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Management of Patients With Oncologic or Degenerative Neurologic Disorders
Management of Patients With Oncologic or Degenerative Neurologic Disorders
Management of Patients With Oncologic or Degenerative Neurologic Disorders
Chapter 70
70
Management
Management ofof Patients
Patients With
With
Oncologic
Oncologic or
or Degenerative
Degenerative
Neurologic
Neurologic Disorders
Disorders
Brain Tumors
• Symptoms depend on the location and size of the lesion and the
compression of associated structures
• Manifestations
– Localized or generalized neurologic symptoms
– Symptoms of increased ICP
– Headache
– Vomiting
– Visual disturbances
– Seizures
• Hormonal effects with pituitary adenoma
• Loss of hearing, tinnitus, and vertigo with acoustic neuroma
• Brain tumors
– Benign or malignant
– Classification is based on location and histologic
characteristics
• Primary or Secondary
– Primary originate from cells within the brain;
progress locally; rarely metastasize outside CNS
– Secondary develop from structures outside the
brain; metastatic
• Increased ICP
– Skull contains brain matter, intravascular blood, and
CSF
– Monro-Kelli doctrine explains the dynamic equilibrium
of the cranial contents
• If any component of the skull increases in volume,
ICP increases unless one of the other components
decreases in volume
– Compression of intracranial veins, reduction of CSF
volume, decreased cerebral blood flow, reduction of
intra- and extracellular brain tissue mass
• Headache
– Most common in early morning; worsens with coughing, straining,
or sudden movement; deep, expanding, dull, unrelenting
• Vomiting
– Seldom related to food intake, may be projectile
• Visual disturbances
– Compression of third cranial nerve; diplopia, hemianopia, varying
levels of blindness
• Seizures
– Common, occur in 60%; greatest risks in frontal, parietal, and
temporal lobe tumors
• Neurologic examination
• CT scan
• MRI
• PET scan
• EEG
• Cytologic study of cerebrospinal fluid
• Biopsy
• Self-care deficit
• Imbalanced nutrition
• Anxiety
• Interrupted family processes
• Triad of symptoms
– Motor dysfunction
• Chorea; disorganized gait, eventually unable to walk;
loss of bladder and bowel control
– Cognitive impairment
• Attention, emotion recognition; dementia in later stage
– Behavioral features
• Nervous, irritable, impatient; uncontrollable fits of
anger; depression, apathy, anxiety, psychosis,
euphoria; impaired judgment and memory