Central nervous system

In this chapter, we describe central nervous system (CNS) complications of cancer commonly presenting to the emergency department, including altered mental status, high intracranial pressure/brain herniation, status epilepticus (convulsive and nonconvulsive), acute ischemic stroke, intracranial hemorrhage, and cerebral venous sinus thrombosis. We also briefly discuss the effects of SARS-CoV-2 on the CNS. Many patients present with more than one problem and more than one cause. This multiplicity can make diagnosis and management difficult. The goal is to preserve life and function, achieved by early, correct diagnosis. Still, patients come late in the disease course, or these neurological emergencies unfold quickly and catastrophically. Acute mental status change is the top neurological symptom in cancer patients; it is the final common path to intracranial hypertension, epileptic seizures, infection, electrolyte abnormalities, intracranial hemorrhage, ischemic stroke, and adverse effects from drugs. The emergency physician should also be comfortable in starting discussions on goals of care and advance care planning before admission to other hospital areas.