View source for Cerebral edema in brain cancer

==Background==
*Classification of malignant tumor type does not typically change emergency care
*Majority of tumors encompassed by<ref>DeAngelis LM. Brain tumors. N Engl J Med. 2001 Jan 11. 344(2):114-23.</ref>:
**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<ref>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.</ref>
*Findings:
**AMS
**Extremity sensory/motor deficit
**Bradycardia, elevated BP, irregular breathing
**EOM abnormalities
**Pupillary size abnormalities
**Extensor plantar response

==Corticosteroids==
*Reduce tumor capillary permeability, inflammatory cytotoxicity
*IV bolus 10-20 mg dexamethasone 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>
**Followed by 4 mg IV q6hrs
**PO and IV dosing equivalent bioavailability
**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>:
**GI bleeds - ensure GI prophylaxis
**Osteoporosis - avoid in pathologic fx
**Neuropsychiatric - avoid in acute psychosis
**Steroid myopathy - consider nonfluorinated steroids, such as prednisone, over dexamethasone

==See Also==
*[[Elevated intracranial pressure]]
*[[Corticosteroids]]

==References==
<references/>

[[Category:Neurology]]
[[Category:Heme/Onc]]