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Central Nervous System

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Oncologic Emergency Medicine

Abstract

In this chapter, we describe central nervous system (CNS) complications of cancer commonly presenting to the emergency department, including altered mental status, high intracranial pressure/brain herniation, status epilepticus (convulsive and nonconvulsive), acute ischemic stroke, intracranial hemorrhage, and cerebral venous sinus thrombosis. We also briefly discuss the effects of SARS-CoV-2 on the CNS. Many patients present with more than one problem and more than one cause. This multiplicity can make diagnosis and management difficult. The goal is to preserve life and function, achieved by early, correct diagnosis. Still, patients come late in the disease course, or these neurological emergencies unfold quickly and catastrophically. Acute mental status change is the top neurological symptom in cancer patients; it is the final common path to intracranial hypertension, epileptic seizures, infection, electrolyte abnormalities, intracranial hemorrhage, ischemic stroke, and adverse effects from drugs. The emergency physician should also be comfortable in starting discussions on goals of care and advance care planning before admission to other hospital areas.

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Authors and Affiliations

  1. Department of Neurology, University of Texas Medical Branch, Galveston, TX, USA

    Prashant Rai

  2. Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, TX, USA

    Akhil Shivaprasad

  3. Kenneth R. Peak Brain and Pituitary Tumor Center, Department of Neurosurgery, Houston Methodist Hospital, Houston, TX, USA

    Ivo W. Tremont-Lukats

  4. Department of Neuro-Oncology, MD Anderson Cancer Center, Houston, TX, USA

    Sudhakar Tummala

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  1. Prashant Rai
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  2. Akhil Shivaprasad
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  3. Ivo W. Tremont-Lukats
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  4. Sudhakar Tummala
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Correspondence to Ivo W. Tremont-Lukats .

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Editors and Affiliations

  1. Former Professor and Founding Chair (Retired), The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Knox H. Todd

  2. Professor and Chair, Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA

    Charles R. Thomas, Jr.

  3. Professor and Chair, Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Kumar Alagappan

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Rai, P., Shivaprasad, A., Tremont-Lukats, I.W., Tummala, S. (2021). Central Nervous System. In: Todd, K.H., Thomas, Jr., C.R., Alagappan, K. (eds) Oncologic Emergency Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-67123-5_16

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