: Neuropathic pain is well known and has been described in several cerebral, spinal and peripheral conditions. However, neuropathic itch and pruritus is more controversial and is often considered to be part of the neuropathic pain complex.

Background: Mantle-field radiotherapy (mRTx) was a well-established part of treatment in Hodgkin's lymphoma. Several publications have pointed out that late effects result in a variable distribution of atrophy of neck and shoulder muscles. The clinical distribution is confined to radiation, whereas clinical symptoms develop within several years after the radiation.

Background: Lymphoma can affect the peripheral nervous system in several ways. Although treatment related toxicity is the main cause of neuropathy, isolated neoplastic peripheral nerve lesions, either as presenting symptom, during the disease or at recurrence have been described.They often present as painful, radiating neuropathies in one extremity, but several nerves can be affected as a multiplex type.

Cancer is becoming a treatable and even often curable disease. The neuromuscular system can be affected by direct tumor invasion or metastasis, neuroendocrine, metabolic, dysimmune/inflammatory, infections and toxic as well as paraneoplastic conditions. Due to the nature of cancer treatment, which frequently is based on a DNA damaging mechanism, treatment related toxic side effects are frequent and the correct identification of the causative mechanism is necessary to initiate the proper treatment. The peripheral nervous system is conventionally divided into nerve roots, the proximal nerves and plexus, the peripheral nerves (mono- and polyneuropathies), the site of neuromuscular transmission and muscle. This review is based on the anatomic distribution of the peripheral nervous system, divided into cranial nerves (CN), motor neuron (MND), nerve roots, plexus, peripheral nerve, the neuromuscular junction and muscle. The various etiologies of neuromuscular complications - neoplastic, surgical and mechanic, toxic, metabolic, endocrine, and paraneoplastic/immune - are discussed separately for each part of the peripheral nervous system.

Meningeal involvement of multiple myeloma is rare. A patient with multiple myeloma presented with bilateral abducens nerve palsies. In the MRI neither lytic skull lesions nor meningeal enhancement could be found. The diagnosis was based on CSF studies and cytology. A neurologic remission was achieved with intrathecal chemotherapy.