Intracranial Neoplasm - Astrocytoma - Frontal lobes

Terms in this set (32)

What is intracranial secondary to for all intracranial diseases that cause death?
Stroke
What is a glioma?
Tumor of glial cells of the brain or spinal cord
(glial cells support, insulate, and metabolically assist the neurons)
What are types of gliomas?
Astrocytomas
Oligodendrogliomas
Ependymomas
Where do astrocytomas occur?
frontal lobe
Describe grades I-II of astrocytomas
Slow growing
Make up 10-12% of primary brain tumors in adults
Most common in children w/ brain tumors
Describe grades III-IV of astrocytomas
Faster growing w/ higher rates of mitosis
Make up 20-30% of primary brain tumors in adults
Highly anaplastic
What are s/s of brain tumors?
Headache
Visual changes
Nausea
Vomiting
Mental changes
Lethargy
Behavior changes
Seizures
Hemiparesis, hemiplegia
Incoordination
Ataxia
Anosmia (inability to smell)
Papilledema (optic disc swelling, ICP)
Sensory impairments
Cranial n. palsies
Language and speech deficits
Facial numbness
Hearing disturbances
Swallowing difficulties
Paralysis of outward gaze
What is a s/s in children?
diastasis of cranial sutures
Enlarge head size
What are some possible etiologies of gliomas?
Tumorigenesis
Chromosome 17 abnormalities
Tuberous sclerosis
True or False: Chromosome 17 abnormalities are present in all grades of astrocytes
TRUE
What is tuberous sclerosis?
genetic disorder associated w/ astrocytomas
causes non-malignant tumors to form in may different organs, primarily in brain, eyes, heart, skin, kidney, and lungs
What is tumorigenesis?
a multi-step process w/ other contributing factors
What are risk factors?
Exposure to ionizing radiation
Sustained exposure to certain pesticides, vinyl chloride, nitrosoureas, polycyclic hydrocarbons
Occupation: synthetic rubber processes, vinyl chloride production, petrochemical and oil refining
Infection, trauma, immunosuppression
Certain viruses (Epstein-barr, primary CNS lymphoma)
Radiation tx for scalp ringworm in children
Frequent exposure to full mouth dental X-rays
What increases risk of childhood tumors?
Maternal diet of nitric containing cured meats
Describe the pathogenesis of Grade I
Pilocytic astrocytoma
"Juvenile astrocytoma" --> considered benign or malignant
Grows slowly and often becomes cystic
Mitoses are absent or very rare
Describe the pathogenesis of Grade II
May be diffuse, infiltrative, or fibrillary --> unconfined and can't be removed b/c spread out (like tentacles)
More anaplastic
Describe the pathogenesis of Grade III
Infiltrative tumor that invades cerebral parenchyma
Typically involve white matter of the cerebral hemisphere
Contain a mix of cells and cell grades
Describe the pathogenesis of Grade IV
"Glioblastoma multiforme (GBM)"
Same as grade III
More aggressive
Invades both cerebral hemispheres via corpus callosum
Highly vascular tumor
Clinical manifestations of Grades I and II for adults
Typically age 30-50
Usually located in cerebrum, frontal lobe
Unilateral or focal headaches
Increased ICP
Personality disorders
Clinical manifestations of Grades I and II in children
Appear in cerebellum
Unilateral cerebellar ataxia involving limbs and trunk
Increased ICP
Headaches less common
Clinical manisfestations in Grades III and IV
Most fx for ages 50-60
Rapidly progressive symptoms:
- unilateral headache followed by general headache
- increased ICP
- seizures
- lethargy
- memory loss
- motor weakness
- personality changes
What is the survival rate for low grade astrocytomas w/ full excision?
5-10 yr survival rates of 100%
What is the survival rate for low grade astrocytomas w/ partial excision?
10 year survival rate of 35%
What is the survival rate for low grade astrocytomas if untreated?
10 year survival rate of 11%
True or False: Not all malignant astrocytomas will recur
FALSE
All malignant astrocytomas will recur
What is the 5 year survival rate of Grade III astrocytoma w/ optimal tx?
20%
What is the survival rate for Grade IV w/ optimal tx?
Rare long term survival
What is optimal tx for astrocytoma?
Surgery, radiation
What are the implications for PT?
Mobility and neuromuscular problems (paresis, balance, loss ADLs)
Cervical pain and unsteady gait
Being aware of expected symptoms related to tumor locations
Expect rapid decline of condition
What are some acute post op management implications for PT?
Bed rest precautions for 24 hrs
Awareness of surgical complications
May have decreased level of consciousness
Elevation of head for ICP
Skin and respiratory changes are documented
Pt shoulder never be positioned on operative side
Fx position changes
What are the initial outcomes expected post op?
Full ROM
Active when possible
Optimal cardiopulm func
Eventual independent bed mobility, transfers, ADLs, and ambulation
What are some red flags?
Headaches
Vomiting
Blurred vision
Seizures
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