Lara LZI, Sánchez DJS, Martínez REA, Pascual ES, Asiain VJA, Peniche MKG, García MRC, Calyeca SMV

Idioma: Español
Referencias bibliográficas: 40
Paginas: 48-52
Archivo PDF: 242.29 Kb.

RESUMEN

Los esteroides se han usado desde 1960 y, aunque están vinculados a efectos secundarios potenciales, desempeñan un papel decisivo en el tratamiento del edema cerebral asociado con tumores cerebrales de origen primario o secundario. Por otro lado, los esteroides juegan un rol de suma importancia dentro del manejo inicial, considerando que la mayoría de los tumores desencadena edema vasogénico. Presentamos el caso de una mujer de 48 años de edad con desviación de la comisura labial, hemiparesia hemicorporal izquierda y somnolencia secundarias a tumoración temporal derecha; fue tratada con 8 mg de dexametasona intravenosa cada ocho horas, con mejoría de sus signos y síntomas (reversión de la hemiparesia fasciocorporal izquierda y mejoría del estado de conciencia). Debido a sus propiedades farmacológicas, la dexametasona se considera el esteroide de elección para el tratamiento del edema cerebral peritumoral, tiene un mínimo efecto mineralocorticoide, alta potencia y una vida media más prolongada que el resto, aunque cualquier otro esteroide podría ser eficaz si se administra en dosis equivalentes. Actualmente, no se tiene definida la dosis, el tiempo de tratamiento y el esquema de reducción ideal respecto al uso de dexametasona en el paciente con edema cerebral peritumoral; las recomendaciones encontradas son dispares.

REFERENCIAS (EN ESTE ARTÍCULO)

1. Ruderman N, Hall T. Use of glucocorticoids in the palliative treatment of metastatic brain tumors. Cancer. 1965;18:298-306.

2. Jelsma R, Bucy PC. The treatment of glioblastoma multiforme of the brain. J Neurosurg. 1967;27(5):388-400.

3. Guinto G, Ortega CJ, Palacios BA. Manual de diagnóstico para el consultorio. Editorial Litoral. México, DF; 2004. pp. 135-138.

4. Boyd TS, Mehta MP. Stereotactic radiosurgery for brain metastases. Oncology (Williston Park). 1999;13(10):1397-1409.

5. Galicich JH, French LA, Melby JC. Use of dexamethasone in treatment of cerebral edema associated with brain tumors. J Lancet. 1961;81:46-53.

6. Murayi R, Chittiboina P. Glucocorticoids in the management of peritumoral brain edema: a review of molecular mechanisms. Childs Nerv Syst. 2016;32(12):2293-2302.

7. Inaba H, Pui CH. Glucocorticoid use in acute lymphoblastic leukaemia. Lancet Oncol. 2010;11(11):1096-1106.

8. Papadopoulos MC, Saadoun S, Binder DK, Manley GT, Krishna S, Verkman AS. Molecular mechanisms of brain tumor edema. Neuroscience. 2004;129(4):1011-1020.

9. Mahajan S, Bhagat H. Cerebral oedema: pathophysiological mechanisms and experimental therapies. J Neuroanaesthesiol Crit Care. 2016;3(4):22-28.

10. Rodríguez-Boto G, Rivero-García M, Gutiérrez-González M, Márquez-Rivas J. Conceptos básicos sobre la fisiopatología cerebral y la monitorización de la presión intracraneal. Neurología. 2015;30(1):16-22.

11. Klatzo I. Evolution of brain edema concepts. Acta Neurochirurgica. 1994;60:3-6.

12. Fishman RA. Brain edema. N Engl J Med. 1975;293(14):706-711.

13. Bingaman WE, Frank JI. Malignant cerebral edema and intracranial hypertension. Neurol Clin. 1995;13(3):479-509.

14. Bhardwaj A, Ulatowski JA. Cerebral edema: hypertonic saline solutions. Curr Treat Options Neurol. 1999;1(3):179-188.

15. Kaal EC, Vecht CJ. The management of brain edema in brain tumors. Curr Opin Oncol. 2004;16(6):593-600.

16. Nag S, Manias JL, Stewart DJ. Pathology and new players in the pathogenesis of brain edema. Acta Neuropathol. 2009;118(2):197-217.

17. Tsukita S, Furuse M. Claudin-based barrier in simple and stratified cellular sheets. Curr Opin Cell Biol. 2002;14(5):531-536.

18. Michinaga S, Koyama Y. Pathogenesis of brain edema and investigation into anti-edema drugs. Int J Mol Sci. 2015;16(5):9949-9975.

19. Esquenazi Y, Lo VP, Lee K. Critical care management of cerebral edema in brain tumors. J Intensive Care Med. 2017;32(1):15-24.

