Cerebral edema in brain cancer: Difference between revisions
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*Cerebral edema in itself does not produce neuro findings until ICP elevation causes ischemia<ref>Pollay M. Blood-Brain Barrier, Cerebral Edema. In : Wilkins RH, Rengachary SS, editors. Neurosurgery. 2nd ed. New York: Mc Graw Hill Book Co., 1996;335-44.</ref>
*Cerebral edema in itself does not produce neuro findings until ICP elevation causes ischemia<ref>Pollay M. Blood-Brain Barrier, Cerebral Edema. In : Wilkins RH, Rengachary SS, editors. Neurosurgery. 2nd ed. New York: Mc Graw Hill Book Co., 1996;335-44.</ref>
*Findings:
*Findings:
**AMS
**[[Altered mental status]]
**Extremity sensory/motor deficit
**Extremity [[numbness|sensory]]/[[weakness|motor deficit]]
**Bradycardia, elevated BP, irregular breathing
**[[Bradycardia]], [[hypertension|elevated BP]], irregular breathing
**EOM abnormalities
**EOM abnormalities
**Pupillary size abnormalities
**Pupillary size abnormalities
**Extensor plantar response
**Extensor plantar response
**See also: [[Herniation Syndromes]]


==Corticosteroids==
==[[Corticosteroids]]==
*Reduce tumor capillary permeability, inflammatory cytotoxicity
*Reduce tumor capillary permeability, inflammatory cytotoxicity
*IV bolus 10-20 mg dexamethasone on initial presentation<ref>Nahaczewski AE et al. Dexamethasone Therapy in Patients With Brain Tumors - A Focus on Tapering. J Neurosci Nurs. 2004;36(6):340-343.</ref>
*[[Dexamethasone]] IV bolus 10-20mg on initial presentation<ref>Nahaczewski AE et al. Dexamethasone Therapy in Patients With Brain Tumors - A Focus on Tapering. J Neurosci Nurs. 2004;36(6):340-343.</ref>
**Followed by 4 mg IV q6hrs
**Followed by 4mg IV q6hrs
**PO and IV dosing equivalent bioavailability
**PO and IV dosing equivalent bioavailability
**May see improvement within 12-48hrs
**May see improvement within 12-48hrs
*Complications<ref>Dietric J et al. Corticosteroids in brain cancer patients: benefits and pitfalls. Expert Rev Clin Pharmacol. 2011 Mar; 4(2): 233–242.</ref>:
*Complications<ref>Dietric J et al. Corticosteroids in brain cancer patients: benefits and pitfalls. Expert Rev Clin Pharmacol. 2011 Mar; 4(2): 233–242.</ref>:
**GI bleeds - ensure GI prophylaxis
**[[GI bleed]]s - ensure GI prophylaxis
**Osteoporosis - avoid in pathologic fx
**Osteoporosis - avoid in pathologic [[fracture]]
**Neuropsychiatric - avoid in acute psychosis
**Neuropsychiatric - avoid in acute [[psychosis]]
**Steroid myopathy - consider nonfluorinated steroids, such as prednisone, over dexamethasone
**Steroid myopathy - consider nonfluorinated steroids, such as [[prednisone]], over dexamethasone


==See Also==
==See Also==
*[[Elevated intracranial pressure]]
*[[Elevated intracranial pressure]]
*[[Corticosteroids]]
*[[Brain tumor]]


==Sources==
==References==
<references/>
<references/>


[[Category:Neurology]]
[[Category:Neurology]]
[[Category:Heme/Onc]]
[[Category:Heme/Onc]]

Latest revision as of 00:07, 1 October 2019

Background

  • Classification of malignant tumor type does not typically change emergency care
  • Majority of tumors encompassed by[1]:
    • Metastasis
    • Gliomas
    • Meningiomas
    • Pituitary adenomas
    • Acoustic neuromas

Clinical Features

Corticosteroids

  • Reduce tumor capillary permeability, inflammatory cytotoxicity
  • Dexamethasone IV bolus 10-20mg on initial presentation[3]
    • Followed by 4mg IV q6hrs
    • PO and IV dosing equivalent bioavailability
    • May see improvement within 12-48hrs
  • Complications[4]:
    • GI bleeds - ensure GI prophylaxis
    • Osteoporosis - avoid in pathologic fracture
    • Neuropsychiatric - avoid in acute psychosis
    • Steroid myopathy - consider nonfluorinated steroids, such as prednisone, over dexamethasone

See Also

References

  1. ↑ DeAngelis LM. Brain tumors. N Engl J Med. 2001 Jan 11. 344(2):114-23.
  2. ↑ Pollay M. Blood-Brain Barrier, Cerebral Edema. In : Wilkins RH, Rengachary SS, editors. Neurosurgery. 2nd ed. New York: Mc Graw Hill Book Co., 1996;335-44.
  3. ↑ Nahaczewski AE et al. Dexamethasone Therapy in Patients With Brain Tumors - A Focus on Tapering. J Neurosci Nurs. 2004;36(6):340-343.
  4. ↑ Dietric J et al. Corticosteroids in brain cancer patients: benefits and pitfalls. Expert Rev Clin Pharmacol. 2011 Mar; 4(2): 233–242.
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