levetiracetam and Melanoma

Brain metastases originate from other primary cancers within the body, most commonly lung, breast, and melanoma. Because patients with brain metastasis, stroke, or intracranial hemorrhage may present with similar acute neurologic symptoms, clinicians must have a high suspicion for brain metastasis and perform an immediate workup to rule out life-threatening conditions. This case report focuses on the clinical symptoms, diagnostics, and treatment options for brain metastasis in a patient with multiple malignancies.

Topics: Brain Neoplasms; Cranial Irradiation; Dexamethasone; Esophageal Neoplasms; Humans; Levetiracetam; Magnetic Resonance Imaging; Male; Melanoma; Neoplasms, Multiple Primary; Nervous System Diseases; Prostatic Neoplasms; Radiosurgery; Scalp; Seizures; Skin Neoplasms; Tomography, X-Ray Computed

Nearly 75% of patients with metastatic melanoma develop brain metastases. We here report the case of an 83 year-old woman hospitalized for secondarily generalized clonic seizures of the left leg with partial convulsive seizures in the Resuscitation Department. Melanoma resection of the left ankle had been performed 6 months before her admission. Neurological examination showed left ataxic crural monoparesis. Electro-encephalogram showed central and right frontal focus with left-sided dissemination. Gadolinium-enhanced magnetic resonance imaging (MRI) of the brain showed multiple supratentorial and subtentorial encephalic lesions with varying size and shape, with T1 hypersignal (A and A'), haemorrhage on T2*-weighted sequences (B and B'), gadolinium-enhancing T1 with perilesional edema on Flair sequences. Positron emission tomography (PET) showed multiple lymph node and bone metastases. Lymph node biopsy was negative for VE1 antibody with no BRAFV600E mutation by immunohistochemistry. An increase in the number of metastatic lesions was observed during control brain CT scan despite 10 brain radiotherapy sessions motivating palliative care. Epileptic seizures were controlled with levetiracetam. In patient with multiple hemorrhagic and spontaneous brain lesions, it is essential to obtain informations on patient's history of melanoma and to perform a thorough dermatologic examination in order to investigate its cause and to establish adequate therapeutic treatment.

Topics: Aged, 80 and over; Anticonvulsants; Bone Neoplasms; Brain Neoplasms; Female; Humans; Levetiracetam; Lymphatic Metastasis; Magnetic Resonance Imaging; Melanoma; Positron-Emission Tomography; Seizures; Skin Neoplasms