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Department of Neurology

 

Milestone 13: Neuro-Oncology — Patient Care

 

Specifics about each Level and each Item:  What you do you need to know:
 

Level 2

Identifies neuro-oncological emergencies and initiates management

Epidural spinal cord compression
Cerebral Herniation

Provides differential diagnosis of brain or spine mass

Imaging of brain tumor vs. abscess, stroke, MS
Imaging of spinal tumor vs. myelitis, AVM, AVF


Level 3

Identifies neurologic complications due to cancer or the treatment of cancer

Metastasis to:

Brain
Meninges
Bone (compression of spinal cord or roots)
Plexus
Peripheral nerve

Paraneoplastic syndromes, including

Lambert-Eaton myasthenic syndrome
Sensory Neuronopathy
Cerebellar degeneration
Limbic encephalitis
Opsoclonus - Myoclonus
Anti-NMDA receptor encephalitis (ovarian teratoma)
Dermatomyositis

Chemotherapy toxicity

Vascular disorders, including PRES
Chemotherapy associated peripheral neuropathy

Radiation toxicity

Leukoencephalopathy
Radiation necrosis
Radiation plexopathy

Steroid myopathy

Opportunistic infections, espeically PML

Hypercoagulability

Seizures

Appropriately refers for advanced testing, including biopsy

Brain and mengingeal biopsy


Level 4 

Manages neurologic complications due to cancer or the treatment of cancer

Metastasis to:

Brain
Meninges
Bone (compression of spinal cord or roots)
Plexus
Peripheral nerve

Paraneoplastic syndromes, including

Lambert-Eaton myasthenic syndrome
Sensory Neuronopathy
Cerebellar degeneration
Limbic encephalitis
Opsoclonus - Myoclonus
Anti-NMDA receptor encephalitis (ovarian teratoma)
Dermatomyositis

Chemotherapy toxicity

Vascular disorders, including PRES
Chemotherapy associated peripheral neuropathy

Radiation toxicity

Leukoencephalopathy
Radiation necrosis
Radiation plexopathy

Steroid myopathy

Opportunistic infections, espeically PML

Hypercoagulability

Nutritional Deficiences, especially Vitamin B1

Seizures


Resources for each Level:

Level 2 Resources:

General service rotations
Neuroradiology elective
Summer lecture series on: Neuro-onc emergencies
Continuum
Literature readings

Texts:

Expert Differential Diagnoses: Brain and Spine. Anne G Osborn (Author), Jeff Ross (Author), Julia Crim (Author), Karen L Salzman (Author), Susan I Blaser (Author)
Publisher: Lippincott Williams & Wilkins 2008

Plum and Posner's Diagnosis of Stupor and Coma. Jerome B. Posner, Clifford B. Saper, Nicholas Schiff, Fred Plum. 2007.


Level 3 Resources:

General service rotations
Continuum
Literature readings
CPC (Neuro-onc cases)
Weekly CNS tumor board

Texts:

Cancer Neurology in Clinical Practice: Neurologic Complications of Cancer and Its Treatment (Current Clinical Oncology). David Schiff, Santosh Kesari, Patrick C. Y. Wen. 2008.


Level 4 Resources

Texts:

Cancer Neurology in Clinical Practice: Neurologic Complications of Cancer and Its Treatment (Current Clinical Oncology). David Schiff, Santosh Kesari, Patrick C. Y. Wen. 2008.