Neurological emergencies in cancer: pathophysiological and prognostic implications with a focus on the elderly

Abstract

Introduction: Neurological emergencies in cancer patients are associated with high mortality. This mortality rate is particularly prevalent in the older adult population, for whom limited scientific evidence exists. The objective of this review was to describe the pathophysiological mechanisms and prognosis of the main neurological emergencies that occur in older patients with cancer and lead to their admission to the Intensive Care Unit. To this end, a narrative review of the literature available in databases and search engines such as PubMed, Medline, Scopus, Scielo, and Google Scholar was conducted using the search terms: neuro-oncological emergencies, neurological complications, oncological intensive care, prognostic factors for cancer mortality, and their English translations. The review was conducted between November 2024 and March 2025. Forty-nine references from articles that met the inclusion criteria were used. Among the main results, it is worth highlighting that the main neurological complications described are predominantly metabolic encephalopathy, stroke, status epilepticus, and intracranial hypertension. These factors share mechanistic relationships with neurocritical patients in general, although cancer appears to be a significant factor in their onset and mortality prognosis. This is accompanied by other variables of prognostic interest such as advanced age, cancer stage, individual functional status, hyperglycemia, sepsis, septic shock, and artificial ventilation. It is concluded that pathophysiological and prognostic knowledge of critically ill older neuro-oncology patients is still limited and warrants multiple investigations in their own clinical context. This is because the greatest available evidence corresponds to young adult neurocritical patients without cancer.