Brain Metastasis in the Emergency Department: Epidemiology, Presentation, Investigations, and Management

Brain metastases (BMs) are the most prevalent type of cerebral tumor, significantly affecting survival. In adults, lung cancer, breast cancer, and melanoma are the primary cancers associated with BMs. Symptoms often result from brain compression, and patients may present to the emergency department...

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Bibliographic Details
Published in:Cancers 2024-07, Vol.16 (14), p.2583
Main Authors: Zoghbi, Marianne, Moussa, Mohammad Jad, Dagher, Jim, Haroun, Elio, Qdaisat, Aiham, Singer, Emad D, Karam, Yara E, Yeung, Sai-Ching J, Chaftari, Patrick
Format: Article
Language:English
Subjects:
Anticonvulsants
Brain cancer
Brain tumors
Breast cancer
Cancer
Cancer therapies
Chemotherapy
Corticosteroids
Development and progression
Edema
Emergency medical care
Emergency medicine
Emergency service
Epidemiology
Epilepsy
Evidence-based medicine
Hemorrhage
Hospitals
Immunotherapy
Investigations
Kidney cancer
Lung cancer
Medical prognosis
Medical treatment
Melanoma
Metastases
Metastasis
Morbidity
Mortality
Neurological diseases
Patients
Pneumonia
Prostate
Quality of life
Radiation
Radiation therapy
Radiosurgery
Seizures
Seizures (Medicine)
Survival
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Description
Summary:Brain metastases (BMs) are the most prevalent type of cerebral tumor, significantly affecting survival. In adults, lung cancer, breast cancer, and melanoma are the primary cancers associated with BMs. Symptoms often result from brain compression, and patients may present to the emergency department (ED) with life-threatening conditions. The goal of treatment of BMs is to maximize survival and quality of life by choosing the least toxic therapy. Surgical resection followed by cavity radiation or definitive stereotactic radiosurgery remains the standard approach, depending on the patient's condition. Conversely, whole brain radiation therapy is becoming more limited to cases with multiple inoperable BMs and is less frequently used for postoperative control. BMs often signal advanced systemic disease, and patients usually present to the ED with poorly controlled symptoms, justifying hospitalization. Over half of patients with BMs in the ED are admitted, making effective ED-based management a challenge. This article reviews the epidemiology, clinical manifestations, and current treatment options of patients with BMs. Additionally, it provides an overview of ED management and highlights the challenges faced in this setting. An improved understanding of the reasons for potentially avoidable hospitalizations in cancer patients with BMs is needed and could help emergency physicians distinguish patients who can be safely discharged from those who require observation or hospitalization.
ISSN:2072-6694
2072-6694
DOI:10.3390/cancers16142583