MedifocusHealth

Brain Edema

Brain edema (swelling) is a common occurrence in brain tumor patients. The swelling is caused by the accumulation of fluids in the tissue around the tumor. This exerts pressure on the brain that can lead to additional symptoms including headaches, seizures, and focal neurological deficits. Brain edema may initially be due to the tumor itself or it may occur as a result of treatment (craniotomy or radiation therapy).

The first-line treatment for brain edema is the administration of steroids. The most commonly used steroids for brain edema are prednisone and dexamethasone (Decadron). Patients who are given steroids must be carefully monitored for side-effects which may include:

• weight gain
• upset stomach
• muscle weakness
• increased susceptibility to infections
• mood swings
• insomnia
• increased blood sugar levels - particularly dangerous in diabetics

Headaches

Headache is another common symptom in patients with a brain tumor. The "classic" brain tumor headache is characterized as severe, worse in the morning, and is accompanied by nausea and/or vomiting. Studies have shown, however, that only about 20% of patients with a brain tumor experience the "classic" brain tumor headaches. Most patients develop headaches that are characterized as "tension headaches" - a constant, dully achy feeling on both sides of the head.

Headaches associated with a brain tumor are thought to be due to the increased intracranial pressure leading to brain edema. Newly diagnosed brain tumor patients are often prescribed steroids to reduce the extent of brain edema which also helps to relieve the headaches. After surgery to remove a brain tumor, patients will also often experience a reduction in headaches due to a decrease in the intracranial pressure. Some patients, however, may experience headaches for several days after brain surgery (postoperative craniotomy headache) that can usually be relieved with analgesic medications. The recurrence of frequent headaches after surgery may be a symptom of brain edema or tumor recurrence and requires prompt follow-up evaluation.

Seizures

It has been estimated that 30% to 90% of patients with a brain tumor experience seizures. Depending upon the area of the brain where the tumor is located, the severity of the seizures can range from a simple focal seizure involving only a simple sensory or motor function during which the patient may not even be aware that they are having a seizure to a grand mal seizure which involves loss of consciousness and excessive movement of the hands and feet. Seizures associated with a brain tumor are often treated with anticonvulsant medications such as phenytoin (Dilantin), carbamazepine (Tegretol), valproate (Depacon), or phenobarbital. Sometimes these anticonvulsant medications are used in combination to better control the seizures and minimize side-effects.

Focal Neurological Deficits

As mentioned previously, a brain tumor may also cause focal neurological deficits that can impair the patient's functional abilities and lead to difficulties in performing routine activities of daily living. For example, patients may experience cognitive deficits (memory loss), sensory deficits (changes in vision, smell, taste) or motor deficits (weakness, loss of balance, swallowing difficulties). Simple activities of daily living such as walking, bathing, eating, or speaking suddenly become difficult for the patient to accomplish. When functional deficits occur, the initial step is a complete neurological evaluation to determine the nature and extent of the deficits. Once the evaluation has been completed, a rehabilitation plan can be devised to address the specific focal deficits to help improve the patient's ability to function and perform routine daily activities. Rehabilitation usually involves a multidisciplinary team of health care professionals including a physical therapist, occupational therapist, and speech therapist.

Psychosocial Support