Neurological and Medical Complications in Brain Tumor Patients. 2026 Update

Abstract Purpose of Review Patients with brain tumors have a plethora of potential complications that arise from both the tumor and its therapeutic management. These complicate clinical management and produce morbidity and occasionally mortality. In this review we discuss the most common neurological and medical complications that include tumor-related epilepsy, vasogenic edema, infection, thromboembolism, endocrine abnormalities and cognitive impairment and its management. This review is an update to the 2020 article by Schiff and Alyahya. Recent Findings IDH mutant gliomas cause neuronal hyperexcitability via D-2 -hydroxyglutarate production; use of IDH inhibitors may lower the rate of seizures in this patient population. Pneumocystis prophylaxis with antibiotics has been traditionally recommended with radiation and concurrent temozolomide chemotherapy but newer data suggest no difference in hospitalization or survival. Podoplanin produced by tumor cell releases into the circulation, often via extracellular vesicles, activates platelets and may contribute to venous thrombus formation. Direct oral Anticoagulants (DOACs) are the treatment of choice for venous thromboembolism, with high quality of evidence and a strong recommendation in cancer-associated thrombosis. Though brain tumor patients were underrepresented in clinical trials, retrospective studies support its safety in this population. Summary Brain tumor patients are prone to complications arising from both the tumor and the treatment strategies. Management requires a multidisciplinary strategy with supportive medications including antiseizure medications, corticosteroids, anticoagulants for thromboembolism, and neurocognitive rehabilitation. Early recognition and timely intervention can reduce the morbidity associated with these complications leading to better patient outcomes.