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Most common sources of intracranial metastasis
Lung cancer
Breast cancer
Skin cancer (melanoma)
Kidney cancer
GI tract cancer
10–15% of brain metastases are of unknown primary source
Most common metastatic carcinomas to the leptomeninges are breast, lymphomas, and leukemia
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Laboratory and radiology studies are the same as for primary neoplasms
Lumbar puncture is needed only if carcinomatous meningitis is suspected
Elevated cerebrospinal fluid pressure, pleocytosis, increased protein levels, and decreased glucose concentration are seen
Malignant cells may be found on cytology
In leptomeningeal metastases, CT scans show contrast enhancement in the basal cisterns or hydrocephalus without any evidence of mass lesions
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A single cerebral metastasis may be irradiated, sometimes following surgical excision
Systemic immunotherapy may also be an acceptable initial option in select cases
Leptomeningeal metastases receive irradiation and intrathecal methotrexate
For multiple cerebral metastases or widespread systemic disease,
Stereotactic radiosurgery, whole-brain radiotherapy, or both, sometimes helps
Systemic chemotherapy or immunotherapy may be options
Otherwise, palliative care