An abnormal growth of tissue found inside the skull.
The nervous system specifically the CENTRAL NERVOUS SYSTEM.
± BRAIN ± SPINAL CORD
Primary - Originating in the brain. - Named after by their location, the type of cell they are made of, or both.
1. ± Oligodendrocytomamaybe low or high grade
Tumors Gliomas . Gliomas are categorized and graded according to its degree of malignancy:
± Astrocytomas ± most common type of glioma. which forms the supporting tissue of the CNS.
± Glioblastoma Multiforme ± the fastest growing and most malignant type of tumor usually found in the cerebrum area of the brain.Tumor arising from glial cells.
Tumors arising from supporting structures 3. Developmental tumors 4. Metastatic lesions
Nausea and vomiting .
.Balance difficulties.Visual and auditory problems .Headaches .Motor Problems .Symptoms
-Seizures .Behavioral and Cognitive symptoms .
PET) EEG (electroencephalo gram) Lumbar puncture Biopsy (required for definitive diagnosis. MRI.Assessment/Diagnostics
neurological examination imaging studies and test (CT scan.)
Surgery Radiation Chemotherapy
± Remove or destroy the entire tumor without increasing the neurologic defect or to relieve symptoms by partial removal.
Transsphenoidal microsurgical removal (pituitary adenomas) craniotomy
± Iodine 131
Assess gag reflex and ability to swallow Neurologic assessment Orientation to 3 spheres Seizure precaution Motor function assessment
Signs and Symptoms: Headache Gait disturbances Visual impairment Personality changes Altered mentation seizures
Goal: Palliative care Survival Rate: No treatment ± 1 month Corticosteriod treatment ± 2 months Radiation therapy ± 3 ± 6 months
lomustine and vincristine)
. prednisone) ± Osmotic agents (mannitol) ± Antiseizures (phenytoin)
± Chemo Drugs:
Carmusine (BCNU) Lomustine (CCNU) PCV (triple drug combo of procarbazine HCl. Medications:
± Corticosteroids (dexamethasone.
Assess: Baseline neurologic status Nutritional Status Intervene: Compensating for self ± care deficit Improving nutrition Relieving anxiety
intramedullary lesions (within the spinal cord) 2. Extramedullary ± extradural lesions (outside the dural membrane)
.Spinal Cord Tumor
Classification: 1. Extramedullary ± intradural lesions (within or under the spinal dura)
Signs and Symptoms Localized or shooting pains Weakness Loss of reflexes above the tumor level
Progressive loss of motor function paralysis
Assessment and Diagnostics
Neurologic examination X ± rays Radionuclide bone scans MRI (most sensitive diagnostic tool)
Surgery (primary treatment) Decompression of the spinal cord Chemotherapy Radiation therapy
Pre ± operatively: Recognition of neurologic changes Assessing weakness. muscle wasting. spasticity Teaching breathing technique Post ± operatively: Managing Pain Monitoring and Managing Complications
skull or to the brain or brain trauma to the Most common head.
. injuries which are quite common. cause of death Also called from trauma in traumatic brain the US.Head Injury
Any injury that Includes injury to results in damage the scalp.
lacerations. Secondary Injury:
± Evolves over the ensuing hours and days after the initial injury and primarily due to brain swelling or bleeding.
2. Primary Injury:
± Initial damage to the brain that results from the traumatic event Includes: contusions. torn blood vessels from impact.
Signs and Symptoms
Lose of consciousness Bleeding Slowed breathing Confusion Seizures Skull Fracture Fluid drainage from the nose.
. mouth or ears that is clear or bloody. Headache that may be severe Increased drowsiness Slurred speech Stiff neck Swelling at the site of the injury.
bruise Laceration. Scalp profusely bleed when injured because the constriction of blood vessels is poor.Scalp Injury
Isolated Scalp Trauma ± generally a minor head injury.open or cut wound Subgaleal hematoma (beneath the layers of the scalp)
Diagnosis: Physical examination Inspection Palpation
. Results of Trauma: Abrasion ± brush/wound Contusion.
It may occur with or without damage to the brain.SKULL FRACTURE
Classfication: Break in the continuity of the skull caused by forceful trauma. Linear Comminuted Depressed basilar
SIGNS OF SKULL FRACTURE: Bruising or deformity of the skull Discoloration under the eye and on forehead A dark mark below the ear (battle sign) Unequal pupils Bleeding from the ear Clear or bloody fluid from the nose
Assessment and diagnostics:
X-ray CT scan MRI Cerebral angiography
Close observation is essential Surgery (if necessary) Antibiotic therapy BT (if indicated Avoid sneezing or coughing (for basal fracture) Elevate head 30 degrees
or a blunt trauma to the head is so severe that it opens the scalp. skull and dura.Brain Injury
Closed (blunt) brain injury When the head accelerates then rapidly decelerates or collides with another object and brain tissue is damaged but no opening through the skull or dura. enters the brain and damages the soft brain tissue in its path (penetrating injury).
. Open brain injury Occurs when an object penetrates the skull.
Temporary loss of neurologic function with no apparent structural damage. Frontal lobe ± bizarre irrational behavior Temporal ± temporary amnesia or disorientation S/Sx: Postconscious syndrome: Dizziness Irritability Anxiety Lethargy Headaches
WOF: Difficulty awakening Difficulty speaking Confusion Severe headache Vomiting Weakness on one side of the body
Diffuse Axonal Injury Involves widespread damage to the axons in the cerebral hemispheres.Contusion More severe injury The brain is bruised with possible surface hemorrhage. corpus collosum and brainstem
Classification: Hematomas that develop within the cranial vault are the most serious brain injuries. Epidural (above the dura) Subdural (below the dura) Intracerebral (within the brain)
dilation and fixation of the pupils or paralysis of extremity
Treatment: Trephination Craniotomy Drain insertion
Momentary loss of consciousness followed by lucid interval Increased ICP Signs of compression (deterioration of consciousness.
Acute and Subacute Associated with major head injuries S/SX (over 24 ± 48 hours)
± ± ± ± ±
Changes in LOC Pupillary signs Hemiparesia Coma Inc BP. slowing RR
Chronic Most frequent among elderly S/SX
± ± ± ±
Severe headache Personality changes Mental deterioration Focal seizures
. Dec HR.
Commonly seen in head injuries when force is exerted to the head over a small area.
Assessment Initial physical and neurologic examination Diagnosis CT scan MRI PET X ± ray (in case of SCI)
Treatment of inc ICP Surgery Maintain adequate O2 Elevate head of bed Maintain normal blood volume
Supportive Measures Ventilatory support Seizure precaution (benzodiazepines) F&E maintainance Nutritional support (NGT feeding) Pain and anxiety management
etc. epilepsy.) bed with consideration to aspiration ± Suctioning ± Monitor ABG values
Maintaining Monitor for airway declining neurologic function ± Elevate head of
± ± ± ± LOC Vital signs Motor function Other neurologic signs (pupils. anosmia.
Promote adequate nutrition
Maintain Body temp Monitor frequently Cooling blankets TSB
Parenteral nutrition via central line NGT feeding
cerebral perfusion Cerebral edema and herniation Impaired oxygenation and ventilation Impaired fluid & electrolyte and nutritional balance Post traumatic seizures
.Maintain skin integrity Reposition pt every 2 hours Assess body surface and document skin integrity Provide skin care Prevent sleep pattern disturbance
Monitor and mange potential complications Dec.