Expert: Claes-Gustaf Nordquist, M.D. - 3/5/2008

Question
Dear Dr. Nordquist,

My husband was treated with gammaknife for 2 parallel small close to the surface brain tumors last Thursday, February 28th. That evening and the following Friday he was fine and symptom free. Since Saturday he has had headaches that come and go but are much worse in the early hours of the morning ( ca. 1 to 6am). Since the headaches became much more severe Sunday, Monday, and Tuesday  very early in the morning he was given a CAT scan today that revealed the swelling had disappeared for one of the tumors but for the other the swelling was significant. He also had vomiting this morning (3 times within 20 minutes). He's been taking cortisone and mannitolo along with stomach and pressure medicine plus seizure meds. Since he should be getting better, not worse, I am looking for answers. The brain tumors are a repition of renal cancer. Could the doctors that did the gamma treatment here in Florence have done a bad job and my husband is having this difficulty as a result? What are the possible answers. Even though the cortisone has been doubled along with mannitol this evening he woke up (he is now hospitalized again) at 11pm with a very bad headache for which he was given tramodolo via iv. These attacks of very bad pain also sometimes occur if he changes position like standing up  or can be relieved by moving about. Please let me have you opinion and if I have not given you enough information let me know what is missing from this picture. Thank you very much,

Claire Ringressi

Answer
Radiation therapy to the brain almost always results in brain swelling. How much depends on how much radiation that has been given BUT there are also individual variations. It also takes some time for this swelling to pass. Cortisone can be used to lessen the swelling but also here there may be individual variations. So I can not say that what you describe indicates that anyone has done anything wrong. This kind of treatment is somewhat desperate but since other options are few I think I must call it justified. I wish your husband a full and speedy recovery!