Brain Metastasis Differential Diagnoses

Updated: Nov 21, 2022
  • Author: Victor Tse, MD, PhD; Chief Editor: Nicholas Lorenzo, MD, CPE, MHCM, FAAPL  more...
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Diagnostic Considerations

Any subacute neurological disease: About 11% of mass lesions in patients with cancer are not metastases. Mass lesions that can masquerade as brain metastasis include abscess (20%) and granuloma (less common and mostly associated with mycobacterial or fungal infection).

Acute demyelinating diseases (mostly secondary to acute postinfective demyelination)

Progressive multifocal leukoencephalopathy (PML)

Radiation necrosis, if patient had prophylactic radiotherapy for previous metastases to the brain

Nonbacterial thrombotic endocarditis (NBTE) and intravascular thrombosis: This is frequently encountered in patients with disseminated disease of the lung, breast, or GI or genitourinary tract or with tumors of hematopoietic origin. NBTE is uncommon in patients whose disease is in remission.

Resolving hematoma due to coagulopathy secondary to NBTE or intravascular thrombosis from associated coagulation disorder

Coagulopathy: Coagulopathies have been associated with breast cancer and leukemia. In some cases, cardiolipin antibodies are present; in other cases, abnormalities in viper-venom coagulation results have been documented.

Differential Diagnoses