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Cerebral Metastasis with Raised ICP — RACP Adult Medicine MCQ

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EasyNeurologyCerebral Metastasis with Raised ICPRACP Adult Medicine

A 55-year-old man presents with progressive headache, nausea, and papilloedema. MRI shows a large solitary ring-enhancing lesion in the right frontal lobe with surrounding oedema and midline shift. He has a history of lung cancer. What is the most appropriate immediate management?

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Correct answer: C — IV dexamethasone 8-16 mg stat

Raised ICP from cerebral metastasis with surrounding oedema requires IV dexamethasone (8-16 mg stat then 4 mg QID) to reduce vasogenic oedema. This is often rapidly effective within hours. LP is CONTRAINDICATED with mass lesion and midline shift (coning risk). Definitive management depends on number/location of metastases, primary tumour type, and performance status.

Reference: eTG Neurology – 2024 – Raised ICP; NICE 2024 Brain Metastases