Study guide
Brain, Spinal & Leptomeningeal Cancer Emergencies
ABPN Neurocritical Care Study Guide Exam
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1 Chapter 1: Neurologic Examination & Coma Assessment in the ICU
Current Examination, Blueprint & Preparation Neurologic Examination in Critically Ill Patients Coma Evaluation & Consciousness Alterations Delirium & Toxic-Metabolic Encephalopathy in the ICU
2 Chapter 2: Cerebral Physiology & Intracranial Dynamics
Cerebral Blood Flow, Metabolism & Autoregulation Intracranial Pressure & Compliance Cerebral Edema & Herniation Syndromes
3 Chapter 3: Intracranial Hypertension & Cerebral Perfusion Management
Tiered ICP Management Protocols Hyperosmolar Therapy & Fluid Management Advanced & Refractory ICP Interventions
4 Chapter 4: Airway, Mechanical Ventilation & Pulmonary ICU Management
Emergency Airway Management & Neuro-Intubation Mechanical Ventilation Strategies in Acute Brain Injury Tracheostomy & Ventilator Weaning in Neurocritical Care Pulmonary Complications in the Neuro-ICU Obstructive Lung Disease, Pulmonary Hypertension & Bronchoscopy
5 Chapter 5: Hemodynamics, Shock & Cardiovascular Management
Hemodynamic Monitoring & Blood Pressure Targets Vasoactive Agents: Inotropes, Vasopressors & Antihypertensives Cardiac Complications of Brain Injury
6 Chapter 6: Neuropharmacology, Analgesia & Sedation
ICU Sedation & Analgesia Neuromuscular Blockade & Monitoring Propofol Infusion Syndrome & Drug Toxicities Antiseizure Drug Pharmacology in the ICU
7 Bleeding, Thrombosis & Hematologic Emergencies
Warfarin & Heparin Reversal Direct Oral Anticoagulant (DOAC) Reversal Antiplatelet Management & Platelet Dysfunction Venous Thromboembolism Prophylaxis & Management Transfusion, Coagulopathy, TMA & Cellular-Therapy Neurotoxicity
8 Chapter 8: Systemic ICU Care, Fluids, Electrolytes & Endocrine
Hyponatremia & Osmoregulation: SIADH vs Cerebral Salt Wasting Diabetes Insipidus, Hypernatremia & Endocrine Crises Critical Care Prophylaxis, Nutrition & Infection Prevention
9 Systemic Trauma & Environmental Injury
Polytrauma, Chest Injury & Abdominal Hemorrhage Burns, Electrical Injury & Hanging
10 Cardiac Emergencies & Mechanical Support
IABP, Ventricular Devices & ECMO Acute Coronary, Valvular, Rhythm & Aortic Emergencies
11 Kidney Injury, Acid–Base & Renal Replacement
Acute Kidney Injury & Renal Drug Clearance Acid–Base Disorders, Electrolytes & Renal Replacement
12 Systemic Infection & Endocrine Emergencies
Sepsis, Endocarditis & Antimicrobial Principles Thyroid, Adrenal & Dysglycemic Emergencies
13 Gastrointestinal & Hepatic Emergencies
Acute Abdomen, GI Bleeding & Abdominal Compartment Syndrome Acute Liver Failure, Cirrhosis & Hepatic Drug Effects
14 Chapter 9: Neuroimaging in the Neuro-ICU
Non-Contrast CT & CT Angiography CT Perfusion & Advanced Perfusion Imaging Magnetic Resonance Imaging in Critical Illness
15 Chapter 10: Electrophysiology & Neuromonitoring
Continuous EEG & ACNS Standardized Critical Care Terminology Invasive Neuromonitoring: ICP & External Ventricular Drains Multimodal Monitoring: PbtO2, Microdialysis & Transcranial Doppler
16 Angiography, Electrodiagnosis & CSF Analysis
Conventional Angiography & Cranial–Spinal Shunts EMG, Nerve Conduction & Acute Muscle Disease CSF Analysis: Infection, Inflammation & Hemorrhage
17 Chapter 11: Bedside Procedures, Ultrasound & Death by Neurologic Criteria
Critical Care Procedural Skills Critical Care Ultrasound & Echocardiography Determination of Death by Neurologic Criteria
18 Chapter 12: Acute Ischemic Stroke & Reperfusion Therapies
