concise material from exam point of view (especially RGUHS)

1. Sandesh Rayamajhi
MPT-II year

2. Brain tumors
 Definition
 Causes
 Types
 Clinical features
 Neurocutaneous disorders
 Causes
 Types
 Clinical features
 Assessment
 PT management


3.  Definition:
word – “ swelling”
 A tumor is commonly used as a synonym
for a neoplasm that appears enlarged in
size.
 It is an abnormal mass of tissue which may
be solid or fluid- filled.
 Latin

4.  Genetic
factorsTransformation of normal cells to malignant
growth probably results from a variety of
different processesa)Alteration in the expression of protooncogenes
b)Inactivation of expression of tumour
suppressor genes

5. b) Over expression of genes controlling
growth factor
 Cranial irradiation
 Immunosuppression

6. WHO (2000)
 based on the tissue of origin.
Neuroepithelial Astrocytes- Astrocytoma
 Oligodendrocytes- Oligodendroglioma
 Ependymal cells and choroid plexusEpendymoma
Choroid plexus papilloma


7.  Neurons-
Neurocytoma or ganglioglioma or
gangliocytoma
 Pineal cells- Pineocytoma or pineoblastoma
 Poorly differentiated and embryonal cellsMedulloblastoma

8. ASTROCYTOMA
OLIGODENDROGLIOMA

9. EPENDYMOMA
CHOROID PLEXUS
PAPILLOMA

10. NEUROCYTOMA
PINEOCYTOMA

12. MENINGIOMA
MENINGEAL SARCOMA

13. Meningeal melanoma

14. SCHWANNOMA
NEUROFIBROMA

15. Blood vessels

16. GERMINOMA
TERATOMA

17. CRANIOPHARYNGIOMA
PITUITARY ADENOMA

18. EPIDERMOID OR
DERMOID CYSTS
COLLOID CYSTS

19. CHORDOMA
GLOMUS JUGULARE
TUMOUR

20. CHONDROMA
CHONDROSARCOMA

22.  Symptoms
tend to develop insidiously,
gradually progressing over a few weeks or
years, depending on the degree of malignancy.
 Intracranial
tumours are considered in relation
to these common clinical manifestation:

23.  Changes
in mental function
 Headaches
 Vomiting
 Seizures- 30%

24.  Periodic
bifrontal and bioccipital
headaches
 Projectile vomiting
 Mental torpor
 Unsteady gait
 Sphincteric incontinence
 Papilledema

25.  Symptoms
and signs of general cerebral
impairment and increased pressure occur
late or not at all.

26.  Hereditary
disorders, characterized by
multiorgan malformations and tumours.
 Phakomatoses
or Neurocutaneous
Syndromes
 Disorders
of central nervous system that
additionally result in lesions on the skin
and the eye.

27.  Neurofibromatosis
 Tuberous
 Sturge Von
sclerosis
Weber syndrome
Hippel- Lindau disease
 Ataxia
Telangiectasia

28.  Tuberous
sclerosis an autosomal
dominant condition.
 Many children born with TS are the first
cases in a family.
 Majority of TS is caused by a new gene
change (mutation).
 Gene localized to chromosome 9 and 16.

29.  NF1
is an autosomal dominant condition
 Gene on chromosome 17.
 NF2- autosomal dominant conditon
 Gene on chromosome 22.

30.  NF
may also be the result of a new gene
change. Half of NF cases are caused by a new
mutation.
 Males and females are equally affected.
Schwannomatosis- a recently recognized form
of NF that is genetically distinct from NF1 and
NF2.
 It occurs rarely.

31.  The
cause of Sturge-Weber disease is
unknown and is considered to be sporadic.
 Ataxia telangiectasia is autosomal
recessive disorder.
 Mutation in the ATM gene- chromosome
11.

32.  Neurofibromatosis
(NF):
 There are three distinct types of NF,
classified as NF I, NF II, and
Schwannomatosis.
NF1 It is characterized by café au lait spots and
neurofibromas.
 Von Recklinghausen’s disease.
 Subcutaneous neurofibromata

33.  Mollusca
fibrosa
 Plexiform neuroma
Skeletal manifestations Scoliosis ( 50%)
 Subperiosteal neurofibromas
 Sphenoid wing dysplasia
 Occular manifestations- Lisch nodules

34. Neurological manifestations Mental retardation and Epilepsy- 15%
 Neoplasia
NF2 It is autosomal dominant disorder
characterized by tumours of the 8th cranial
nerve ( vestibular division).
 Café au lait spots – rare

35.  Schwannomatosis-
The primary feature is the growth of
multiple schwannomas throughout the
body except the vestibular nerve is not
involved.
 Extremely intense pain- main symptom.
 Numbness
 Tingling or weakness in the fingers and
toes.

