Oncologic emergencies of the central nervous system (CNS)

In this chapter, we succinctly describe and explain the major complications in the central nervous system of patients with cancer seen in emergency areas. Many patients present with more than one of these problems and with more than one cause. This multiplicity can make the diagnosis and management of these neurologic conditions complex. The ideal outcome is to preserve life and function, many times determined by an early, correct diagnosis and management that begins in the emergency department. Unfortunately many patients come late in the disease course, or these neurological complications develop quickly and catastrophically despite the best effort. A change in mental status is the most frequent neurological symptom in cancer patients, and its correct diagnosis is challenging as there are many possible causes including increased intracranial pressure, epileptic seizures, infection, electrolyte abnormalities, intracranial hemorrhage, and adverse effects from drugs including opioids, benzodiazepines, antihistaminics, chemotherapy agents, immunosuppressors, and antibiotics. Finally, it is important to remember that in many cases, recognition of poor prognosis and institution of advance care planning, supportive care, and ultimately hospice case are the right interventions to make even in the emergency department.