20. Broholm H, Rubin I, Kruse A, Braendstrup O, Schmidt K, Skriver EB, et al. Nitric oxide synthase expression and enzymatic activity in human brain tumors. Clin Neuropathol. 2003;22(6):273-281.

21. Chio CC, Baba T, Black KL. Selective blood-tumor barrier disruption by leukotrienes. J Neurosurg. 1992;77(3):407-410.

22. Heiss JD, Papavassiliou E, Merrill MJ, Nieman L, Knightly J, Walbridge S, et al. Mechanism of dexamethasone suppression of brain tumor-associated vascular permeability in rats. Involvement of the glucocorticoid receptor and vascular permeability factor. J Clin Invest. 1996;98(6):1400-1408.

23. Förster C, Silwedel C, Golenhofen N, Burek M, Kietz S, Mankertz J, et al. Occludin as direct target for glucocorticoid-induced improvement of blood-brain barrier properties in a murine in vitro system. J Physiol. 2005;565:475-486.

24. Yang JT, Lee TH, Lee IN, Chung CY, Kuo CH, Weng HH. Dexamethasone inhibits ICAM-1 and MMP-9 expression and reduces brain edema in intracerebral hemorrhagic rats. Acta Neurochir (Wien). 2011;153(11):2197-2203.

25. Ryken TC, McDermott M, Robinson PD, Ammirati M, Andrews DW, Asher AL et al. The role of steroids in the management of brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol. 2009;96(1):103-114.

26. Miller JD, Leech P. Effects of mannitol and steroid therapy on intracranial volume–pressure relationships in patients. J Neurosurg. 1975;42(3):274-281.

27. Miller JD, Sakalas R, Ward JD, Young HF, Adams WE, Vries JK, Becker DP. Methylprednisolone treatment in patients with brain tumors. Neurosurgery. 1977;1(2):114-117.

28. Yeung WT, Lee TY, Del Maestro RF, Kozak R, Bennett J, Brown T. Effect of steroids on iopamidol blood–brain transfer constant and plasma volume in brain tumors measured with X-ray computed tomography. J Neurooncol. 1994;18(1):53-60.

29. Hardwidge C, Hettige S. Tumours of the central nervous system. Surgery. 2012;30(3):155-161.

30. Bell BA, Smith MA, Kean DM, McGhee CN, MacDonald HL, Miller JD, et al. Brain water measured by magnetic resonance imaging. Correlation with direct estimation and changes after mannitol and dexamethasone. Lancet. 1987;1(8524):66-69.

31. Sneed PK. Metastatic brain tumors. Brain Cancer Atlas of Clinical Oncology of the American Cancer Society. 2002;375-390.

32. Roth P, Wick W, Weller M. Steroids in neurooncology: actions, indications, side-effects. Curr Opin Neurol. 2010;23(6):597-602.

33. Hempen C, Weiss E, Hess CF. Dexamethasone treatment in patients with brain metastases and primary brain tumors: do the benefits outweigh the side-effects? Support Care Cancer. 2002;10(4):322-328.

34. Dietrich J, Rao K, Pastorino S, Kesari S. Corticosteroids in brain cancer patients: benefits and pitfalls. Expert Rev Clin Pharmacol. 2011;4(2):233-242.

35. Vecht CJ, Hovestadt A, Verbiest HB, van Vliet JJ, van Putten WL. Dose-effect relationship of dexamethasone on Karnofsky performance in metastatic brain tumors: a randomized study of doses of 4, 8, and 16 mg per day. Neurology. 1994;44(4):675-680.

36. Sturdza A, Millar BA, Bana N, Laperriere N, Pond G, Wong RK, et al. The use and toxicity of steroids in the management of patients with brain metastases. Support Care Cancer. 2008;16(9):1041-1048.

37. Millar BM, Bezjak A, Tsao M, Sturdza A, Laperriere N. Defining the impact and contribution of steroids in patients receiving whole-brain irradiation for cerebral metastases. Clin Oncol (R Coll Radiol). 2004;16(5):339-344.

38. Kostaras X, Cusano F, Kline GA, Roa W, Easaw J. Use of dexamethasone in patients with high-grade glioma: a clinical practice guideline. Curr Oncol. 2014;21(3):493-503.

39. Kotsarini C, Griffiths PD, Wilkinson ID, Hoggard N. A systematic review of the literature on the effects of dexamethasone on the brain from in vivo human-based studies: implications for physiological brain imaging of patients with intracranial tumors. Neurosurgery. 2010;67(6):1799-1815.

40. Roth P, Happold C, Weller M. Corticosteroid use in neuro-oncology: an update. Neurooncol Pract. 2015;2(1):6-12.