Managing patients with gliomas

Knowing the grim prognosis of gliomas, how do you manage a patient with a suspected or definitively diagnosed high-grade (grade III or IV) astrocytoma?
In this Medmastery video, we will review how to offer support and manage these patients.
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It's time to demystify the diagnosis and management of neurological disorders commonly seen in primary and acute care situations.

[@sanbetski]

awesome video!

[@crenapun57]

tq

[@shantanusapru]

I'm afraid some of the info is incorrect (or at best, controversial): # The prognosis of Gr III astrocytoma is not as grim as that of Gr IV GBM, so one needs to be cautious in one's prognostication. # Although there is a role of steroids in Mx of high grade gliomas (HGGs), however, there is no robust evidence that they have benefit as a *routine* medication, provided there are no signs or symptoms of raised ICT or other neurological symptoms (I'm talking pre-Sx). In other words, if an HGG is discovered 'incidentally', and there are no signs/symptoms of raised ICT or midline shift etc, then there is little evidence to administer *routine* steroids! Instead, pt should be taken up for Sx as soon as feasible (some surgeons like to administer steroids in order to 'buy time' or 'bide out' while planning for Sx, but that is controversial at best, and not known to be useful/beneficial). # Same goes for 'routine' anticonvulsant use. No robust evidence to suggest that such use is medically beneficial or even indicated. These should be used if there is history of (or high index of suspicion of) actual seizures. Some people use anticonvulsants as routine if the tumour approaches/encroaches near the 'fluent'/'motor' areas; however, again, no evidence to suggest that this is beneficial. Instead, here, short course of steroids should be/are used to reduce edema & decrease probability of seizures happening. # "...rapid and *painless* decline to coma"??!! Wow! You have no idea, do you?! Pts may experience steroid-refractory headaches for days or even weeks! They may have refractory seizures! End of life may be far from 'painless' in these pts., unfortunately, and the family members need to be counselled such & be made mentally prepared to deal with the inevitable coma-demise... Rest: Agree with the multidisciplinary care required, as well as end-of-life decision making & counselling initiated early on.