Medical Therapy

Corticosteroids often markedly improve neurologic symptoms by reducing peritumoral vasogenic edema. Generalized symptoms, such as headache and lethargy, respond more consistently than do focal symptoms and signs. The clinical response is usually apparent within a day and peaks by 7 days. Dexamethasone, which has the benefit of lacking mineralocorticoid effect, is the steroid used most frequently. Steroids are considered palliative treatment that is used transiently, while other, more definitive therapy is planned or delivered. Treatment with steroids alone results in a median survival of


8-10 weeks. The dose of steroid medication should be tapered and discontinued when clinically possible, to avoid side effects such as myopathy, psychiatric change (agitation, delirium, and psychosis), gastric disturbances (ulceration with bleeding or perforation) and opportunistic infections.

Prophylactic anticonvulsants are not indicated unless there is a history of seizure.

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