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Neuro 2 > Neuro Oncology - Keller > Flashcards

Neuro Oncology - Keller Flashcards

1
Q

What is rehab guided by for patients with brain tumors

A

Findings from initial exam
For cerebral tumors: headaches, seizures, mental change/behavior, hemiparesis/weakness, midline shift.

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2
Q

What would be findings from a frontal lobe tumor

A
  1. Weakness
  2. Ataxia
  3. Hemiparesis
  4. Gait disturbances
  5. Impaired sensation
  6. Urinary incontinence
  7. Impaired judgement
  8. Personality changes
  9. Short term memory loss
  10. Behavioral changes.
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3
Q

What are occipital lobe findings

A
  1. Visual disturbances
  2. Homonymous Hemianopia
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4
Q

What are parietal lobe common findings

A
  1. Sensation loss
  2. Tactile localization
  3. Sterognosia — recognizing form of object without visual/auditory info
  4. Autopagnosia — body scheme
  5. Anosognosia — lack of awareness of disability
  6. Aphasia
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5
Q

What are temporal lobe common findings

A
  1. Difficulty with recognizing sounds
  2. Memory impairments
  3. Vision impairments
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6
Q

What are basal ganglion common findings

A
  1. Contralateral choreoathetosis — combo of chorea (irregular migrating contractions) and athetosis (twisting and writhing)
  2. Contralateral dystonia
  3. Movement disorders
    have to be careful with athetosis movements because they can hurt each other
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7
Q

Corpus callosum findings

A
  1. Apraxia
  2. Agraphia
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8
Q

Cerebellum findings

A
  1. Ataxia
  2. Dysmetria
  3. Nystagmus
    treat very similar to cerebellar stroke
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9
Q

Brainstem findings

A
  1. Cranial nerve dysfunction
  2. Ataxia
  3. Papillary abnormalities
  4. Nystagmus
  5. Hemiparesis
  6. Autonomic dysfunction
    these tumors can get really life threatening fast because of basic bodily functions
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10
Q

Presenting signs and symptoms from intra-dural extramedullary tumors

A
  1. Local neck or back pain
  2. Radicular pain
  3. Weakness or sensory symptoms below level of tumor (typically recognized first on side tumor is present on)
  4. Spinal cord compression — paraplegia, loss of bowel and bladder control (saddle numbness)
  5. Nerve root compression — focal muscle wasting
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11
Q

Presenting signs and symptoms from intra-dural Intramedullary tumors

A
  1. Constant back and neck pain
  2. Pain and midline tenderness at level of tumor and at night
  3. Weakness
  4. Spasticity
  5. Poor coordination
  6. Parenthesias
  7. Stiffening gait
  8. Clonus
  9. Scoliosis or Torticolis
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12
Q

Spinal tumor interventions

A
  1. Joint mobility — want to maintain ROM, prevent contractures
  2. Balance
  3. Motor control training
  4. Strengthening — depends where tumor is and how stable the vertebrae are
  5. Aerobic endurance — both on foot or in wheelchair
  6. Pain management
  7. Wound care
  8. Functional training
  9. Lymphedema management
  10. Bracing needs — selected as conservative care or adjust to interventions
  11. Equipment needs
  12. Bowel and bladder management.
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13
Q

Contraindications/precautions for spinal tumors

A
  1. Ultrasound
  2. Diathermy
  3. Laser
  4. Hot/cold or topical agents at location of skin undergoing radiation
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14
Q

Barriers to rehab

A
  1. Patients, families, medical providers knowledge of the benefits of rehab and accessibility to rehab
  2. Overwhelmed by diagnosis, complexity, cost, resources
  3. Limited workforce of rehab personnel with expertise and experience
  4. Lack of coordinated care
  5. Lack of standardized rehab clinical protocols and outcome measures
  6. Limited coverage
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15
Q

Goals of rehab

A
  1. Minimize negative effects of immobilization
  2. Maximize safety
  3. Maximize level of function
  4. Ambulation IF ABLE
  5. Maximize nutritional intake
  6. Educate
  7. Address psychosocial stressors
  8. Assist in discharge recommendations
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16
Q

What are barriers in acute hospitalization

A
  1. Rapid changes in medical condition
  2. Lack of knowledge of the role of rehab among healthcare providers
  3. Delay in identification and initials of rehab
  4. Gaps in communications
17
Q

What are barriers to post-acute inpatient rehab

A
  1. Medical fragility of patient and increased likelihood of emergent discharge back to acute care
  2. Logistical and financial implications of rehab with chemo
  3. Challenges in achieving 3 hours of therapy a day
18
Q

What are barriers to therapy at any level for these patients

A
  1. Fatigue
  2. Poor appetitive
  3. Nausea
  4. Constipation
  5. Insomnia
  6. Cognitive deficits
  7. Depression and anxiety
19
Q

What is cerebral edema/herniation

A

Cerebral edema is often associated with brain tumors. An increase in ICP may cause brain herniation or compromise of brain’s blood supply
Signs = increase in lethargy/unable to arouse, dilated pupils, headache, change in posture, change in reflexes, coma.
Treatment that can help = hyperventilation to decrease partial pressure of CO2, Dexamethasone, emergency surgery to relieve pressure

20
Q

What is epidural cord compression

A

Most commonly due to hematogenous spread of tumor cells through bone marrow leading to vertebral collapse
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)
Treatment that can help = corticosteroids, laminectomy/vertibrectomy, radiotherapy, chemo

21
Q

Seizures in this population

A

Increase length of seizure or duration — can sometimes be 3-4 minutes which would def be a medical emergency
- Primary role is to continue to monitor and communicate with team: change in anticonvulsant medication or dosage.

