This chapter addresses the topic of brain tumors as causes of epilepsy. It focuses on secondary brain tumors, commonly referred to as solid metastatic brain tumors, and neoplastic meningitis. Epileptic seizures in patients with cerebral metastatic disease are most likely multifactorial, however, a number of factors are considered to be contributing to the development and continuation of these seizures in a subgroup of individuals. Antiepileptic drugs are known to reduce the activity of chemotherapeutic drugs. The treatment of epilepsy in patients with secondary brain tumors should involve a multidisciplinary team that is knowledgeable about all the surgical, radiation, and therapeutic options in the management of these patients. Research needs to be focused on the best antiepileptic drug (AED) or drug combination to use in these patients so that new practice guidelines can be developed to improve patient care.

Cancer-related intracerebral bleeding is an uncommon cause of hemorrhage and represents only a fraction of all non-traumatic intracranial hemorrhages (ICHs). The mechanisms of intratumoral hemorrhage remain unclear, but include tumor necrosis, rupture of tumor blood vessels and invasion of parenchymal blood vessels by tumor. Metastatic brain tumors can cause intracerebral hemorrhage. Brain metastases from any primary tumor can cause bleeding, but the different primaries have a wide variability in their tendency to bleed. A tumor embolus may cause an aneurysm that can lead to potentially fatal intraparenchymal or subarachnoid hemorrhages. The clinical presentation of intratumoral hemorrhage is often indistinguishable from spontaneous ICH from more typical etiologies such as hypertension. Radiotherapy should be administered according to the appropriate protocol regardless of whether the tumor is associated with hemorrhage. The prognosis of a hemorrhagic neoplasm is primarily determined by the prognosis of the underlying malignancy.