Continuum (Minneap Minn). 2024 Jun 1;30(3):845-877. doi: 10.1212/CON.0000000000001435.
Neuro-oncologic emergencies have become more frequent as cancer remains one of the leading causes of death in the United States, second only to heart disease. This article highlights key aspects of epidemiology, diagnosis, and management of acute neurologic complications in primary central nervous system malignancies and systemic cancer, following three thematic classifications: (1) complications that are anatomically or intrinsically tumor-related, (2) complications that are tumor-mediated, and (3) complications that are treatment-related.
The main driver of mortality in patients with brain metastasis is systemic disease progression; however, intracranial hypertension, treatment-resistant seizures, and overall decline due to increased intracranial burden of disease are the main factors underlying neurologic-related deaths. Advances in the understanding of tumor-specific characteristics can better inform risk stratification of neurologic complications. Following standardized grading and management algorithms for neurotoxic syndromes related to newer immunologic therapies is paramount to achieving favorable outcomes.
Neuro-oncologic emergencies span the boundaries of subspecialties in neurology and require a broad understanding of neuroimmunology, neuronal hyperexcitability, CSF flow dynamics, intracranial compliance, and neuroanatomy.
癌症仍是美国主要死亡原因之一，仅次于心脏病，因此神经肿瘤急症的发生愈发频繁。本文重点介绍原发性中枢神经系统恶性肿瘤和全身肿瘤中急性神经并发症的流行病学、诊断和治疗方面的关键内容，主要根据以下三种主题分类：（1）与解剖结构或肿瘤本身相关的并发症；（2）与肿瘤相关的并发症；（3）与治疗相关的并发症。
脑转移患者的主要死亡驱动因素是全身疾病进展；然而，颅内压升高、治疗抵抗性癫痫发作以及由于颅内疾病负担增加导致的整体恶化，是与神经相关死亡的主要因素。对肿瘤特异性特征的深入了解可以更好地进行神经并发症的风险分层。针对新型免疫治疗相关神经毒性综合征的标准化分级和管理算法至关重要，可实现良好的治疗效果。
神经肿瘤急症涉及神经病学和神经免疫学、神经元过度兴奋、CSF 流动动力学、颅内顺应性和神经解剖学等多个专业领域，需要广泛的了解。
