Noh Thomas, Walbert Tobias
Department of Neurosurgery, Henry Ford Health System, Detroit, MI, United States.
Department of Neurosurgery, Henry Ford Health System, Detroit, MI, United States; Department of Neurology, Henry Ford Health System, Detroit, MI, United States.
Handb Clin Neurol. 2018;149:75-88. doi: 10.1016/B978-0-12-811161-1.00006-2.
Patients who have brain metastases can suffer from a medley of symptoms, including headaches, seizures, cognitive impairment, fatigue, and focal deficits. As therapies have evolved, so has the management of these symptoms as patients survive longer. This chapter focuses on the clinical presentation of brain metastases, the treatment of those symptoms, and palliation in end-of-life management. Brain metastases are the most common cerebral malignancy. They can present with various symptoms, which can have significant impact on patients' quality of life throughout the course of their disease. Most of these symptoms are related to direct brain compression from the tumor or from edema. The location of the metastases will determine the focal deficits incurred and most patients will be on a course of steroids tapered according to their clinical status. The chapter includes a list of potential side-effects and considerations for management. Palliative care is an essential and important part of approaching patients with metastases. Early and clear communication about end-of-life decision making is encouraged with multiple easily accessible tools. For patients near the end of life, comfort is the ultimate goal in providing a good quality of life.
患有脑转移瘤的患者可能会出现一系列症状，包括头痛、癫痫发作、认知障碍、疲劳和局灶性神经功能缺损。随着治疗方法的不断发展，随着患者生存期的延长，这些症状的管理也在不断变化。本章重点关注脑转移瘤的临床表现、这些症状的治疗以及临终管理中的姑息治疗。脑转移瘤是最常见的脑部恶性肿瘤。它们可表现出各种症状，在疾病过程中会对患者的生活质量产生重大影响。这些症状大多与肿瘤或水肿对大脑的直接压迫有关。转移瘤的位置将决定所产生的局灶性神经功能缺损，大多数患者将根据其临床状况接受逐渐减量的类固醇治疗。本章列出了潜在的副作用及管理方面的注意事项。姑息治疗是治疗转移瘤患者的重要组成部分。鼓励通过多种易于获取的工具，就临终决策进行早期且清晰的沟通。对于接近生命末期的患者，舒适是提供良好生活质量的最终目标。
