Ch. 70

Cerebellar tumor localized symptoms

A cerebellar tumor causes dizziness; an ataxic or staggering gait with a tendency to fall toward the side of the lesion; marked muscle incoordination; and nystagmus (involuntary rhythmic eye movements), usually in the horizontal direction.

MRI scan

A magnetic resonance imaging (MRI) scan is the most helpful diagnostic tool for detecting brain tumors, particularly smaller lesions, and tumors in the brain stem and pituitary regions, where bone is thick (Fig. 70-2). MRI is also useful in monitoring response to treatment.

Parietal Lobe localized symptoms

A parietal lobe tumor may cause decreased sensation on the opposite side of the body and sensory or generalized seizures.

Temporal lobe localized symptoms

A temporal lobe tumor may cause seizures as well as psychological disorders.

Motor cortex of Frontal lobe localized symptoms

A tumor in the motor cortex of the frontal lobe produces hemiparesis and partial seizures on the opposite side of the body or generalized seizures A frontal lobe tumor may also produce changes in emotional state and behavior, as well as an apathetic mental attitude. The patient often becomes extremely untidy and careless and may use obscene language.

Occipital lobe localized symptoms

An occipital lobe tumor produces visual manifestations: contralateral homonymous hemianopsia (visual loss in half of the visual field on the opposite side of the tumor) and visual hallucinations.

Brain Stem tumor localized symptoms

Brain stem tumors may be associated with cranial nerve deficits and complex motor and sensory function.

Chemotherapy

Chemotherapy may be used in conjunction with radiation therapy, or as the sole therapy, with the goal of increasing survival time. The greatest challenge in chemotherapy of brain tumors is that the blood-brain barrier prevents drugs from getting to the tumor in effective doses without causing systemic toxicity.

CT scan

Computed tomography (CT) scans, enhanced by a contrast agent, can give specific information concerning the number, size, and density of the lesions and the extent of secondary cerebral edema.

Computer-assisted stereotactic (three-dimensional) biopsy

Computer-assisted stereotactic (three-dimensional) biopsy is used to diagnose deep-seated brain tumors and to provide a basis for treatment and prognosis.

Pharmacologic therapy of tumors

Corticosteroids are useful in relieving headache and alterations in level of consciousness. Thought to reduce inflammation and edema around tumors Other medications used include osmotic diuretics (e.g., mannitol [Osmitrol]) to decrease the fluid content of the brain, which leads to a decrease in ICP. Antiseizure medications are used to prevent and treat seizures Venous thromboembolic events, such as deep vein thrombosis and pulmonary embolism, occur in about 15% of patients and are associated with significant morbidity. Patients receiving anticoagulant agents must be closely monitored because of the risk of CNS hemorrhage

Visual Disturbances

Due to papilloedema usually. Additional visual disturbances, such as diplopia (double vision), or visual field deficits may occur with tumors affecting visual pathways

Gliomas

Gliomas—infiltrate any portion of the brain; most common type of brain tumor 1. Astrocytomas (grades I and II) 2. Glioblastoma (astrocytoma grades III and IV) 3. Oligodendroglioma (low and high grades) 4. Ependymoma (grades I to IV) 5. Medulloblastoma

nursing management of tumors

Headache characteristics should be assessed. Upright positioning and pain medications may be useful in managing pain; nurses should evaluate effectiveness of pain management interventions. patient and family should be educated about the possibility of seizure and the need to adhere to prophylactic seizure medications, if prescribed. . The patient with a brain tumor may be at increased risk for aspiration as a result of cranial nerve dysfunction. Medications to alleviate nausea and prevent vomiting should be considered. Preoperatively, the gag reflex and ability to swallow are evaluated. In patients with diminished gag response, care includes educating the patient to direct food and fluids toward the unaffected side, having the patient sit upright to eat, offering a semisoft diet, and having suction readily available. The nurse performs neurologic checks; monitors vital signs; maintains a neurologic flow chart; spaces nursing interventions to prevent rapid increase in ICP; and reorients the patient when necessary to person, time, and place. The use of corticosteroids to control headache and neurologic symptoms requires astute nursing assessment and intervention because many adverse effects can occur, including hyperglycemia, electrolyte abnormalities, and muscle weakness Patients with changes in cognition caused by their lesion require frequent reorientation and the use of orienting devices supervision of and assistance with self-care, and ongoing monitoring and intervention for prevention of injury. Patients with seizures are carefully monitored and protected from injury. Motor function is checked at intervals because specific motor deficits may occur, depending on the tumor's location. When muscle weakness is present, a multidisciplinary approach, including the nurse and physical and occupational therapists, can be used to preserve muscle strength, promote range of motion, and facilitate independence in self-care. Sensory disturbances are assessed and any area of numbness should be protected from injury. Speech is evaluated, and patients with speech deficits can be educated to use alternative forms of communication. Eye movement and pupillary size and reaction may be affected by cranial nerve involvement. Fatigue is common during therapy; efforts should be made to conserve energy and promote rest. Caregiving family members should be included in the plan of care.

