FIGURE 12.1 A) Head CT scan showing a left cerebellar mass with associated edema producing effacement of the 4th ventricle. B) At a higher level, a second mass is seen in the left parietooccipital area. Note the dilatation of the third ventricle. C) After surgical excision of the cerebellar mass, the CT scan shows persistent edema with mass effect but less prominent than before and reappearance of a visible 4th ventricle.
KEY POINTS TO REMEMBER REGARDING DETERIORATION FROM BRAIN METASTASIS
- Acute neurological decline from brain metastasis or malignant brain tumor is most frequently due to worsening vasogenic edema or hemorrhage.
- Precipitating causes (such as seizures, hypoventilation, and hyponatremia) need to be recognized and treated without delay.
- Glucocorticosteroids are the best medical treatment for vasogenic edema.
- Surgical treatment (tumor removal or debulking) becomes urgent or emergent in rapidly deteriorating patients, presence of a large hemorrhage, and 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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