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Yıl:2014; Cilt: 7; Sayı: 4>> Özet
Türkiye Klinikleri Psikiyatri Özel Dergisi; 2014;7(4):26-33
Sistemik Kanserlerin Nöropsikiyatrik Komplikasyonları
G Vural, Ş Temel, O Deniz, D Büyüköz, H Bektaş, A Çayköylü
 Yıldırım Beyazıt Üniversitesi, Ankara
Nöropsikiyatrik komplikasyonlar kanserli hastalarda sık olarak ortaya çıkar. Bu komplikasyonlar sistemik kanserin direkt ya da indirekt etkileri ile meydana gelir. Direkt etkiler, beyin metastazlarını, spinal kord kompresyonunu, leptomenigeal metastazları ve değişik nöropatileri içine alır. İndirekt etkiler ise metabolik ensefalopati, enfeksiyonlar, strok, paraneoplastik sendromlar ve kemoterapi ya da radyoterapiye bağlı yan etkilerdir. Bu komplikasyonlar rutin kemoterapiden sonra bu hastaların hastaneye yatırılmalarının en sık sebebidir. Beyin metastazları kanserli hastaların %20-40'ını etkileyen en sık komplikasyondur; tipik olarak başağrısı, değişmiş mental durum ya da fokal güçsüzlükle kendini gösterir. Diğer sık metastatik komplikasyon epidural spinal kord basısı ve leptomeningeal metastazlardır Kord basısı acil tıbbi bir durum olabilir ve yüksek doz kortikosteroid tedavisinin hızlı uygulanması, radyoterapi ya da cerrahi dekompresyon nörolojik fonksiyonları korumak için sıklıkla gereklidir. Eğer hasta birden fazla yerin tutuluşuna işaret eden nörolojik disfonksiyona sahipse leptomeningeal metastazlardan şüphe edilmelidir. Metabolik ensefalopati, kanser hastalarında değişmiş mental durumun sık non-metaztatik sebebidir. İskemik ya da hemorajik strok gibi serebrovasküler komplikasyonlar direkt invazyon, koagulasyon bozuklukları, kemoterapi yan etkileri ve nonbakteriyel endokarditi ihtiva eden tümörle ilgili birbirinden farklı durumlarda ortaya çıkabilirler. Paraneoplastik nörolojik sendromlar kanserli hastalarda sık ortaya çıkar; ancak tümörün metastazı, infiltrasyonu ya da tedavisi bu sendromlara sebep olmaz.
Neuro-psychiatric Complications of Systemic Cancers
Neuro-psychiatric complications occur frequently in patients with cancer. These complications are caused by direct or indirect effects of systemic cancers. Direct effects include brain metastases, spinal cord compression, leptomeningeal metastases, and various neuropathies. Indirect effects also are metabolic encephalopathy, stroke, infections, paraneoplastic syndromes, and side effects due to chemotherapy or radiotherapy. After routine chemotherapy, these complications are the most common reason for hospitalization of these patients. Brain metastases are the most prevalent complication, affecting 20 to 40 percent of cancer patients and typically presenting as headache, altered mental status or focal weakness. Other common metastatic complications are epidural spinal cord compression and leptomeningeal metastases. Cord compression can be a medical emergency, and the rapid institution of high-dose corticosteroid therapy, radiation therapy or surgical decompression is often necessary to preserve neurologic function. Leptomeningeal metastases should be suspected when a patient presents with neurologic dysfunction in more than one site. Metabolic encephalopathy is the common nonmetastatic cause of altered mental status in cancer patients. Cerebrovascular complications such as stroke or hemorrhage can occur in a variety of tumor-related conditions, including direct invasion, coagulation disorders, chemotherapy side effects and nonbacterial thrombotic endocarditis. Paraneoplastic neurological syndromes occur with increased frequency in patients with cancer and are not caused by metastasis, direct infiltration or therapy of the tumor

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