Difference between revisions of "Brain tumor"

(Management)
(Evaluation)
 
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*[[Focal neuro deficit]]s
 
*[[Focal neuro deficit]]s
 
**[[Cranial nerve palsies]]
 
**[[Cranial nerve palsies]]
**Behavioral changes, psychosis
+
**Behavioral changes, [[psychosis]]
 
**Focal [[weakness]]
 
**Focal [[weakness]]
**Focal sensory deficits
+
**Focal [[numbness|sensory deficits]]
 
**Abnormal [[reflexes]]
 
**Abnormal [[reflexes]]
 
**Endocrinopathies (craniopharyngiomas and other suprasellar tumors)
 
**Endocrinopathies (craniopharyngiomas and other suprasellar tumors)
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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
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==Evaluation==
 
==Evaluation==
*CT head
+
*[[CT head]]
*MRI required for small tumors or areas not well visualized on CT (e.g. posterior fossa)
+
*[[brain MRI|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]])
 
*Evaluate for other causes of symptoms (i.e. [[stroke]], metabolic derangement, [[ICH]])
  
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***[[Dexamethasone]] 10-20mg IV, followed by 4mg IV q6h
 
***[[Dexamethasone]] 10-20mg IV, followed by 4mg IV q6h
 
**Elevate head of bed to 30 degrees, provide adequate sedation in intubated patients
 
**Elevate head of bed to 30 degrees, provide adequate sedation in intubated patients
**Maintain cerebral perfusion (euvolemia, vasopressors if necessary)
+
**Maintain cerebral perfusion (euvolemia, [[vasopressors]] if necessary)
 
**Consider osmotherapy (e.g. [[hypertonic saline]], [[mannitol]])
 
**Consider osmotherapy (e.g. [[hypertonic saline]], [[mannitol]])
 
*Treat [[seizure]] with [[benzodiazepines]] +/- [[AEDs]], prophylactic AEDs are not recommended
 
*Treat [[seizure]] with [[benzodiazepines]] +/- [[AEDs]], prophylactic AEDs are not recommended

Latest revision as of 22:29, 2 October 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