Neurocritical Care

Contrast-enhanced MRI is the most common test.

Corticosteroids for brain edema

Dexamethasone commonly used for vasogenic edema associated with tumors

Reduces peritumoral edema and symptoms associated with increased ICP. Temporarily

reduces symptoms (neurologic dysfunction, seizures, headache)

ii.

Dose is commonly 4 mg intravenously every 6 hours.

iii.

May use other corticosteroids at comparable doses

Use of acid-suppressive agents (famotidine) may help with concomitant steroid use to reduce the risk

of GI complications (Wien Med Wochenschr 1988;138:97-101).

Consideration for glycemic control

Metabolism induced by phenytoin (because of increased cytochrome P450 [CYP] activity)

High risk of VTE

Consider using combination pharmacologic/mechanical prophylaxis.

Enoxaparin is superior to warfarin for the treatment of VTE in oncology patients.

Seizure prophylaxis

Not typically indicated

Around 50% of patients with primary brain tumor present with seizure, which must be treated with

anticonvulsant medications.

Phenytoin, carbamazepine, and levetiracetam are often recommended; however, caution should

be used with agents that have been associated with Stevens-Johnson syndrome/toxic epidermal

necrolysis (e.g., phenytoin, carbamazepine) in patients who also require radiation therapy.

of possible drug interactions with chemotherapy.

Exact incidence is unknown because of inconsistent monitoring and diagnosis.

(greater than 7 days), 80% in patients with multiorgan failure

Typically suspected when patients do not wean well from the ventilator or if their limbs are weak/flaccid

includes evaluation for critical illness myopathy, Guillain-Barré syndrome, electrolyte abnormalities

The cause of critical illness polyneuropathy is unknown, but several hypotheses exist.

Mitochondrial dysfunction in critical illness may cause energy stress in vulnerable neurons.