Neuro-Oncology II Flashcards
What is rehabilitation guided by?
findings of initial examination
Cerebral tumors symptoms
- Headaches
- Seizures
- Mental Change and Behavior
- Hemiparesis/Weakness
- Midline shift- Impact on presenting symptoms
Frontal Lobe Common Findings
- Ataxia
- Hemiparesis
- Gait disturbances
- Impaired sensation
- Urinary incontinence
- Impaired judgement
- Personality changes
- Short term memory loss
- Impaired judgement
- Personality changes
- Communication problems
- Behavioral changes
Occipital lobe common findings
- visual disturbances
- homonymous hemianopsia
parietal lobe common findings
- Sensation loss
- Tactile localization
- Sterognosia – recognizing form of object without visual/auditory information
- Autopagnosia (body scheme) * Anosognosia (lack of awareness of disability)
- Aphasia
Temporal lobe common findings
- Difficulty with recognizing sounds
- Memory impairments
- Vision impairment
Basal Ganglion Common Findings
- Contralateral choreoathetosis- combination of chorea (irregular migrating contractions) and athetosis (twisting and writhing)
- Contralateral dystonia
- Movement disorders
Corpus Callosum Commons findings
- apraxia
- Agraphia
Cerebellum common findings
- ataxia
- dysmetria
- nystagmus
Brainstem common findings
- Cranial nerve dysfunction
- Ataxia
- Papillary abnormalities
- Nystagmus
- Hemiparesis
- Autonomic Dysfunction
Intradural- Extramedullar tumors presenting signs and symptoms by type
- Local neck or back pain
- Radicular pain is common
- Weakness or sensory
symptoms below level of tumor (typically recognized first on side tumor is present) - Spinal Cord Compression-
paraplegia, loss of bowel or
bladder control - Nerve Root Compression-
focal muscle wasting
Intradural- Intramedullary Tumors Presenting signs and symptoms
- Constant back and neck pain * Pain and midline tenderness at the level of the tumor and at night (pain worse in recumbent position)
- Weakness
- Spasticity
- Poor coordination
- Paresthesias
- Stiffening of gait
- Clonus
- Scoliosis or Torticolis
look at spinal tumor interventions if you want
im not gonna
Contraindications/Precuations for spinal tumors
- Ultrasound
- Diathermy
- Laser
- Hot/Cold or topical agents at location of skin undergoing radiation
Barriers to Rehabilitation
- Patients, Families, Medical Providers knowledge of the benefits of rehabilitation and accessibility to rehabilitation
- Overwhelmed by diagnosis, complexity, cost, resources
- Limited Workforce of rehabilitation personnel with expertise and experience
- Lack of coordinated care
- Lack of standardized rehabilitation clinical protocols and outcome measures
- Limited coverage
Goals of Rehabilitation
- Minimize negative effects of immobilization
- Maximize safety
- Maximize level of function
- Ambulation if they are able
- Maximize nutritional intake
- Education
- Address psychosocial stressors
- Assist in discharge recommendations
Barriers in acute hospitalization
- Rapid changes in medical
condition - Lack of knowledge of the role of rehabilitation among healthcare providers
- Delay in identification and
initiation of rehabilitation - Gaps in communication
Barriers to Post-Acute Inpatient Rehabilitation
- Medical fragility of patient and increased likelihood of emergent discharge back to acute care
- Logistical and financial implications of rehabilitation with chemotherapy
- Challenges in Achieving 3 hours of therapy a day
Barriers to Therapy at Any Level
- Fatigue
- Poor Appetite
- Nausea
- Constipation
- Insomnia
- Cognitive Deficits
- Depression and Anxiety
Cerebral Edema/ Herniation
Cerebral edema is often association with brain tumors. Increase in ICP may cause brain herniation or
compromise of brain’s blood supply
Cerebral Edema/Herniation Signs
- increase in lethargy/unable to arouse, dilated pupils, headache, change in posture, change in reflexes, coma
- Hyperventilation – decrease the partial pressure of CO2
- Dexamethasone
- Emergency Surgery to relieve pressure
Epidural Cord Compression
most commonly due to
hematogenous spread of tumor cells through bone marrow leading to
vertebral collapse
Epidural Cord Compression Signs
- Pain is present in 95% and usually precedes other symptoms by 1-2 months, weakness (generally symmetric), ascending numbness, autonomic
dysfunction (commonly urinary retention) - Corticosteroids
- Laminectomy/Vertibrectomy * Radiotherapy
- Chemotherapy
Seizures
- Increase in length of seizures or duration
- Primary role is to continue to monitor and communicate with team
- change in anticonvulsant medication or dosage
Venous Thromboembolism
- Common in individuals with brain tumor
- Signs of DVT- heat, swelling, pain
- IVC filter placement
Red flag headache symptoms
- Change in Headache intensity or duration
- Association with fever
- Occurring with new neurological signs
Paraneoplastic cerebellar degeneration
- Thought to have an autoimmune etiology
- Most common paraneoplastic syndrome affecting the brain
- Subacute syndrome that progresses over weeks or months
- Severe truncal and limb ataxia and dysarthria
Hydrocephalus
- Increase in brain tumor mass impacts ventricles or
normal passage of CSF - Confusion, Disorientation, or both
- Lethargy
- Headaches
- Irritability or personality changes
- Blurred or double vision
- Seizures
- Urinary Incontinence
- Walking difficulties/Balance deficits
Fatigue Factors
- Direct Cancer Burden
- Cancer Treatment Burden- Surgery, Chemotherapy, Radiation, Hormone Therapy
Medications - Psychosocial Burden- Depression, Anxiety, Sleep Disruption, Pain, Expectancy, Self-Efficacy, Cognition, Strain on Relationship, Employment Problems, Financial Concerns
- Comorbid Conditions- Anemia, Muscle Wasting, Thyroid Disease, Cardiac Disease, Pulmonary Disease, Renal Disease, Malnutrition, Infection
Additional contributing factors of fatigue
metabolic problems,
deconditioning, anxiety, depression, medication effects
What may be affected due to neuroinflammation caused by brain radiation?
