[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Central nervous system](https://durgical.com/en/general-pathology/areas/cns/) › Brain metastases and paraneoplastic syndromes

# Brain metastases and paraneoplastic syndromes

- Lesion

Cancers from the lung, breast, skin and kidney often spread to the brain; others act at a distance by antibodies that attack nerve tissue.

Updated Nov 12, 2026

## Key points

- Usual primaries: lung (most common), breast, melanoma, kidney, colon.
- Site: grey-white junction, often multiple, sharp border, ring enhancement with much vasogenic edema; melanoma, kidney and choriocarcinoma metastases tend to bleed.
- Leptomeningeal carcinomatosis: tumour cells in CSF; cranial nerve palsies and nodular meningeal thickening; common with breast, lung, lymphoma and leukemia.
- Paraneoplastic cerebellar degeneration: anti-Yo (breast, ovary), Purkinje cell loss.
- Limbic encephalitis and sensory neuronopathy: anti-Hu (small cell lung cancer); anti-NMDA receptor encephalitis: ovarian teratoma in young women.
- Opsoclonus-myoclonus: neuroblastoma in children, anti-Ri in adults; Lambert-Eaton syndrome: small cell lung cancer.

## What it is

Metastases are the most common brain tumours in adults. They usually arrive through the blood and lodge at the grey-white junction, where vessels narrow, forming well-defined masses with much edema. Lung, breast, melanoma, kidney and colon are the usual primaries; cancer can also spread diffusely through the meninges (carcinomatous meningitis). Paraneoplastic neurologic syndromes are immune attacks on the nervous system triggered by tumour antigens, often appearing before the cancer is known.

## Step by step

- A tumour expresses a protein normally restricted to the nervous system.
- The immune system reacts and makes antibodies and T cells against it.
- Activated cells and antibodies cross into the nervous system.
- T cells destroy neurons with intracellular antigens; antibodies to surface antigens alter function.
- The neurologic syndrome often appears before the cancer is found.

## Paraneoplastic neurologic syndromes

| Syndrome | Antibody | Usual tumour | Target |
| --- | --- | --- | --- |
| Cerebellar degeneration | Anti-Yo (PCA-1) | Ovary, breast | Purkinje cells |
| Limbic encephalitis, sensory neuronopathy | Anti-Hu (ANNA-1) | Small cell lung cancer | Neuronal nuclei; dorsal root ganglia |
| [Anti-NMDA receptor encephalitis](https://durgical.com/en/conditions/autoimmune-encephalitis/) | Anti-NMDAR | Ovarian teratoma | Synaptic NMDA receptors |
| [Opsoclonus-myoclonus](https://durgical.com/en/conditions/neuroblastoma/) | Anti-Ri; often none in children | Neuroblastoma (children), breast, lung | Brainstem and cerebellum |
| [Lambert-Eaton myasthenic syndrome](https://durgical.com/en/conditions/lambert-eaton-myasthenic-syndrome/) | Anti-VGCC (P/Q type) | Small cell lung cancer | Presynaptic calcium channels |
| Stiff-person syndrome | Anti-amphiphysin | Breast | Inhibitory synapses |

## Clinical notes

- Brain metastases cause headache, seizures and focal deficits; single lesions may be resected or treated with radiosurgery.
- A new paraneoplastic syndrome should prompt a search for the hidden tumour; treating the tumour can help the syndrome.

## Memory aid

Lung, breast, skin, kidney, colon travel to the brain; antibodies travel instead when the tumour stays home.

## Test yourself

Think of the answer, then tap the question to see it.

## Where in the brain do metastases usually lodge?

At the junction of grey and white matter, where vessels narrow and tumour cells are trapped.

## Which tumour is classically associated with anti-NMDA receptor encephalitis?

Ovarian teratoma, usually in young women.

## Which antibody and tumour cause paraneoplastic cerebellar degeneration?

Anti-Yo antibodies with ovarian or breast cancer, destroying Purkinje cells.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/general-pathology/brain-metastases-and-paraneoplastic-syndromes/)

[More Pathology questions →](https://durgical.com/en/practice/?f=pathology)

## Elsewhere in DurgiPedia

- [Tumor immunology and checkpoint inhibitors](https://durgical.com/en/immunology/tumor-immunology-and-checkpoint-inhibitors/)
- [Autoantibodies: the table to know](https://durgical.com/en/immunology/autoantibodies-the-table-to-know/)

## Connections

## Related 7

- [CNS tumours: an overview](https://durgical.com/en/general-pathology/cns-tumours-an-overview/)
- [Pathways of spread and the usual metastatic sites](https://durgical.com/en/general-pathology/pathways-of-spread-and-the-usual-metastatic-sites/)
- [Paraneoplastic syndromes: the table to know](https://durgical.com/en/general-pathology/paraneoplastic-syndromes-the-table-to-know/)
- [Lung carcinoma: spread and paraneoplastic syndromes](https://durgical.com/en/general-pathology/lung-carcinoma-spread-and-paraneoplastic-syndromes/)
- [Melanoma: subtypes, Breslow and markers](https://durgical.com/en/general-pathology/melanoma-subtypes-breslow-and-markers/)
- [Lambert–Eaton syndrome and toxins of the junction](https://durgical.com/en/general-pathology/lambert-eaton-syndrome-and-toxins-of-the-junction/)
- [Vasculitic, paraneoplastic and paraprotein neuropathies](https://durgical.com/en/general-pathology/vasculitic-paraneoplastic-and-paraprotein-neuropathies/)

## Related conditions 9

- [Brain metastases](https://durgical.com/en/conditions/brain-metastases/)
- [Lung cancer](https://durgical.com/en/conditions/lung-cancer/)
- [Breast cancer](https://durgical.com/en/conditions/breast-cancer/)
- [Melanoma](https://durgical.com/en/conditions/melanoma/)
- [Renal cell carcinoma](https://durgical.com/en/conditions/renal-cell-carcinoma/)
- [Autoimmune encephalitis (including anti-NMDA receptor encephalitis)](https://durgical.com/en/conditions/autoimmune-encephalitis/)
- [Lambert-Eaton myasthenic syndrome](https://durgical.com/en/conditions/lambert-eaton-myasthenic-syndrome/)
- [Malignant spinal cord compression](https://durgical.com/en/conditions/malignant-spinal-cord-compression/)
- [Colorectal cancer](https://durgical.com/en/conditions/colorectal-cancer/)

[← All of general pathology](https://durgical.com/en/general-pathology/)

Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [Metastatic brain tumor: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000769.htm) (MedlinePlus, US National Library of Medicine, 2026).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

---
Source: https://durgical.com/en/general-pathology/brain-metastases-and-paraneoplastic-syndromes/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/brain-metastases-and-paraneoplastic-syndromes/