Expert: Claes-Gustaf Nordquist, M.D. - 7/22/2009

Question
I am a nurse and I fear a member of my family is ill.  I think she may know but is trying to keep it from us (no doubt her way of being protective.) Here is what I know; she is a 60 yo female of Asian decent in remission from breast cancer after single radical mastectomy and chemo around four years ago, she recently had an MRI which showed "a large blank spot" as she described it.  She has been adamant that her neurologist thinks "its nothing" and that it needs no further investigation. She has normally been the type to be very proactive for her health but she refuses to get a second opinion on this matter. Not to mention the fact that she can't seem to explain to us the reason she needed to see a neurologist in the first place. The above along with a few of signs that I have noticed are the reasons I believe there may be more to the story than what she is telling us. The signs I have observed; fairly newly developed abnormal tongue movements...to possibly be described as a resting tremor?  When her mouth is open her tongue is moving rhythmically from right to left, it is notably more so right after she stops speaking.  She seems to be unaware of this.  Also she shows signs of mania...has extreme flight of ideas, it is almost impossible to follow her in a conversation yet she doesn't seem to care if you follow her or not.  She is overly energetic with lessened need for sleep but if she stops moving for more than five minutes or so she nods off.  She has been like this for as long as I've known her (around 2 1/2 years..I met her after the cancer and treatments) but it seems to be getting worse as time goes by.  I know this isn't enough information to make a diagnosis but I thought you may be able to point me in the right direction. Could she suffering metastasis from her breast ca? Am I off track?

Answer
It is possible but by no means sure. And without much more information it is - as you already know - impossible to get any further.  It is certainly not unknown for a breast cancer to spread to the brain but I do need more facts to evaluate this better.