Elsevier

Neurologic Clinics

Volume 25, Issue 4, November 2007, Pages 1035-1071
Neurologic Clinics

Medical Management of Brain Tumor Patients

https://doi.org/10.1016/j.ncl.2007.07.015Get rights and content

Brain tumors can present challenging medical problems. Seizures, peritumoral edema, venous thromboembolism, fatigue, and cognitive dysfunction can complicate the treatment of patients who have primary or metastatic brain tumors. Effective medical management results in decreased morbidity and mortality and improved quality of life for affected patients.

Section snippets

Epidemiology and pathophysiology

The incidence of seizures among patients who have brain tumor is related to tumor type and ranges from 30% to 70% [2], [3]. Low-grade gliomas present more frequently with seizures (60% to 85%) than high-grade primary brain tumors (20% to 40%) or metastases (15% to 20%) [4], [5], [6], [7]. Cortical tumors more likely cause seizures than infratentorial, deep gray, or white matter lesions [5]. Several mechanisms are implicated in seizure development. These include an imbalance between inhibitory

Pathophysiology

Cerebral edema may be defined broadly as a pathologic increase in the amount of total brain water content leading to an increase in brain volume [39]. It occurs when plasma-like fluid enters the brain extracellular space through impaired capillary endothelial tight junctions in tumors (vasogenic edema) [40] and is a significant cause of morbidity and mortality. The molecular constituents of brain endothelial tight junctions consist of transmembrane proteins occludin, claudin 1 and 5, and

Epidemiology and pathophysiology

VTE is the second leading cause of death in patients who have cancer [130]. The association between brain tumors and thromboembolic disease is a well-known phenomenon and contributes significantly to morbidity and mortality. The incidence of deep vein thrombosis (DVT) or pulmonary emboli (PE) in patients who have brain tumor varies significantly in different studies (3% to 60%) [131], [132], [133], [134]. In patients who have high-grade gliomas outside the perioperative period, the incidence is

Neurocognitive symptoms

The majority of patients who have brain tumor experience distressing neurocognitive symptoms. These symptoms include fatigue, depression, and cognitive impairment and contribute to a marked reduction of quality of life [205]. Appropriate assessment of these symptoms, with particular consideration of their multidimensional nature, is critical in all patients who have brain tumor to allow for timely identification and development of a rational therapeutic strategy. Potential etiologic factors and

Summary

Seizures, cerebral edema, thromboembolic complications, neurocognitive dysfunction, and depression are common challenges in patients who have brain tumor and account for significant morbidity and mortality. Effective medical management of these complications can improve quality of life significantly. Current evidence suggests that anticoagulation for VTE in patients who have brain tumor does not increase the risk for intracranial hemorrhage significantly, unless there is a clear

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