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. GeneticfactorsTransformation 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. ASTROCYTOMAOLIGODENDROGLIOMA 9. EPENDYMOMACHOROID PLEXUS PAPILLOMA 10. NEUROCYTOMAPINEOCYTOMA 11. MENINGIOMAMENINGEAL SARCOMA 12. Meningeal melanoma 13. SCHWANNOMANEUROFIBROMA 14. Blood vessels 15. GERMINOMATERATOMA 16. CRANIOPHARYNGIOMAPITUITARY ADENOMA 17. EPIDERMOID OR DERMOID CYSTSCOLLOID CYSTS 18. CHORDOMAGLOMUS JUGULARE TUMOUR 19. CHONDROMACHONDROSARCOMA 20. Symptomstend to develop insidiously, gradually progressing over a few weeks or years, depending on the degree of malignancy. Intracranialtumours are considered in relation to these common clinical manifestation: 21. Changesin mental function Headaches Vomiting Seizures- 30% 22. Periodicbifrontal and bioccipital headaches Projectile vomiting Mental torpor Unsteady gait Sphincteric incontinence Papilledema 23. Symptomsand signs of general cerebral impairment and increased pressure occur late or not at all. 24. Hereditarydisorders, characterized by multiorgan malformations and tumours. Phakomatosesor NeurocutaneousSyndromes Disordersof central nervous system that additionally result in lesions on the skin and the eye. 25. Neurofibromatosis Tuberous Sturge VonsclerosisWeber syndromeHippel- Lindau disease AtaxiaTelangiectasia 26. Tuberoussclerosis 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. 27. NF1is an autosomal dominant condition Gene on chromosome 17. NF2- autosomal dominant conditon Gene on chromosome 22. 28. NFmay 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. 29. Thecause 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. 30. Neurofibromatosis(NF): There are three distinct types of NF, classified as NF I, NF II, and Schwannomatosis. NF1 It is characterized by caf au lait spots and neurofibromas. Von Recklinghausens disease. Subcutaneous neurofibromata 31. Molluscafibrosa Plexiform neuroma Skeletal manifestations Scoliosis ( 50%) Subperiosteal neurofibromas Sphenoid wing dysplasia Occular manifestations- Lisch nodules 32. Neurological manifestations Mental retardation and Epilepsy- 15% NeoplasiaNF2 It is autosomal dominant disorder characterized by tumours of the 8th cranial nerve ( vestibular division). Caf au lait spots rare 33. 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. 34. Autosomaldominant disorder with high sporadic mutation rate. Characterized by cutaneous, neurologic, renal, skeletal, cardiac and pulmonary abnormalities. Adenoma sebaceum Shagreen patch. Pitted teeth 35. Facialangioma 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 36. Haemangioblastomasin 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 37. Louis-Bar syndrome Multisystem disorder is characterized by Cerebellar ataxia Occular and cutaneous telangiectasia Immunodeficiency 38. Evaluation Comprehensiveexamination and assessment of all systems.Athorough review- medical history and an understanding of the medical diagnosis. 39. Importantpsychosocial factorsoccupation, support system, personal goals and role in the family. Examinationof all the systems through functional tasks 40. FunctionalAssessment 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. 41. Goalsetting 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. 42. Comprehensivecaregiver training to independent mobility with transition back to a work environment. 43. Sideeffects and Considerations Mindful of the side effects when developing a plan of intervention. Fatigue,low blood count, and gastrointestinal complaints- limit a patients ability to fully participate in the planned therapy session. 44. Theclinician must be flexible to determine the optimal time for intervention. Changesin cognition or personality as a result of the tumours location. 45. Intervention- Theultimate goal- to achieve maximum restoration of function, within the limits imposed by the disease, in the clients preferred environment. Begins in the intensive care unit and continues in the inpatient, outpatient, and home health settings. 46. Communicationwith nursing staffregarding present medical status and an understanding of ICP, hemodynamic values, and monitoring devices is crucial to determining tolerance for therapy intervention.. 47. Medicallystable patient- upgrade mobility and prepare for the next stage of rehabilitation. Inpatient rehabilitation setting- Treatment focuses on optimizing functional capabilities to prepare for discharge. 48. Integratingpersonal goals and interests into therapeutic intervention invests the client and family in the rehabilitation process. Prepare the client and caregivers for an efficient transition. 49. Utilizingmotor learning principles to teach functional mobility will best produce transfer of learning from a constant environment to an unpredictable home environment. 50. Repeatedpractice 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. 51. Practicingthe whole activity in a variable context, with irregular feedback and decreased physical and verbal guidance. Learningresults in the ability to execute a task in any setting. 52. Communityoutings and home passes naturally provide an environment that facilitates learning. Measure retention and transfer of learning by the clients performance in the community or at home. 53. Thisinformation- used to adjust the treatment plan and make recommendations for environmental modifications that minimize physical and cognitive demands on the client. 54. KennethW. 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. 55. http://www.hopkinsmedicine.org/healthlibrary/conditions/nervous_system_disorders/n eurocutaneous_syndromes_85,P00794