Cerebral edema in brain cancer: Difference between revisions
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*Findings: | *Findings: | ||
**[[Altered mental status]] | **[[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 | ||
*[[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> | *[[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> | ||
| Line 26: | Line 27: | ||
**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 | **[[GI bleed]]s - ensure GI prophylaxis | ||
**Osteoporosis - avoid in pathologic fracture | **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 | ||
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
- 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
- See also: Herniation Syndromes
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
- ↑ 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.