Neurologic Emergencies

  • Patricia BrockEmail author
  • Katy M. Toale
  • Sudhaker Tummala
Part of the MD Anderson Cancer Care Series book series (MDCCS)


Neurologic complications of cancer and its therapy are varied and common, occurring in 30–50 % of cancer patients presenting to emergency departments or for neurologic consultations at teaching hospitals. However, a few true neurologic emergencies require rapid diagnosis and treatment to preserve neurologic function and, in some circumstances, save lives. A collaborative effort among the emergency room physician, the patient’s oncologist, and consultants from neurology, neurosurgery, and radiation oncology services affords the best outcome. Even patients with advanced cancer and limited life expectancies can benefit from prompt therapy when it is appropriate for their circumstances.


Malignant cord compression Seizures Status epilepticus Brain metastasis Cerebral edema Intracranial hemorrhage 

Suggested Readings

  1. Abrahm JL. Assessment and treatment of patients with malignant spinal cord compression. J Support Oncol. 2004;2:377–91.PubMedGoogle Scholar
  2. Alldredge BK, Gelb AM, Isaacs SM, et al. A comparison of lorazepam, diazepam, and placebo for the treatment of out-of-hospital status epilepticus. N Engl J Med. 2001;345:631–7.CrossRefPubMedGoogle Scholar
  3. Alvarez V, Januel JM, Burnand B, Rossetti AO. Second-line status epilepticus treatment: comparison of phenytoin, valproate, and levetiracetam. Epilepsia. 2011;52:1292–6.CrossRefPubMedGoogle Scholar
  4. Arguello F, Baggs RB, Duerst RE, Johnstone L, McQueen K, Frantz CN. Pathogenesis of vertebral metastasis and epidural spinal cord compression. Cancer. 1990;65:98–106.CrossRefPubMedGoogle Scholar
  5. Bach F, Larsen BH, Rohde K, et al. Metastatic spinal cord compression. Occurrence, symptoms, clinical presentations and prognosis in 398 patients with spinal cord compression. Acta Neurochir (Wien). 1990;107:37–43.CrossRefGoogle Scholar
  6. Chaffer CL, Weinberg RA. A perspective on cancer cell metastasis. Science. 2011;331:1559–64.CrossRefPubMedGoogle Scholar
  7. Cole JS, Patchell RA. Metastatic epidural spinal cord compression. Lancet Neurol. 2008;7:459–66.CrossRefPubMedGoogle Scholar
  8. DeAngelis L, Posner J, editors. Neurological complications of cancer. 2nd ed. New York, NY: Oxford University Press; 2009.Google Scholar
  9. Delcourt C, Anderson C. Acute intracerebral haemorrhage: grounds for optimism in management. J Clin Neurosci. 2012;19:1622–6.CrossRefPubMedGoogle Scholar
  10. Fernandez EM, Franck AJ. Lacosamide for the treatment of refractory status epilepticus. Ann Pharmacother. 2011;45:1445–9.CrossRefPubMedGoogle Scholar
  11. Fidler IJ, Yano S, Zhang RD, Fujimaki T, Bucana CD. The seed and soil hypothesis: vascularisation and brain metastases. Lancet Oncol. 2002;3:53–7.CrossRefPubMedGoogle Scholar
  12. Gabriel K, Schiff D. Metastatic spinal cord compression by solid tumors. Semin Neurol. 2004;24:375–83.CrossRefPubMedGoogle Scholar
  13. Gavrilovic IT, Posner JB. Brain metastases: epidemiology and pathophysiology. J Neurooncol. 2005;75:5–14.CrossRefPubMedGoogle Scholar
  14. Grewal J, Grewal HK, Forman AD. Seizures and epilepsy in cancer: etiologies, evaluation, and management. Curr Oncol Rep. 2008;10:63–71.CrossRefPubMedGoogle Scholar
  15. Groves MD. New strategies in the management of leptomeningeal metastases. Arch Neurol. 2010;67:305–12.CrossRefPubMedGoogle Scholar
  16. Heimdal McLinton A, Hutchison C. Malignant spinal cord compression: a retrospective audit of clinical practice at a UK regional cancer centre. Br J Cancer. 2006;94:486–91.CrossRefGoogle Scholar
  17. Helweg-Larsen S, Sǿrensen PS. Symptoms and signs in metastatic spinal cord compression: a study of progression from first symptom until diagnosis in 153 patients. Eur J Cancer. 1994;30A:396–8.CrossRefPubMedGoogle Scholar
  18. Loblaw DA, Laperriere NJ, Mackillop WJ. A population-based study of malignant spinal cord compression in Ontario. Clin Oncol. 2003;15:211–7.CrossRefGoogle Scholar
  19. Lowenstein DH, Alldredge BK. Status epilepticus. N Engl J Med. 1998;338:970–6.CrossRefPubMedGoogle Scholar
  20. Marik PE, Varon J. The management of status epilepticus. Chest. 2004;126:582–91.CrossRefPubMedGoogle Scholar
  21. McMullan J, Sasson C, Pancioli A, Silbergleit R. Midazolam versus diazepam for the treatment of status epilepticus in children and young adults: a meta-analysis. Acad Emerg Med. 2010;17:575–82.PubMedCentralCrossRefPubMedGoogle Scholar
  22. Meierkorda H, Boonb P, Engelsenc B, et al. EFNS guideline on the management of status epilepticus in adults. Eur J Neurol. 2010;17:348–55.CrossRefGoogle Scholar
  23. Silbergleit R, Durkalski V, Lowenstein D, et al. Intramuscular versus intravenous therapy for prehospital status epilepticus. N Engl J Med. 2012;366:591–600.PubMedCentralCrossRefPubMedGoogle Scholar
  24. Sperduto PW, Berkey B, Gaspar LE, Mehta M, Curran W. A new prognostic index and comparison to three other indices for patients with brain metastases: an analysis of 1,960 patients in the RTOG database. Int J Radiat Oncol Biol Phys. 2008;70:510–4.CrossRefPubMedGoogle Scholar
  25. Swisher CB, Doreswamy M, Gingrich KJ, Vredenburgh JJ, Kolls BJ. Phenytoin, levetiracetam, and pregabalin in the acute management of refractory status epilepticus in patients with brain tumors. Neurocrit Care. 2012;16:109–13.CrossRefPubMedGoogle Scholar
  26. Taylor JW, Schiff D. Metastatic epidural spinal cord compression. Semin Neurol. 2010;30:245–53.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Patricia Brock
    • 1
    Email author
  • Katy M. Toale
    • 2
  • Sudhaker Tummala
    • 3
  1. 1.Department of Emergency Medicine, Unit 1468The University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.The University of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.Department of Neuro-OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA

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