Pathophysiologic Results of Neurologic Oncologic Disorders Manifestations depend upon the tissues infiltrated and compressed by the neoplasm Pathophysiologic events may include: Increase ICP Seizures Hydrocephalus Altered pituitary function

Oncologic Tumors Brain tumors Benign or malignant Classification is based upon location and histological characteristics Types of primary tumors Gliomas (arises from glial cells) Meningiomas Acoustic neuromas (tumor of the eighth cranial nerve) Pituitary adenomas Angiomas—masses of abnormal blood vessels Metastatic tumors

Brain Tumors Symptoms are dependent upon 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 Hormonal effects with pituitary adenoma Loss of hearing, tinnitus, and vertigo with acoustic neuroma

Diagnostic Evaluation Neurologic examination CT scan MRI Cytological study of cerebral spinal fluid Biopsy

Medical Management Specific treatment depends upon the type, location, and accessibility of the tumor Surgery Goal is removal of tumor without increasing neurologic symptoms or to relieve symptoms by decompression Radiation therapy External beam radiation Brachytherapy Chemotherapy

Spinal Cord Tumors Classified according to their anatomic relation to the spinal cord Intramedullary: within the cord Extramedullary: extradural; outside the dural membrane Manifestations include pain, weakness, and loss of motor function, loss of reflexes, loss of sensation Treatment depends upon type of tumor and location Surgical removal Measures to relieve compression: dexamethasone combined with radiation

Parkinson’s Disease Associated with decreased levels of dopamine due to destruction of cells in the substantia nigra in the basal ganglia; this effects the neurotransmission of impulses Manifestations: tremor, rigidity, bradykinesia, postural instability, depression and other psychiatric changes, dementia, sleep disturbances, Medical management Pharmacologic treatment Surgical procedures Other therapies

Pathophysiology of Parkinson’s Disease

Treatment Levodopa Anticholinergics Amantadine hydrochloride (antiviral) Monoamine Oxidase Inhibitors (inhibit dopamine breakdown)

Nursing diagnosis Impaired physical mobility related to muscle rigidity and motor weakness Self-care deficits (feeding, dressing, hygiene, and toileting) related to tremor and motor disturbance Constipation related to medication and reduced activity Imbalanced nutrition, less than body requirements, related to tremor, slowness in eating, difficulty in chewing and swallowing Impaired verbal communication related to decreased speech volume, slowness of speech, inability to move facial muscles Ineffective coping related to depression and dysfunction due to disease progression

Alzheimer's Disease The most common cause of dementia A chronic, progressive, degenerative brain disorder that effects 4.5 million people in the United States Research suggests oxidative stress plays a role in the pathophysiology of this disease

Degenerative Disk Disease Most back problems are related to disk disease. Degenerative changes occur with aging or are the result of previous trauma. In herniation of the intervertebral disk (ruptured disk), the nucleus of the disk protrudes into the annulus (the fibrous ring around the disk), with subsequent nerve compression. Continued pressure may produce degenerative changes in the nerves with resultant changes in sensation and motor responses.

Normal Spinal Vertebral and Ruptured Vertebral Disk

Clinical Manifestations A herniated disk with accompanying pain may occur in any portion of the spine: cervical, thoracic (rare), or lumbar. The clinical manifestations depend on the location, the rate of development (acute or chronic), and the effect on the surrounding structures. Low back pain with muscle spasms, followed by radiation of the pain into one hip and down into the leg (sciatica). Paresthesia

Management Treatment is usually conservative—rest and medications. Surgery may be required. Discectomy: removal of herniated or extruded fragments of intervertebral disk Laminectomy: removal of the bone between the spinal process and facet pedicle junction to expose the neural elements in the spinal canal; this relieve compression of the cord and roots Hemilaminectomy: removal of part of the lamina and part of the posterior arch of the vertebra Partial laminectomy or laminotomy: creation of a hole in the lamina of a vertebra

Nursing Process: The Care of the Patient with Cervical Diskectomy—Assessment Determining the onset, location, and radiation of pain Assessing for paresthesia, limited movement, and diminished function of the neck, shoulders, and upper extremities Determine whether the symptoms are bilateral Cervical spine palpated to assess muscle tone and tenderness Range of motion in neck and shoulders is evaluated Health issues Patient education

Nursing Process: The Care of the Patient with Cervical Diskectomy—Diagnoses Acute pain related to the surgical procedure Impaired physical mobility related to the postoperative surgical regimen Deficient knowledge about the postoperative course and home care management

Nursing Process: The Care of the Patient with Cervical Diskectomy—Collaborative Problems/Potential Complications Hematoma at the surgical site, resulting in cord compression and neurologic deficit Recurrent or persistent pain after surgery

Nursing Process: The Care of the Patient with Cervical Diskectomy— Nursing Interventions Relieving pain Improving mobility Monitoring and managing potential complications Promoting home and community-based care