Central nervous system tumor

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
  • Seizure
  • Altered mental status, irritability, coma

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

See Also

References

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