PET scan

Positron emission tomography (PET) is used to supplement MRI scanning in centers where it is available. On PET scans, low-grade tumors are associated with hypometabolism, and high-grade tumors show hypermetabolism. This information can be useful in making treatment decisions

Secondary, or metastatic, brain tumors

Secondary, or metastatic, brain tumors develop from structures outside the brain and are twice as common as primary brain tumors. Metastatic lesions to the brain can occur from the lung, breast, lower gastrointestinal tract, pancreas, kidney, and skin (melanomas) neoplasms. Single or multiple metastases may occur, and brain metastases may be found at any time during the disease course, even at initial diagnosis of the primary disease. The highest incidence of brain tumors in adults occurs in the fifth through seventh decades of life.

Seizures

Seizures are common, occurring in up to 70% of persons with brain tumors Tumors of the frontal, parietal, and temporal lobes carry the greatest risk of seizures; seizures are unusual with brain stem or cerebellar tumors.

Surgical management

The objective of surgical management is to remove as much tumor as possible without increasing the neurologic deficit (paralysis, blindness), or to relieve symptoms by partial removal (decompression). Surgery also provides tissue to establish a definitive diagnosis

Neurodegenerative

a disease, process, or condition leading to deterioration of cells or function of the nervous system.

Acoustic Neuroma

a tumor of the eighth cranial nerve—the cranial nerve most responsible for hearing and balance usually arises just within the internal auditory meatus, where it frequently expands before filling the cerebellopontine recess

Spondylosis

degenerative changes occurring in a disk and adjacent vertebral bodies; can occur in the cervical or lumbar vertebrae

Radiculopathy

disease of a spinal nerve root, often resulting in pain and extreme sensitivity to touch.

Papilledema

edema of the optic nerve

Electroencephalogram

electroencephalogram can detect abnormal brain waves in regions occupied by or adjacent to tumor; it is used to evaluate temporal lobe seizures and to assist in ruling out other disorders.

Dyskinesia

impaired ability to execute voluntary movements

Sciatica

inflammation of the sciatic nerve, resulting in pain and tenderness along the nerve through the thigh and leg.

nystagmus

involuntary, rhythmic eye movement

Headache

is most common in the early morning and is made worse by coughing, straining, or sudden movement. Headaches are usually described as deep or expanding or as dull but unrelenting

Vomiting

is usually the result of irritation of the vagal centers in the medulla. Forceful vomiting is described as projectile vomiting. Headache may be relieved by vomiting.

akathisia

motor restlessness, urgent need to move around, agitation

paresthesia

numbness, tingling, or a "pins and needles" sensation

Primary brain tumor

originate from cells within the brain. most primary brain tumors originate from glial cells (cells that make up the structure and support system of the brain and spinal cord) and are supratentorial (located above the covering of the cerebellum). Primary tumors progress locally and rarely metastasize outside the CNS exposure to ionizing radiation is the only known modifiable risk factor

Dementia

progressive, organic mental disorder characterized by personality changes, confusion, disorientation, and deterioration of intellect associated with impaired memory and judgement.

Chorea

rapid, jerky, involuntary, purposeless movements of the extremities or facial muscles, including facial grimacing

Meningiomas

represent 15% of all primary brain tumors, are common benign encapsulated tumors of arachnoid cells on the meninges slow growing, occur most often in middle-aged adults, and are more common in women

Pituitary adenomas

represent about 10% to 15% of all brain tumors and may be treated by surgery and occasionally radiation therapy Pituitary tumors cause symptoms as a result of pressure on adjacent structures or hormonal changes. Pressure from a pituitary adenoma may be exerted on the optic nerves, optic chiasm, or optic tracts or on the hypothalamus or the third ventricle if the tumor invades the cavernous sinuses or expands into the sphenoid bone. pressure effects produce headache, visual dysfunction, hypothalamic disorders (disorders of sleep, appetite, temperature, and emotions), increased ICP, and enlargement and erosion of the sella turcica.

Micrographia

small, and often illegible handwriting

Autologous bone marrow transplantation

used in some patients who will receive chemotherapy or radiation therapy, because it can "rescue" the patient from the bone marrow toxicity associated with high doses of chemotherapy and radiation.

Bradykinesia

very slow voluntary movements and speech

homonymous hemianopsia

visual loss in half of the visual field on the opposite side of a lesion

Dysphonia

voice impairment or altered voice production