Extensive cerebral metastases from neuroendocrine carcinoma of the prostate

Excerpt

Sir, a 78-year-old man was admitted for evaluation of acute confusional state. He had a history of inoperable prostatic carcinoma with orchiectomy 6 years prior to admission and had received chemotherapy with cisplatin for hepatic metastases the year before (results of histological studies were not available). A computed tomography scan did not reveal any relevant pathological findings; notably, no metastases could be seen. Clinically, the man was somnolent and could neither give date, time nor location correctly. There were no pareses or apparent sensory disturbances. Brainstem reflexes were all normal. The plantar response on both sides was flexor. The man’s confusion was attributed to hypovolemia, and the clinical status gradually improved after administration of fluid and electrolytes. After 5 days, the man was released to home. He was admitted again 10 days later, and this time he was stuporous, and both plantar responses were extensor. Despite admission of fluids and electrolytes, the man’s condition rapidly deteriorated, and he died 5 days after the second admission. …