Neuro-oncological emergencies requiring critical care intervention

Patients with primary or metastatic brain tumours can deteriorate abruptly, and the acute physician is often the first to respond. This review covers the recognition and initial management of the neurological emergencies most likely to need critical care: raised intracranial pressure from peritumoural oedema and herniation; seizures and status epilepticus, including non-convulsive status epilepticus (NCSE); intracranial haemorrhage; acute hydrocephalus; and venous thromboembolism. It also covers two treatment-related emergencies that the general physician must now recognise: immune effector cell-associated neurotoxicity syndrome after chimeric antigen receptor (CAR) T-cell therapy, and immune checkpoint inhibitor encephalitis. Throughout, the text indicates wither recommendations rest on guidelines and where on observational data. The focus is on recognising time-critical treatment, timely escalation to neurosurgical and neurocritical care services, and the early, values-based discussion of goals of care.