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Brain Metastases — SCE Medical Oncology MCQ

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HardOncological EmergenciesBrain MetastasesSCE Medical Oncology

A patient with a 4 cm brain metastasis has a seizure, GCS 11, extensive vasogenic oedema and 8 mm midline shift. What is the immediate combined management while definitive intervention is arranged?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Give intravenous dexamethasone, treat the seizure and obtain urgent neurosurgical review

Explanation lettering: C = shown as A · A = shown as B · D = shown as C · B = shown as D

D is correct. Neurological compromise from tumour-related vasogenic oedema requires prompt dexamethasone; a commonly used severe-symptom total is 16 mg daily, adjusted to response and local protocol. A witnessed seizure requires acute antiseizure treatment, and a large accessible lesion with shift demands urgent neurosurgical and oncology review. Lumbar puncture is dangerous with mass effect, radiotherapy is not the first stabilisation step, and osmotherapy may be an adjunct in impending herniation but cannot replace corticosteroid, seizure and definitive assessment. Airway and critical-care support run in parallel when consciousness is impaired.

Reference: NICE NG99 brain tumour recommendations: https://www.nice.org.uk/guidance/ng99/chapter/recommendations