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Brain fag — Clinical Guidelines

Overview

Brain fag, often used colloquially to describe anxiety or stress-related symptoms mimicking neurological conditions, lacks a standardized clinical definition within the provided abstracts. However, symptoms may overlap with those experienced by patients with brain metastases, including cognitive dysfunction, anxiety, and functional impairments 7 13.

Diagnosis

Clinical evaluation focusing on symptom presentation and neurological examination 7 13.

Imaging studies (MRI, CT) to rule out organic causes such as brain metastases or other tumors 1 30.

Neuropsychological testing to assess cognitive function and differentiate from organic brain disorders 19.

Management

Symptomatic treatment with anxiolytics or cognitive enhancers as needed, based on individual symptomatology 7 13.

Psychological support and counseling to address anxiety and stress 13.

For suspected underlying organic causes, referral for neuro-oncology evaluation and management as per brain metastasis guidelines 2 3 4 5.

Special Populations

Pediatrics: Awake craniotomy techniques under sedation are well-tolerated and safe for brain tumor resection in children 6 10 22 23 25.

Elderly: Integration of hospice care improves quality of life for elderly patients with brain metastases 8.

Comorbidities: Management of venous thromboembolism with anticoagulation does not increase the risk of intracranial hemorrhage in patients with brain metastases 11.

Key Recommendations

Conduct thorough neuroimaging (MRI/CT) to exclude organic brain pathology in patients presenting with symptoms suggestive of brain fag 1 30. (Evidence: Moderate)

Provide psychological support and cognitive behavioral therapy for anxiety and stress management 13. (Evidence: Expert opinion)

For patients with suspected brain metastases, follow ASCO-SNO-ASTRO guideline recommendations for radiation therapy and systemic therapy 2 4 5. (Evidence: Strong)

