Cerebral edema in brain cancer

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

  • Maintain high index of clinical suspicion
  • Cerebral edema in itself does not produce neuro findings until ICP elevation causes ischemia[2]
  • Findings:
    • Altered mental status
    • Extremity sensory/motor deficit
    • Bradycardia, elevated BP, irregular breathing
    • EOM abnormalities
    • Pupillary size abnormalities
    • Extensor plantar response

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.