This chapter discusses the diagnosis, evaluation and management of disseminated intravascular coagulation and thrombotic thrombocytopenic purpura (TTP)/hemolytic uremic syndrome (HUS). The classic presentation of TTP involves a pentad of symptoms that include fever, neurological signs, anemia, thrombocytopenia, and renal dysfunction. This collection of symptoms is only seen in 20-30% of cases and it is strongly recommended to suspect the condition and manage it as such if a patient exhibits three or more of those features. HUS is most commonly seen in children and often follows an infectious illness, usually diarrhea. Morbidity and mortality in patients with TTP/HUS are usually attributed to thrombosis rather than anemia and bleeding. Patients with TTP can present with neurological symptoms that can be life threatening themselves or complicated by a life-threatening event. Patients (usually children) presenting with HUS may have significant renal dysfunction requiring dialysis.

Neuro-oncologic emergencies are a diverse group of disorders that occur frequently in patients with brain tumors and other types of cancer. The most common structural alterations that cause mental status changes are the presence of primary or metastatic brain tumors. Seizures are common in patients with primary and metastatic brain tumors. In patients with a diagnosed brain tumor, the most common cause for seizure activity is nontherapeutic or inadequate anticonvulsant levels. The most important predisposing factors for cerebrovascular disease in cancer patients are direct effects of tumors on blood vessels, tumor-induced coagulation disorders (hemorrhagic and thrombotic), and treatment-related injury to blood vessels. Focal neurological signs and symptoms are common in patients with brain tumors and other forms of neuro-oncologic disease. In patients with systemic or central nervous system cancer, back pain is often the first sign of a more virulent underlying neurological process.