diagnosis of a brain tumour

Dec 08, 2012 17:47

ANSWERED. Thank you all so much for your help ( Read more... )

~medicine: injuries: head injuries, uk: london, uk: health care and hospitals

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kryssa_girl December 9 2012, 19:48:56 UTC
Internal Medicine Resident from US: When someone comes in with seizures and hallucinations, and then has another one in the emergency department, they are usually guaranteed at least a CT and an MRI, with a healthy dose of EEG on top of it. He would be a full admission to the hospital; you don't just "watch" someone who's actively seizing and hope it gets better.

Something else to keep in mind is that Neurology, Neurosurgery, and possibly Oncology specialists will probably be on the case. Neuro would probably start him on anti-epileptic medications, regardless of whether or not he needed surgery now, just to control his symptoms. They might even start an anti-psychotic for the hallucinations, and steroids to decrease pressure on the brain. Neurosurg would evaluate him as 'emergent', 'urgent', or 'elective'. If he was emergent, it literally means that his life is at stake - he will die OMG RITE NOW without the surgery. Urgent means that something needs to be done sooner than later, but if the situation is not appropriate (such as not being in his home country) it can wait. They will also do more thorough imaging studies on his body to get an idea of what kind of tumor it is; it could be a primary brain tumor (glioma), or it could be metastatic (like melanoma, lung cancer, sarcoma, etc). That will determine the type of treatment, too.

This guy sounds like he requires urgent care; he's not dying (as in, excessive edema and pressure from the tumor pushing his brain out of his skull and actively killing him), but he will need treatment soon. Also, he may not be perfectly safe to fly (the way a non-cancerous pt would be), but he is definitely not going to be able to fly after surgery for at least a few weeks. This isn't even counting on complications such as bleeding, intensive care stay, and rehabilitation afterwards. It could be months before he gets clearance, especially if his functional capacity dips down to 'can't even stand up without two people holding him up'. If he has a primary care physician back in NJ, there may be some conversations between England and NJ about where he should be sent the minute he touches down.

My best guess, take with some salt: England will stabilize him - give anti-seizure meds, possibly drill a hole in his skull to relieve pressure and get a biopsy - but I deeply doubt they will actually attempt to remove the tumor, especially if it turns out to be metastatic (and yes, I have seen metastatic cancer in 20 year olds). Rather, they would probably prefer to leave the most invasive aspects of work-up and treatment to New Jersey.

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nerd_do_well December 9 2012, 20:04:32 UTC
Wow! Thank you for such a detailed answer - you've knocked every problem I had right on the head, which I'm inordinately grateful for.

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