Central nervous system tumor: Difference between revisions
ClaireLewis (talk | contribs) |
No edit summary |
||
| (5 intermediate revisions by 2 users not shown) | |||
| Line 1: | Line 1: | ||
{{Adult top}} [[Central nervous system tumor (peds)]].'' | |||
==Background== | ==Background== | ||
*Metastatic tumors more common than primary CNS in adults | *Metastatic tumors more common than primary CNS in adults | ||
| Line 8: | Line 9: | ||
*[[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) | ||
| Line 19: | Line 20: | ||
**[[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 | **[[Bulging fontanelle]] in infants | ||
*[[Seizure]] | *[[Seizure]] | ||
*[[Altered mental status]], irritability, coma | *[[Altered mental status]], irritability, coma | ||
| Line 29: | Line 30: | ||
==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]]) | ||
| Line 37: | Line 38: | ||
***[[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 22:16, 11 November 2020
This page is for adult patients. For pediatric patients, see: Central nervous system tumor (peds).
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
- Depend on location and size of tumor
- Focal neuro deficits
- Cranial nerve palsies
- Behavioral changes, psychosis
- Focal weakness
- Focal sensory deficits
- Abnormal reflexes
- Endocrinopathies (craniopharyngiomas and other suprasellar tumors)
- Bowel/bladder dysfunction
- Features of elevated ICP (from cerebral edema, tumor bleed, or mass effect
- Headache (from increased pressure on heavily innervated meninges)
- Red flags: worse in the morning, worse with valsalva, wakes from sleep, daily
- Nausea/vomiting
- Also typically worse in the morning
- Papilledema, dilated optic nerve
- Cushing's triad: Bradycardia, hypertension, irregular respirations
- Bulging fontanelle in infants
- Headache (from increased pressure on heavily innervated meninges)
- Seizure
- Altered mental status, irritability, coma
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)
- Dexamethasone 10-20mg IV, followed by 4mg IV q6h
- 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)
- Corticosteroids (reduce tumor capillary permeability, inflammatory cytotoxicity)
- Treat seizure with benzodiazepines +/- AEDs, prophylactic AEDs are not recommended
- Consult neurosurgery
Disposition
See Also
- Cerebral edema in brain cancer
- Elevated ICP
- Brain herniation syndromes
- Oncologic emergencies
- Seizure, Seizure (peds)
- Headache, Headache (peds)
- CNS tumors (peds)