Cerebral edema in brain cancer
- Classification of malignant tumor type does not typically change emergency care
- Majority of tumors encompassed by:
- Pituitary adenomas
- Acoustic neuromas
- Maintain high index of clinical suspicion
- Cerebral edema in itself does not produce neuro findings until ICP elevation causes ischemia
- Reduce tumor capillary permeability, inflammatory cytotoxicity
- Dexamethasone IV bolus 10-20mg on initial presentation
- Followed by 4mg IV q6hrs
- PO and IV dosing equivalent bioavailability
- May see improvement within 12-48hrs
- 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
- DeAngelis LM. Brain tumors. N Engl J Med. 2001 Jan 11. 344(2):114-23.
- 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.
- Nahaczewski AE et al. Dexamethasone Therapy in Patients With Brain Tumors - A Focus on Tapering. J Neurosci Nurs. 2004;36(6):340-343.
- Dietric J et al. Corticosteroids in brain cancer patients: benefits and pitfalls. Expert Rev Clin Pharmacol. 2011 Mar; 4(2): 233–242.