Acute Ischemic Stroke Management & Thrombolysis Endovascular Thrombectomy & Large Vessel Occlusion Malignant Hemispheric & Cerebellar Infarction
19 Chapter 13: Spontaneous Intracerebral Hemorrhage & Intraventricular Hemorrhage
Acute Intraparenchymal Hemorrhage Management Intraventricular Hemorrhage & Hydrocephalus Surgical Evacuation & Minimally Invasive Surgery in ICH
20 Chapter 14: Aneurysmal Subarachnoid Hemorrhage & Delayed Cerebral Ischemia
Aneurysmal Subarachnoid Hemorrhage: Acute Resuscitation & Securing Delayed Cerebral Ischemia & Cerebral Vasospasm Non-Aneurysmal Subarachnoid Hemorrhage & Vascular Malformations
21 Venous, Spinal & Traumatic Vascular Disease
Cerebral Venous Thrombosis & Spinal Cord Infarction Traumatic Dissection, Carotid–Cavernous Fistula & Penetrating Injury
22 Chapter 15: Traumatic Brain & Spinal Cord Injury
Severe Traumatic Brain Injury & Contusions Acute Traumatic Spinal Cord Injury & Neurogenic Shock Spine Trauma, Fractures & Cord Syndromes
23 Chapter 16: Status Epilepticus, Seizures & Neuromuscular Emergencies
Status Epilepticus: Convulsive & Non-Convulsive Refractory & Super-Refractory Status Epilepticus Acute Neuromuscular Respiratory Failure
24 Chapter 17: Post-Cardiac Arrest Care, CNS Infections & Encephalitis
Targeted Temperature Management & Post-Cardiac Arrest Care Post-Cardiac Arrest Neuroprognostication Acute CNS Infections, Encephalitis & Inflammatory Emergencies
25 Neuroinflammation & Neurooncology
Fulminant Demyelination & Autoimmune Encephalitis Brain, Spinal & Leptomeningeal Cancer Emergencies
26 Pregnancy, Transplantation & Pediatric Care
Pregnancy, Postpartum & Post-Transplant Neurologic Care Pediatric Neurocritical Care
27 Chapter 18: Neurosurgical & Perioperative Emergencies
Postoperative Neurosurgical Complications Device Complications: EVDs, Shunts & ICP Monitors Cerebral Hyperperfusion Syndrome & Post-Interventional Emergencies
28 Chapter 19: Ethics, Palliative Care & Organ Donation in the Neuro-ICU
Communication, Surrogate Decision-Making & Conflict Resolution Neuroprognostication Ethics, Withdrawal of Life Support & Palliative Care Organ Donation & Management of the Deceased Donor
Brain, Spinal & Leptomeningeal Cancer Emergencies
Key Takeaways Explain This Topic AI
Tumor-associated vasogenic edema may respond to dexamethasone; steroids do not treat every cause of cerebral edema.
Suspected metastatic spinal cord compression requires urgent imaging and coordinated treatment.
Leptomeningeal disease may cause multifocal cranial, spinal, and radicular abnormalities or hydrocephalus.
Progression, radiation injury, infection, vascular disease, and treatment toxicity can produce similar imaging or symptoms.
Last updated: October 2026
Identify the Immediate Mechanism
The official neurooncology topics include primary brain tumors, brain and spinal metastases, carcinomatous meningitis, paraneoplastic syndromes, and radiation or chemotherapy complications. A cancer label does not explain the acute event by itself. Determine whether the patient has mass effect, hemorrhage, hydrocephalus, ischemia, seizures, infection, metabolic failure, or treatment toxicity. Each mechanism leads to a different immediate intervention.
A new focal deficit may be an acute stroke, even in a patient with known metastases. Altered consciousness may reflect nonconvulsive seizures or medication accumulation rather than tumor growth. Obtain an examination and relevant imaging, review recent treatment and organ function, and correct glucose and oxygenation while the evaluation proceeds. MRI often characterizes tumor-related disease better than CT, but a rapidly available CT may first identify hemorrhage, major mass effect, or hydrocephalus.
