781 - The Risk of Tapering Dexamethasone in the Treatment of Vasogenic Edema in the Setting of a High-Grade Glioblastoma: A Case Report

Case Diagnosis: Glioblastoma Multiforme-Induced Vasogenic Edema

Case Description: The patient is a 69-year-old female who presented with a high-grade glioblastoma multiforme (GBM). The patient underwent a surgical resection of a left frontal brain lesion with gleolan. Patient displayed significant expressive aphasia and right hemiparesis. She was discharged to inpatient rehabilitation. 1 week after transfer, she developed worsening right-sided weakness. CT imaging revealed cerebral edema for which she was given 4 mg dexamethasone every six hours with subsequent tapering of the dose. Patient was later transferred to the emergency department for further evaluation after functional decline. CT imaging revealed worsening left frontal-parietal swelling and MR imaging revealed increased neoplastic processes consistent with GBM. Dexamethasone was restarted at 4mg every six hours. Patient has since remained functionally stable.

Discussions: GBM is the most common malignant primary brain tumor in adults. GBM-induced brain edema has commonly been treated with dexamethasone. However, it is unclear whether patients should be tapered off steroids or be placed on dexamethasone indefinitely. For high-grade GBM with minimal neurologic symptoms, Lau et al. recommends starting 4-8mg or 16mg of dexamethasone with tapering after a few days. Meanwhile, Kostaras et al. recommends slow tapering starting with 4mg twice daily for 7 days, then 2mg twice daily for 7 days, then 1mg twice daily for 7 days. Tapering dexamethasone mitigates dexamethasone side effects. Less literature exists to support indefinite dexamethasone in GBM with vasogenic edema, but should be considered to prevent functional decline.

Conclusions: In GBM-induced brain edema, dexamethasone has been shown to help with functional recovery and can play a role in limiting cancerous growth. Different tapering schedules have been supported to reduce dexamethasone’s side effect profile. Before deciding to taper dexamethasone, it is critical to assess the risk of further functional decline and to consider the option of giving dexamethasone indefinitely.