Imaging of extracranial head and neck lesions in cancer patients: a symptom-based approach

Besides intracranial lesions, neurological symptoms are also caused in cancer patients by extracranial lesions in the head and neck. Common symptoms caused by such lesions include visual loss, visual field defect, diplopia, ptosis, sensory abnormalities of the head and neck region, facial nerve palsy, dysphagia, dysarthria, hoarseness, and syncope. Some cancer patients often have multiple cranial nerve involvement, which is associated with several syndromes such as jugular foramen syndrome. The main causes of cranial nerve dysfunction due to extracranial lesions include bone and nodal metastasis, perineural tumor spread, inflammation, and radiation injury. The location of the lesions causing the neurological symptom may be estimated by the symptoms and physical examination. However, CT/MRI is critical for reaching the final diagnosis and for treatment planning and management of the cancer patients. Moreover, early identification of the extracranial lesions may significantly affect patient care and alter outcomes. Thus, radiologists should be familiar with imaging findings of the common neurological disorders and the complex anatomy of the head and neck region, which should be checked in cancer patients with neurological symptoms.