Tumor Edema, Hemorrhage, and CSF Obstruction
Vasogenic edema around a tumor reflects increased vascular permeability and extracellular fluid accumulation. Dexamethasone can reduce symptomatic edema; use a syndrome-appropriate dose and reassess for tapering rather than continuing high doses indefinitely. Monitor hyperglycemia, infection, psychiatric effects, weakness, and gastrointestinal risk. Steroids do not replace surgery for a critically compressive mass or CSF diversion for obstructive hydrocephalus.
If primary CNS lymphoma is suspected and the patient is stable, discuss steroids with the diagnostic team because treatment can reduce biopsy yield. If impending herniation requires emergency therapy, stabilize first and coordinate the diagnostic consequences. A rigid rule to withhold all steroids regardless of clinical danger is inappropriate.
Tumors and metastases can bleed, and cancer-associated thrombosis can coexist with intracranial hemorrhage. Manage the immediate bleeding and mass effect, assess coagulation and drug exposure, and individualize anticoagulation decisions. A seizure caused by an intracranial lesion requires treatment; routine primary seizure prophylaxis in every seizure-free brain-tumor patient is a different question and is not established as universally beneficial.
Acute problem Key assessment Potential urgent pathway
Mass effect with declining consciousness CT/MRI, pupils, systemic stability Neuroprotection and neurosurgical assessment
Obstructive hydrocephalus Ventricular and lesion anatomy Appropriate CSF diversion
New seizure or unexplained coma EEG and structural/metabolic assessment Antiseizure treatment and cause control
- Intratumoral hemorrhage Hemorrhage severity, coagulopathy, mass effect Bleeding and surgical management
- Spinal Cord and Epidural Disease
Metastatic spinal cord compression can begin with back pain, radicular symptoms, weakness, sensory change, or bladder dysfunction. A patient with cancer and new neurologic findings needs urgent spinal imaging and multidisciplinary assessment. A single symptomatic level does not guarantee that there is only one lesion; imaging coverage is selected for the clinical situation.
Stabilize a potentially unstable spine and discuss corticosteroids, surgery, radiation, or other treatment urgently with the relevant teams. The choice depends on mechanical stability, degree of compression, tumor biology, prior treatment, systemic condition, and patient goals. Do not wait for complete paralysis or established urinary retention to request help. Pain may be absent or unreportable in a sedated patient.
Leptomeningeal and Paraneoplastic Disease
Leptomeningeal metastasis , also called carcinomatous meningitis, can affect multiple cranial nerves, roots, and cerebral regions and can impair CSF circulation. Headache, diplopia, radicular pain, weakness, or hydrocephalus may occur in combination. MRI with appropriate contrast sequences and CSF cytology or other selected studies contribute to diagnosis. An initial negative CSF cytology does not exclude disease; repeat adequate sampling may be needed when safe and clinically useful.
Paraneoplastic neurologic syndromes arise through immune mechanisms rather than direct tumor invasion. Encephalitis, cerebellar dysfunction, neuropathy, or neuromuscular junction disease can precede discovery of the cancer. Interpret antibody findings in the clinical context and search for a relevant malignancy. Tumor treatment and immune treatment are coordinated according to the syndrome; not all intracellular-antigen and cell-surface-antigen disorders respond identically.
Radiation and Drug Complications
Delayed radiation injury can mimic progression, while acute or subacute treatment effects can cause edema, seizures, or cognitive change. MRI perfusion, metabolic imaging, serial studies, and sometimes tissue are selected to distinguish recurrence from treatment effect; no single routine scan feature is perfectly definitive. Radiation can also cause vascular disease and other delayed neurologic complications.
Chemotherapy and targeted or immune therapies can cause encephalopathy, leukoencephalopathy, neuropathy, myopathy, vascular events, or metabolic abnormalities. Consider renal clearance and interactions when symptoms follow a treatment cycle. In an immunosuppressed patient, infection remains a major competing diagnosis. Manage immediately reversible threats while the oncology team evaluates whether the causative therapy must be paused, changed, or treated with a specific rescue strategy.
Sources checked October 17, 2026: EANO–ESMO neurologic complications guideline and brain metastasis guideline .