Difference between revisions of "Brain tumor"

(Evaluation)
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**[[Nausea/vomiting]]
 
**[[Nausea/vomiting]]
 
***Also typically worse in the morning
 
***Also typically worse in the morning
**Papilledema, dilated optic nerve
+
**[[Papilledema]], dilated optic nerve
**Cushing's triad: [[Bradycardia]], hypertension, irregular respirations
+
**Cushing's triad: [[Bradycardia]], [[hypertension]], irregular respirations
**Bulging fontenelle in infants
+
**[[Bulging fontanelle]] in infants
 
*[[Seizure]]
 
*[[Seizure]]
 
*[[Altered mental status]], irritability, coma
 
*[[Altered mental status]], irritability, coma

Revision as of 18:42, 14 September 2019

Background

  • Metastatic tumors more common than primary CNS in adults
  • CNS tumors are second most common pediatric cancer, leading cause of cancer-related death in children
  • Most primary tumors in children are infratentorial, whereas most infratentorial masses in adults are metastases

Clinical Features

Differential Diagnosis

Evaluation

  • CT head
  • MRI required for small tumors or areas not well visualized on CT (e.g. posterior fossa)
  • Evaluate for other causes of symptoms (i.e. stroke, metabolic derangement, ICH)

Management

  • See elevated ICP
    • Corticosteroids (reduce tumor capillary permeability, inflammatory cytotoxicity)
    • Elevate head of bed to 30 degrees, provide adequate sedation in intubated patients
    • Maintain cerebral perfusion (euvolemia, vasopressors if necessary)
    • Consider osmotherapy (e.g. hypertonic saline, mannitol)
  • Treat seizure with benzodiazepines +/- AEDs, prophylactic AEDs are not recommended
  • Consult neurosurgery

Disposition

See Also

External Links

References