Intracranial metastases occur through hematogenous spread and can present as either single or multiple lesions, with 80% located in the distribution region of the middle cerebral artery. The most common primary tumors causing brain metastases are lung cancer, breast cancer, and melanoma, while brain metastases from sarcomas are relatively rare. Melanoma, choriocarcinoma, and bronchogenic lung cancer are frequently associated with intratumoral hemorrhage in brain metastases.
In 15% of patients, there is no previous history of malignancy, and brain metastases may represent the initial presentation. Tumor compression leads to motor dysfunction or carcinomatous meningitis in 75% of patients with brain metastases. Elevated intracranial pressure occurs in 50% of patients, presenting with symptoms such as hypersomnia and apathy. Seizures are observed in 15% of cases.
After confirming the diagnosis of brain metastases, efforts are made to identify the primary tumor. A single lesion with associated intracranial pressure elevation may be managed with surgical resection. For multiple metastases, treatment options include whole-brain radiotherapy or stereotactic radiosurgery.