Increased Intracranial Pressure in Critically Ill Cancer Patients

Pandhi, Abhi; Krishnan, Rashi; Goyal, Nitin; Malkoff, Marc

doi:10.1007/978-3-319-74588-6_36

Oncologic Critical Care 2019

DOI: 10.1007/978-3-319-74588-6_36

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Increased Intracranial Pressure in Critically Ill Cancer Patients

Abhi Pandhi

Rashi Krishnan

Nitin Goyal

et al.

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Cited by 3 publications

(1 citation statement)

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“…7 If thrombectomy is not performed, a large proximal-vessel stroke typically occurs, potentially leading to extended brain tissue infarction, cerebral edema, and other symptoms of elevated intracranial pressure (eg, nausea, vomiting, headache, visual changes, and cranial neuropathies) that can exacerbate a patient's impairment and suffering. 8,9,10,11 Mr J's thrombectomy was uncomplicated and resulted in rapid and successful left MCA territory reperfusion. A subsequent brain magnetic resonance (MR) image, however, revealed multifocal infarcts affecting the left and the right hemisphere of Mr J's brain and bilateral cerebellar hemispheres, consistent with his presumed cardioembolic etiology.…”

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confidence: 99%

When Should Neuroendovascular Care for Patients With Acute Stroke Be Palliative?

Young

Regenhardt

Sokol

et al. 2021

AMA Journal of Ethics

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Noncurative surgeries intended to relieve suffering during serious illness or near end of life have been analyzed across palliative settings. Yet sparse guidance is available to inform clinical management decisions about whether, when, and which interventions should be offered when ischemic stroke and other neurological complications occur in patients whose survival is extended by other novel disease-modifying interventions. This case commentary examines key ethical and clinical considerations in palliative neuroendovascular care of patients with acute stroke.The American Medical Association designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ available through the AMA Ed Hub TM . Physicians should claim only the credit commensurate with the extent of their participation in the activity. CaseMr J is a 64-year-old man with metastatic non-small cell lung cancer (NSCLC), who, while eating, abruptly developed right hemiplegia and aphasia. He had been diagnosed 10 months earlier with NSCLC; his estimated life expectancy was approximately 1 year. After a course of chemotherapy with pemetrexed and carboplatin, Mr J started pembrolizumab, an antiprogrammed death-1 immune checkpoint inhibitor offered possibly to extend his life but not as a cure for his cancer. 1,2 Since diagnosis, Mr J has suffered multiple hematologic complications, including thrombosis and hemorrhage. When brought to an emergency department, he was confirmed as full code and intubated on arrival due to poor mental status and aspiration risk. Computed tomography (CT) imaging of his head and neck revealed normal brain parenchyma and occlusion of the proximal left middle cerebral artery (MCA), which supplies blood to most of the brain's left hemisphere, including areas critical for language and right-side sensorimotor function. 3 The mechanism of Mr J's left MCA occlusion was presumed to be thromboembolism, to which he was predisposed by hypercoagulability of malignancy, pembrolizumab, 4,5,6 and intracardiac hemostasis, given his known low left ventricular ejection fraction.

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mentioning

confidence: 99%

When Should Neuroendovascular Care for Patients With Acute Stroke Be Palliative?

Young

Regenhardt

Sokol

et al. 2021

AMA Journal of Ethics

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Arterial spin-labeled magnetic resonance perfusion imaging in prediction of pediatric brain tumors grading: inter-observer agreement

Elmansy

Zaki

EL-Bakry

et al. 2023

Egypt J Radiol Nucl Med

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Background Pediatric brain tumors are a major concern with many variable management options. Arterial spin-labeled magnetic resonance perfusion imaging is a relatively new and noninvasive technique that can help in predicting tumor grades and provide us with physiological data about the tumors which significantly aids in all stages of tumor care, including diagnosis, therapy, and follow-up. Aim of the study To determine agreement between independent observers in the assessment and prediction of brain tumor grading in pediatrics by arterial spin-labeled (ASL) magnetic resonance perfusion imaging. Methods Thirty-two patients (21 boys and 11 girls; mean age of (10.28 ± 4.31) years) with brain tumors were evaluated by ASL MRI perfusion. Image analysis was performed by two reviewers for quantifying absolute and relative tumoral blood flow (aTBF and rTBF) as well as qualitative assessment of the tumors in ASL color map images. Results The inter-observer agreement for the mean aTBF and the mean rTBF values of the studied lesions was almost perfect (inter-class correlation coefficient (ICC) = 0.978, 0.997). There was substantial agreement between both observers for the qualitative assessment of the studied lesions in color ASL images (Kappa = 0.779, with % of agreement = 87.0%). The mean aTBF for grade I tumors was (24.64 ± 3.45 ml/100 g/min), for grade II tumors it was (33.81 ± 3.59 ml/100 g/min), while for high-grade tumors (grade III and IV tumors) it was (75.60 ± 20.0 ml/100 g/min) with (p < 0.001). The mean rTBF of grade I, II, and III/IV tumors was (1.01 ± 0.17); (1.07 ± 0.31); and (3.12 ± 0.24) with (p < 0.001). Conclusions Arterial spin-labeled perfusion MRI can help in the challenge of prediction of brain tumor grading in pediatrics with accurate quantitative and semi-quantitative measurements of perfusion parameters of the tumors as well as qualitative and visual assessment of the tumors.

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Oncologic Emergencies

Brydges

2021

AACN Advanced Critical Care

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A new cancer diagnosis is expected to affect approximately 1.9 million people in the United States in 2021. A small percentage of these patients will experience an emergent cancer-related complication. Oncologic emergencies may be encountered in emergency departments or require intensive care management. Patients newly diagnosed with cancer are more likely to present with emergencies related to the underlying malignancies. Oncologic emergencies can have various manifestations, ranging from mechanical obstruction due to tumor growth to metabolic derangements due to abnormal secretions from the tumor. Therefore, early identification and treatment of life-threatening oncologic events is critical. Although there are several different types of oncologic emergencies, this article focuses on metabolic emergencies (tumor lysis syndrome and cytoreductive hyperthermic intraperitoneal chemotherapy) and structural emergencies (increased intracranial pressure and vena cava thrombus). The purpose of this article is to provide acute care clinicians with an overview of selected oncologic emergencies and their evidence-based management.

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Increased Intracranial Pressure in Critically Ill Cancer Patients

Cited by 3 publications

References 63 publications

When Should Neuroendovascular Care for Patients With Acute Stroke Be Palliative?

When Should Neuroendovascular Care for Patients With Acute Stroke Be Palliative?

Arterial spin-labeled magnetic resonance perfusion imaging in prediction of pediatric brain tumors grading: inter-observer agreement

Oncologic Emergencies

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