Disminución del nivel de conciencia en paciente oncológico portador de terapia intratecal: diagnóstico diferencial.
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| Title: | Disminución del nivel de conciencia en paciente oncológico portador de terapia intratecal: diagnóstico diferencial. |
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| Alternate Title: | Decreased level of consciousness in an oncology patient receiving intrathecal therapy: differential diagnosis. |
| Authors: | Páez-Arjona, Claudia1 (AUTHOR) Claudiapaezarjona@hotmail.com, González-Molina, Laura1 (AUTHOR), Moreno-Llorente, Roger1 (AUTHOR), Server-Salvà, Anna1 (AUTHOR), Medel-Rebollo, Francisco J.1 (AUTHOR) |
| Source: | Dolor: Investigación, Clínica & Terapéutica. 2025, Vol. 40 Issue 4, p125-129. 5p. |
| Subjects: | LOSS of consciousness, DIFFERENTIAL diagnosis, HYPERCALCEMIA, MENTAL status examination, SPINAL infusions, PARANEOPLASTIC syndromes, ONCOLOGY, PAIN management |
| Abstract (English): | The differential diagnosis of decreased consciousness in cancer patients is complex, particularly in advanced stages and with polypharmacy. While medications commonly used for pain management can cause drowsiness, it is essential to consider all possible causes. We present the case of an 18-year-old patient diagnosed with stage IV soft tissue sarcoma of the left thigh, with bone metastases (M1). He experienced frequent, hard-to-control breakthrough pain and ultimately received an intrathecal pump implant, which significantly improved pain control. During follow-up, the patient presented to the emergency department with decreased consciousness. Initial suspicion focused on possible neurotoxicity from intrathecal therapy. However, symptoms did not improve after adjusting the intrathecal treatment. Further investigation revealed severe hypercalcemia, later identified as part of a paraneoplastic syndrome. This case highlights the importance of a comprehensive evaluation in patients with altered mental status, especially when multiple potential causes – such as drug effects and metabolic disturbances – are present. [ABSTRACT FROM AUTHOR] |
| Abstract (Spanish): | El diagnóstico diferencial de la disminución del nivel de conciencia en pacientes con dolor oncológico es complejo cuando la enfermedad es avanzada y los pacientes reciben polifarmacia. Aunque los fármacos habitualmente utilizados para el tratamiento del dolor pueden causar somnolencia, es esencial considerar todas las posibles causas. Presentamos el caso de un paciente de 18 años con diagnóstico de sarcoma de partes blandas a nivel del muslo izquierdo en estadio IV por M1 ósea, con episodios frecuentes de dolor irruptivo con difícil control, que finalmente fue tributario de implantación de bomba intratecal, obteniéndose mejoría franca del control del dolor. En su evolución, el paciente acudió a urgencias por bajo nivel de conciencia, orientándose como primera sospecha diagnóstica una posible neurotoxicidad secundaria a terapia intratecal. Sin embargo, el cuadro no mejoró tras ajuste de la terapia intratecal, detectándose finalmente la causa era una hipercalcemia grave, englobada dentro de un síndrome paraneoplásico. [ABSTRACT FROM AUTHOR] |
| Copyright of Dolor: Investigación, Clínica & Terapéutica is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) | |
| Database: | MedicLatina |
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| Abstract: | The differential diagnosis of decreased consciousness in cancer patients is complex, particularly in advanced stages and with polypharmacy. While medications commonly used for pain management can cause drowsiness, it is essential to consider all possible causes. We present the case of an 18-year-old patient diagnosed with stage IV soft tissue sarcoma of the left thigh, with bone metastases (M1). He experienced frequent, hard-to-control breakthrough pain and ultimately received an intrathecal pump implant, which significantly improved pain control. During follow-up, the patient presented to the emergency department with decreased consciousness. Initial suspicion focused on possible neurotoxicity from intrathecal therapy. However, symptoms did not improve after adjusting the intrathecal treatment. Further investigation revealed severe hypercalcemia, later identified as part of a paraneoplastic syndrome. This case highlights the importance of a comprehensive evaluation in patients with altered mental status, especially when multiple potential causes – such as drug effects and metabolic disturbances – are present. [ABSTRACT FROM AUTHOR] |
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| ISSN: | 02140659 |
| DOI: | 10.24875/DOL.M25000019 |