38.  Autosomal
dominant disorder with high
sporadic mutation rate.
 Characterized by cutaneous, neurologic,
renal, skeletal, cardiac and pulmonary
abnormalities.
 Adenoma sebaceum
 Shagreen patch.
 Pitted teeth

40.  Facial
angioma associated with a
leptomeningeal venous angioma.
 Capillary naevus – “Port wine stain”
 Eye disorders
 Atrophic hemisphere
 Epilepsy (75% cases)
 Hemiparesis, homonymous hemianopia
(30%)
 Behavioral disorder and mental retardation

42.  Haemangioblastomas
in the cerebellum,
spinal canal and retina and are associated
with a number of visceral pathologies:
 Renal angioma and Renal cell carcinoma
 Phaeochromocytoma
 Pancreatic adenoma
 Cysts and haemangiomas in liver and
epididymis

44.  Louis-
Bar syndrome
 Multisystem disorder is characterized by Cerebellar ataxia
 Occular and cutaneous telangiectasia
 Immunodeficiency

46.  Evaluation Comprehensive
examination and
assessment of all systems.
A
thorough review- medical history and an
understanding of the medical diagnosis.

47.  Important
psychosocial factorsoccupation, support system, personal
goals and role in the family.
 Examination
of all the systems through
functional tasks

48.  Functional
Assessment The Functional Independence Measure
(FIM)-functional assessment tool used to
measure degree of disability, regardless of
underlying pathology and burden of care to
demonstrate functional outcomes of
rehabilitation and assist clinicians with
discharge planning.

49.  Goal
setting The functional deficits and objective
neurological findings- valuable information
to assess prognosis, establish goals, and
determine a treatment plan.
 Maximize the potential for function,
introduce effective, task-oriented
movement strategies, and offer multiple
movement options.

50.  Comprehensive
caregiver training to
independent mobility with transition back to
a work environment.

51.  Side
effects and Considerations Mindful of the side effects when developing
a plan of intervention.
 Fatigue,
low blood count, and
gastrointestinal complaints- limit a patient’s
ability to fully participate in the planned
therapy session.

52.  The
clinician must be flexible to determine
the optimal time for intervention.
 Changes
in cognition or personality as a
result of the tumour’s location.

53.  Intervention-
 The
ultimate goal- to achieve maximum
restoration of function, within the limits
imposed by the disease, in the client’s
preferred environment.
 Begins in the intensive care unit and
continues in the inpatient, outpatient, and
home health settings.

54.  Communication
with nursing staffregarding present medical status and an
understanding of ICP, hemodynamic
values, and monitoring devices is crucial to
determining tolerance for therapy
intervention.
.

55.  Medically
stable patient- upgrade mobility
and prepare for the next stage of
rehabilitation.
 Inpatient rehabilitation setting- Treatment
focuses on optimizing functional
capabilities to prepare for discharge.

56.  Integrating
personal goals and interests
into therapeutic intervention invests the
client and family in the rehabilitation
process.
 Prepare the client and caregivers for an
efficient transition.

57.  Utilizing
motor learning principles to teach
functional mobility will best produce
transfer of learning from a constant
environment to an unpredictable home
environment.

58.  Repeated
practice of specific parts of a
skill in fixed surroundings, with physical
and verbal guidance throughout the
movement, and frequent feedback during
and following the completion of the task,
are beneficial in teaching acquisition of a
specific movement or activity.

59.  Practicing
the whole activity in a variable
context, with irregular feedback and
decreased physical and verbal guidance.
 Learning
results in the ability to execute a
task in any setting.

60.  Community
outings and home passes
naturally provide an environment that
facilitates learning.
 Measure retention and transfer of learning
by the client’s performance in the
community or at home.

61.  This
information- used to adjust the
treatment plan and make
recommendations for environmental
modifications that minimize physical and
cognitive demands on the client.

62.  Kenneth
W. Lindsay, Ian Bone, Neurology
and Neurosurgery illustrated, 4th Ed.
 Maurice Victor and Raymond D. Adams,
Principles of Neurology, 6th Ed.
 Darcy A. Umphred, Neurological
Rehabilitation, 5th Ed.
 Delisa, Physical Medicine and
Rehabilitation, 4th Ed.

63.  http://www.hopkinsmedicine.org/healthlibra
ry/conditions/nervous_system_disorders/n
eurocutaneous_syndromes_85,P00794