Multisite Disorders Flashcards
Rehabilitation for individuals with brain tumors
- individuals have shown progress in the rehabilitation setting
- Advances in medical and surgical interventions have improved survival rates and is associated with longer life expectancy
Goals of rehab
Improve body structure & function, activity & participation limitations
Improve quality of life
Opportunity to return to home
Takes an interdisciplinary team
Incidence and Etiology
-more tumors are being diagnosed (improved tumor imaging), rather than true increase in occurrence
-Bimodal distribution
Children: 0 – 15 years
Adults: 50-70 years
Etiology
- runs in family is questionable
- common toxic environment or infectious exposure
- association with certain chemicals
Primary brain tumors
- Originate in the CNS
- Primary CNS tumors typically do not metastasize
- Lack of lymphatic system in CNS to transport cancerous cells
Secondary or metastatic tumors
- Spread to the CNS from systemic sites outside of the brain
- **Blood-brain barrier “somewhat” protects the brain from metastasis
Primary tumors
- Gliomas - Four primary categories
- -Astrocytomas
- -Oligodendrogliomas
- -Ependymomas
- -Medulloblastomas
- Meningiomas
- Pituitary adenomas
- Schwannomas
- Primary CNS lymphomas
Gliomas
-Arise from glial cells
-42% of all brain tumors
-Frequently located in the cerebral hemispheres
-Also occurs in the brain stem, optic nerve, and spinal cord
-Malignant tumors are more common after age 75
Benign forms are more common in children
- Astrocytomas
- Derived from astrocytes
- 35% of all brain tumors
- Most common primary brain tumor
- Morphology
- -Circumscribed (“contained”) – less likely of metastasis [easier to remove]
- -Diffuse – infiltrate surrounding brain structures
- Low-grade astrocytomas: slowest growing
- Intermediate-grade astrocytomas, or anaplastic astrocytomas, grow at a moderate rate
- Frequently found in the frontal lobes of adults and the cerebellum in children
- Intervention: Sx, radiation therapy, chemo
Low-Grade Astrocytomas
- Slowest growing of all CNS neoplasms
- Occurs in 3rd and 4th decades of life
- Typically located in the cerebrum
- -Frontal lobes especially
- Characterized by unilateral headaches
- Tend to see personality changes secondary to frontal lobe damage
- Frequently easy to surgically remove- result in better survival rates
Astrocytomas: Glioblastomas
-Glioblastoma Multiforme: Highly malignant grade IV astrocytoma
-Glioblastomas are the fastest growing
Most common malignant brain tumor in adults
-1st symptom is typically a unilateral headache followed by a generalized headache
-Rapid progression of symptoms
-May have seizures
-Intervention: Surgical resection, radiation therapy, stereotactic radiosurgery & chemo
- Oligodendroglioma
- Slow-growing, but progressive tumors that develop over several years
- Tumors in the myelin-producing oligodendrocytes
- ~ 50 % in the frontal lobe
- ~ 50% in the temporal or parietal lobes
- Occurs in adults (40-60 YO)
- Characterized by:
- -Chronic headaches
- -History of partial or generalized seizures
- Ependymoma
- Affects the ependymal lining of the ventricular system
- Can also affect the central canal of the spinal cord
- Common site is 4th ventricle: More prevalent in children
- Get signs/symptoms of increased ICP (e.g. headaches)
- Medulloblastoma
- Arise from primitive embryonic cells
- Rapidly growing, malignant tumor of the cerebellum
- Hydrocephalus is common (4th ventricle compression: Increased ICP
- May metastasize to the spinal cord & higher brain areas
Meningiomas
- Slow growing CNS tumors
- Originate from cells in the dura mater or arachnoid membrane
- 33% of all brain tumors
- Also spinal tumors
- Majority are benign
- Most are well-encapsulated tumors
- Resectable tumors are primarily treated with surgery
Pituitary adenomas
- Benign epithelial tumors of the pituitary gland
- Frequently encroach on the optic chiasm
- Characterized by hyper- or hypo-secretion of hormones
- Rare before puberty
- Female to Male ratio is 3:1
Schwannomas
-Encapsulated tumors composed of neoplastic Schwann cells
Usually involves 8th cranial nerve
-Schwannomas of 8th CN = Acoustic Neuroma
-can involve CN or spinal nerve
Primary CNS lymphomas
- Involved the lymphocytes
- Only 1% of all intracranial tumors
- Increased frequency in individuals with AIDS
- Similar in histology to systemic non-Hodgkin lymphoma cell (but uncertainty arises since the CNS lacks lymphatic tissue)
- 60% in cerebral hemispheres
- also in the cerebellum and brain stem
Metastatic/Secondary Brain Tumors
- Originate from malignancies outside of the CNS
- Spread to the brain, typically through the arterial circulatory system
- 1/3 of secondary brain tumors arise from lung cancer
- Intervention: corticosteroids, brain irradiation, surgery, and/or chemo
Metastatic/Secondary Brain Tumors: Signs & Symptoms -Headaches
-Typically headaches, seizures, cognitive and personality changes, and/or focal signs
-Headaches:
same side of tumor
recent onset and severe
can disrupt sleep
Metastatic/Secondary Brain Tumors: Seizures
Present in 1/3 of cases
Metastatic/Secondary Brain Tumors: Cognitive and personality changes
- Altered mental status
- May start as subtle changes in concentration, memory, affect, personality, initiative, and/or abstract reasoning
- May progress to severe cognitive problems and confusion
- Increased ICP causes drowsiness & decreased levels of consciousness to potential coma
Metastatic/Secondary Brain Tumors: Papilledema
- Swelling of the optic nerve
- Less frequent due to improved diagnostic imaging
Metastatic/Secondary Brain Tumors: Focal S&S
-Frontal lobe
-Occipital lobe
-Temporal lobe
-Cerebellum
-Brain stem
Reticular formation > consciousness and attention
Vital functions associated with cardiovascular and respiratory systems -> death
Can be associated with gait disturbances, diplopia, weakness, headache, vomiting, facial numbness and weakness and personality changes
-Pituitary glands
Tumors here are typically large
Compress the pituitary gland- causes pituitary disorders
