From the FDA Drug Label
Dexamethasone sodium phosphate injection is generally administered initially in a dosage of 10 mg intravenously followed by four mg every six hours intramuscularly until the symptoms of cerebral edema subside Response is usually noted within 12 to 24 hours and dosage may be reduced after two to four days and gradually discontinued over a period of five to seven days. For palliative management of patients with recurrent or inoperable brain tumors, maintenance therapy with two mg two or three times a day may be effective
The patient presents with a meningioma and a fall. Given the potential for cerebral edema, the medical management may involve dexamethasone.
- The initial dosage of dexamethasone is 10 mg intravenously, followed by 4 mg every 6 hours intramuscularly.
- The dosage may be reduced after 2 to 4 days and gradually discontinued over a period of 5 to 7 days.
- For palliative management of patients with recurrent or inoperable brain tumors, maintenance therapy with 2 mg two or three times a day may be effective 1.
From the Research
Medical management for a patient with a meningioma who presents after a fall should focus on symptom control while planning definitive treatment, with initial management including dexamethasone to reduce peritumoral edema and alleviate symptoms like headache and neurological deficits, as supported by the most recent evidence 2. The goal of medical management is to control symptoms and prevent further complications while preparing for definitive treatment.
- Initial management includes:
- Dexamethasone (typically 4-16 mg/day divided into 2-4 doses) to reduce peritumoral edema and alleviate symptoms like headache and neurological deficits.
- Antiepileptic medications such as levetiracetam (500-1000 mg twice daily) should be started if the patient has experienced seizures or if the meningioma is in a location with high seizure risk.
- Pain management with acetaminophen or NSAIDs may be appropriate for headaches. However, medical management is generally temporary while preparing for definitive treatment, which typically involves surgical resection for symptomatic meningiomas.
- For patients who are poor surgical candidates or have incompletely resected tumors, radiation therapy may be considered.
- Regular neurological monitoring and follow-up imaging are essential to track tumor growth. The decision between observation, surgery, or radiation depends on tumor size, location, symptoms, patient age, and comorbidities, as discussed in recent studies 3, 2. Asymptomatic small meningiomas discovered incidentally may be monitored with serial imaging rather than immediate intervention, according to recent guidelines 2. In cases of increased intracranial pressure, management strategies should be selected according to the causative process, and may include surgical intervention to remove significant mass effect, as well as medical therapies to reduce ICP, such as mannitol and hyperventilation, as supported by earlier studies 4, 5.