melatonin production
Management for cancer related fatigue
- Addressing pain
- Addressing psychiatric or metabolic causes
- Adjusting medication
- Sleep Hygiene
- Nutrition
- Energy Conservation techniques and physical exercise
- Psychosocial supports
Cancer related pain - Nociceptive
Pain triggered my activation of peripheral receptive terminals in response to noxious irritants
Cancer related pain - neuropathic
- Pain that includes sensory abnormalities such as thermal
allodynia, paresthesia, hyperalgesia, dysesthesia- may be described as burnings, stabbing, pins and needles - Chemotherapy drug- vincristine may result in polyneuropathy and numbness or burning of
hands and feet
Cancer related pain - myofascial
pain that arises from myofascial trigger points
cancer related pain - thalamic
Pain that is a central pain syndrome characterized by a burning, may be activated by changes in temperature
Cancer related pain - funicular
Pain that is a central pain syndrome characterized by excruciating pain that does not follow any fixed dermatome pattern and occurs caudal to
lesion due to lesion to ascending spinothalamic tracts
Cancer related pain medications
including morphine, methadone, oxycodone, fentanyl, buprenorphine
What is typically prescribed for neuropathic pain
gabapentin
neuroaxial pump
infuse medication to epidural or intrathecal space
Cognitive deficits are common with….
gliomas and can impair patients’ abilities to comprehend information and specifically their capacity to
provide informed consent for treatment and making plans.
* Power of Attorney, Living Will
Education and Information Needs
- Management of Psychological Stress
- Anxiety (approximately 30-50%) * Depression (5-45%)
- Caregiver needs and well-being
- Alternative/Complimentary therapies
- Sexuality
- Change in Family and Life Roles
Cancer Survivorship
- Focus is on the health and well-being of an
individual from the time of diagnosis to death - Inclusive of the physical, mental, emotional, social,
and financial effects of cancer * Starts at the time of diagnosis and continue
through treatment and beyond
3 stages of cancer survivorship
- acute
- extended
- permanent
Acute stage of survivorship
focused on cancer treatment and is initiated
at diagnosis through the end of active treatment
Extended stage of survivorship
occurs after the end of treatment and
focuses on the effects of treatment and follow-up
care
Permanent stage of survivorship
focuses on the years after
cancer treatment has ended
exercise for cancer survivorship
NCCN Guidelines recommend cancer survivors participate in
at least 150–300 min of moderate-intensity activity or 75 min of vigorous-intensity activity per week, along with 2–3 sessions of strength/resistance training per week
individual strategy for acquiring prognostic information
Utilization of all sources of
information on disease and disease process- support groups, Internet, second opinions to the idea of
limited information at a time due to the emotion and personal sense of control (this group was more
capable of accepting greater amount of prognostic information as time passed and disease progressed)
Shared hope
Courage and motivation
to address the fight, Use
of “we” demonstrated
solidarity, as symptoms
progress hope for
survival may be
redefined as hope for
quality of life or “good
days”
engagement in health promotion activities
Optimize physical health to optimize therapeutic effect of treatments, could be dietary, smoking/alcohol
consumption changes, exercise, complementary and alternative therapy
Adjustment to symptom limitations
Reported change regarding role change in
family, activity limitations, working life,
activity out of the home
role transition from family member to care giver
Caregivers may keep
medical record, impact
of cognitive impairments
or lack of self-awareness
place greater
responsibilities on
caregiver; change in
personality often one of
most difficult
discharge planning
- Quality of Life
(remaining life) vs
Ongoing Therapy - Hospice
- Shared Decision
Making
definition of palliative care
- Approach that improves the quality of
life of patients and their families facing life threatening illness - Addresses suffering by providing
support to patients and families addressing practical needs and providing bereavement counselling - Person centered
essential components of palliative care
- Pain * Dyspnea * Fatigue * Sleep Impairment * Mood and distress * Anxiety * Depression * Nausea * Constipation
essential components of palliative care - managing symptoms:
- Pain * Dyspnea * Fatigue * Sleep Impairment * Mood and distress * Anxiety * Depression * Nausea * Constipation
