Question

A 55 year old woman has a modified radical mastectomy for stage II carcinoma of the breast. 5 years later she has new-onset seizures with focal findings. What is your assessment and plan?

Answer 1

A 55-year-old woman with a history of stage II breast cancer and new-onset seizures with focal findings should be assessed for possible brain metastasis with neuroimaging and managed with antiepileptic drugs, along with oncological consultation for further treatment options.

Step-by-step explanation:

A 55-year-old woman with a history of stage II breast cancer treated with modified radical mastectomy now presents with new-onset seizures with focal findings after five years. This clinical presentation is concerning for possible metastasis to the brain, a known complication of breast cancer. The initial assessment should include a thorough history and physical examination focusing on neurological signs, followed by urgent neuroimaging, preferably a brain MRI with contrast, to determine the presence of metastases.

The management plan would include treating the seizures with appropriate antiepileptic drugs (AEDs) to control the seizures. Additionally, coordination of care with an oncologist is essential for the evaluation of cancer recurrence or progression, and to discuss potential treatment options such as surgery, radiation therapy, or systemic therapies depending on the extent of metastasis. A multi-disciplinary team approach that includes neurology, oncology, and possibly radiation oncology will provide comprehensive care for the patient.