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Urgent Options in Brain Metastasis 

Urgent Options in Brain Metastasis
Urgent Options in Brain Metastasis
Neurocritical Care (2 ed.)

Eelco F. M. Wijdicks

, Alejandro A. Rabinstein

, Sara E. Hocker

, and Jennifer E. Fugate


Deterioration of patients with metastasis or malignant brain tumor in close proximity to the brainstem may be due to hemorrhage or brain edema. Precipitating causes (such as seizures, hypoventilation, and hyponatremia) need to be recognized and treated without delay. Options for stabilization and indications for urgent debulking are discussed in this chapter. Glucocorticosteroids are the best medical treatment for vasogenic edema. Surgical treatment (tumor removal or debulking) becomes urgent or emergent in rapidly deteriorating patients, with presence of a large hemorrhage, and in patients refractory to medical treatments. When offering surgery as a life-saving intervention, the future prognosis and wishes of the patient need to be discussed in detail.

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