22
Q

Venous thromboembolism in this population

A

Common in individuals with brain tumor
Signs of DVT = heat, swelling, pain. Need an IVC filter placement

23
Q

Red flag headache symptoms

A
  1. Change in headache intensity or duration
  2. Association with fever
  3. Occurring with new neurological signs
24
Q

Paraneoplastic Cerebellar Degeneration

A

Thought to have an autoimmune etiology, most common paraneoplastic syndrom affecting the brain
- Subacute syndrome that progresses over weeks ro months
- Severe truncal and limb ataxia and dysarthria

25
Q

Hydrocephalus

A

Increase in brain tumor mass impacts ventricles or normal passage of CSF
Signs/Symptoms = confusion, disorientation, lethargy, headaches, irritability/personality changes, blurred or double vision, seizures, urinary incontinence, walking difficulties/balance deficits
they’ll probs need a shunt

26
Q

Fatigue factors that contribute to cancer related fatigue

A
  1. Direct cancer burden
  2. Cancer treatment burden - surgery, chemo, radiation, hormone therapy
  3. Psychosocial burden - depression, anxiety, sleep disruption, pain, expectancy, self-efficacy, cognition, strain on relationship
  4. Comorbid conditions - anemia, muscle wasting, thyroid disease, cardiac disease, pulmonary disease, renal disease, malnutrition, infection
27
Q

Management for fatigue

A
  1. Addressing pain
  2. Addressing psychiatric or metabolic causes
  3. Adjusting medication
  4. Sleep hygiene
  5. Nutrition
  6. Energy conservation techniques and physical exercise
  7. Psychosocial supports
28
Q

Types of cancer related pain

A
  1. Nociceptive — pain triggered by activation of peripheral receptive terminals in response to noxious irritants
  2. Neuropathic — pain that includes sensory abnormalities such as thermal allodynia, parenthesis, hyperalgesia, dysesthesia
  3. Myofascial — pain that arises from myofascial trigger points
  4. Thalamic — pain that is a central pain syndrome characterized by burning, may be activated in changes in temps
  5. Funicular — central pain syndrome characterized by excruciating pain that does not follow any dined dermatomes pattern and occurs caudal to lesion due to lesion to ascending spinothalamic tracts
29
Q

Meds for cancer related pain

A

Morphine, methadone, oxycodone, fentanyl, buprenorphine
- Gabapentin
- Peripheral nerve block
- Neuroaxial pump — infuse meds to epidural or intrathecal space
- Radiation
- Psychological approaches
- Acupunture

30
Q

Cognitive deficits in this population

A
  1. Cog deficits are common with gliomas and can impair patients’ abilities to comprehend info and specifically their capacity to provide informed consent for treatment and making plans
31
Q

What is cancer survivorship

A
  • Focus is on 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.
32
Q

What are 3 stages of survivorship

A
  1. Acute — focused on cancer treatment and is initiated at diagnosis through the end of active treatment
  2. Extended — occurs after the end of treatment and focuses on the effects of treatment and follow-up care
  3. Permanent (long-term) — focuses on the years after cancer treatment has ended
33
Q

What are the important elements of survivorship

A

Nutrition — achieve and maintain close to normal BMI (referral to oncology specialist dietician)
Exercise — safe , tolerable, and effective for most cancer survivors to exercise with positive effects on fatigue, emotional well being, balance, and QOL
Rehab medicine is very important too

34
Q

NCCN guidelines for recommended exercise for cancer survivors

A

Participate at least 150-300 minute of moderate-intensity activity or 75 minutes of vigorous-intensity activity per week, along with 2-3 sessions of strength/resistance training per week

35
Q

Incidirla strategy for acquiring prognostic information

A

Use all sources of information on disease and disease process — support groups, internet, opinions, emotion support groups
may have to educate them on what is accurate info or not

36
Q

What is palliative care

A

Approach that improve 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 counseling

Person centered

37
Q

Essential components of palliative care

A
  1. Building rapport, communication, and supportive relationships with patient and family caregivers
  2. Managing symptoms and existential distress like: pain, dyspnea, fatigue, sleep impairments, mood/anxiety/depression
  3. Exploration of understanding and education about illness and prognosis
  4. Clarification of treatment goals through ongoing communication
  5. Assessment and support of coping and adjustment needs for patient and caregivers.
  6. Assistance with medical decision making
  7. Rehab directed toward optimizing functionality, self-efficacy, self-esteem, and independent capability
  8. Coordination of care with other healthcare providers

Neuro 2 (8 decks)

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