References

1 Scalia G, Silven MP, Costanzo R, Porzio M, Maugeri R, Iacopino DG et al.. Intraventricular Cerebral Metastases: A Comprehensive Systematic Review. Anticancer research 2024. link 2 Vogelbaum MA, Brown PD, Messersmith H, Brastianos PK, Burri S, Cahill D et al.. Treatment for Brain Metastases: ASCO-SNO-ASTRO Guideline. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2022. link 3 Gondi V, Bauman G, Bradfield L, Burri SH, Cabrera AR, Cunningham DA et al.. Radiation Therapy for Brain Metastases: An ASTRO Clinical Practice Guideline. Practical radiation oncology 2022. link 4 Aizer AA, Lamba N, Ahluwalia MS, Aldape K, Boire A, Brastianos PK et al.. Brain metastases: A Society for Neuro-Oncology (SNO) consensus review on current management and future directions. Neuro-oncology 2022. link 5 Martínez-García M, Servitja Tormo S, Vilariño Quintela N, Arance Fernández A, Berrocal Jaime A, Cantos Sánchez de Ibargüen B et al.. SEOM-GEINO clinical guideline of systemic therapy and management of brain central nervous system metastases (2021). Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico 2022. link 6 Lechowicz-Głogowska B, Uryga A, Weiser A, Salomon-Tuchowska B, Burzyńska M, Fortuna W et al.. Awake craniotomy with dexmedetomidine during resection of brain tumours located in eloquent regions. Anaesthesiology intensive therapy 2022. link 7 . MRgFUS-Mediated Antibody Delivery Improves Drug Uptake across the BBB. Cancer discovery 2021. link 8 Mehanna EK, Catalano PJ, Cagney DN, Haas-Kogan DA, Alexander BM, Tulsky JA et al.. Hospice Utilization in Elderly Patients With Brain Metastases. Journal of the National Cancer Institute 2020. link 9 . Diagnosing and managing brain tumours in children. Nursing children and young people 2016. link 10 Goettel N, Bharadwaj S, Venkatraghavan L, Mehta J, Bernstein M, Manninen PH. Dexmedetomidine vs propofol-remifentanil conscious sedation for awake craniotomy: a prospective randomized controlled trial. British journal of anaesthesia 2016. link 11 Kreuziger LB. Balancing bleeding in brain metastases. Blood 2015. link 12 D'Souza DV, Jonckers E, Bruns A, Künnecke B, von Kienlin M, Van der Linden A et al.. Preserved modular network organization in the sedated rat brain. PloS one 2014. link 13 Whittle IR, Lim JX. Overcoming fear and anxiety during awake resection of brain tumours: family support can be pivotal to a successful outcome. British journal of neurosurgery 2013. link 14 Roguin A, Goldstein J, Bar O. Brain tumours among interventional cardiologists: a cause for alarm? Report of four new cases from two cities and a review of the literature. EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 2012. link 15 Shinoura N, Yamada R, Tabei Y, Saito K, Suzuki Y, Yagi K. Advantages and disadvantages of awake surgery for brain tumours in the primary motor cortex: institutional experience and review of literature. British journal of neurosurgery 2011. link 16 Wahab SS, Grundy PL, Weidmann C. Patient experience and satisfaction with awake craniotomy for brain tumours. British journal of neurosurgery 2011. link 17 Andersen JH, Olsen KS. Anaesthesia for awake craniotomy is safe and well-tolerated. Danish medical bulletin 2010. link 18 Gondi V, Mehta MP. Novel insights into the management of brain metastases. Current opinion in neurology 2010. link 19 Wong J, Hird A, Zhang L, Tsao M, Sinclair E, Barnes E et al.. Symptoms and quality of life in cancer patients with brain metastases following palliative radiotherapy. International journal of radiation oncology, biology, physics 2009. link 20 Chow E, Fan G, Hadi S, Wong J, Kirou-Mauro A, Filipczak L. Symptom clusters in cancer patients with brain metastases. Clinical oncology (Royal College of Radiologists (Great Britain)) 2008. link 21 See JJ, Lew TW, Kwek TK, Chin KJ, Wong MF, Liew QY et al.. Anaesthetic management of awake craniotomy for tumour resection. Annals of the Academy of Medicine, Singapore 2007. link 22 Low D, Ng I, Ng WH. Awake craniotomy under local anaesthesia and monitored conscious sedation for resection of brain tumours in eloquent cortex--outcomes in 20 patients. Annals of the Academy of Medicine, Singapore 2007. link 23 Bryan YF, Templeton TW, Nick TG, Szafran M, Tung A. Brain magnetic resonance imaging increases core body temperature in sedated children. Anesthesia and analgesia 2006. link 24 Chow E, Davis L, Holden L, Tsao M, Danjoux C. Prospective assessment of patient-rated symptoms following whole brain radiotherapy for brain metastases. Journal of pain and symptom management 2005. link 25 Hasan RA, Shayevitz JR, Patel V. Deep sedation with propofol for children undergoing ambulatory magnetic resonance imaging of the brain: experience from a pediatric intensive care unit. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies 2003. link 26 Fukaya C, Katayama Y, Yoshino A, Kobayashi K, Kasai M, Yamamoto T. Intraoperative wake-up procedure with propofol and laryngeal mask for optimal excision of brain tumour in eloquent areas. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 2001. link 27 Horne M. 'Do I have a brain tumour, doctor'?. Australian family physician 1997. link 28 Bloomfield EL, Masaryk TJ, Caplin A, Obuchowski NA, Schubert A, Hayden J et al.. Intravenous sedation for MR imaging of the brain and spine in children: pentobarbital versus propofol. Radiology 1993. link 29 Coventry DM, Martin CS, Burke AM. Sedation for paediatric computerized tomography--a double-blind assessment of rectal midazolam. European journal of anaesthesiology 1991. link 30 Leibel SA, Sheline GE. Radiation therapy for neoplasms of the brain. Journal of neurosurgery 1987. link 31 Wong YH, Kalmbach SJ, Hartman BK, Sherman WR. Immunohistochemical staining and enzyme activity measurements show myo-inositol-1-phosphate synthase to be localized in the vasculature of brain. Journal of neurochemistry 1987. link 32 Chow CW, Brittingham J. Perivascular pseudorosettes in childhood brain tumours: an ultrastructural and immunohistochemical study. Pathology 1987. link 33 Pittler SJ, Kozak LP, Wilson JE. In vitro synthesis of rat brain hexokinase. Biochimica et biophysica acta 1985. link90138-2)

Brain fag