PT 536 Progressive Lesions of the CNS PT Implications

reading, body orientation, sensory information, language

Brain tumor impairments consistent with the parietal lobe

thinking, speaking, reasoning, problem solving, compassion

Brain tumor impairments consistent with the frontal lobe

vision

Brain tumor impairments consistent with the occipital lobe lobe

coordination, balance, vestibular, attention

Brain tumor impairments consistent with the cerebellum

breathing, temperature, heart rate

Brain tumor impairments consistent with the brainstem

memories, hearing, behavior, emotions

Brain tumor impairments consistent with the limbic system

headaches, seizures, changes in personality/cognition, changes related to elevated ICP

General clinical symptoms associated with a brain tumor

nausea/vomiting, changes in cranial n function, visual changes, alterations of consciousness

signs of increased ICP

worse in morning, better at night, behind eyes, worsens with activity

common themes with headaches associated with brain tumors

papilledema

swelling of the optic disc, seen in 75% of people with brain tumors

MRI

Most informative diagnostic tool for brain tumors

gadolinium

contrast enhancement used with MRI to distinguish tumors from surrounding area.

CT

diagnostic tool that only really detects larger tumors or things associated with tumors like hydrocephalus or herniation of the brainstem

PET scans

used to estimate boundaries of a tumor as well as track how fast a tumor is growing

fluorodeoxyglucose

radiopharmaceutical used in PET scanning

surgery, radiation, chemotherapy

3 main treatments for primary brain tumors

surgery

usual initial step to tx brain cancer if it is large enough

corticosteroids

given to patients after surgery to remove brain tumor in order to reduce swelling in the brain

radiation

treatment following the removal of a tumor to reduce the risk that the tumor will come back

stereotactic radiosurgery

use of a specialized instrument to locate and treat targets in the brain

"it depends"

prognosis for brain tumors

70%

1 year survival rates for grade 3 glioblastomas

50%

1 year survival rates for grade 4 glioblastomas

40%

2 year survival rates for grade 3 glioblastomas

15%

2 year survival rates for grade 4 glioblastomas

10-20%

5 year survival rates for grade 3 glioblastomas

rare

5 year survival rates for grade 4 glioblastomas

worse for metastatic

prognosis for metastatic brain tumors versus primary brain tumors

encourage mobility but;

pts may have weakness, paralysis, decreased sensation, and pain as well as limitation in daily activities

PT considerations for patients with brain tumors (metastatic and primary)

family training, home mobility for as long as possible

if an individual with a brain tumor has a poor prognosis, what should PT focus on?

functional interventions, prior level of function and exercises

if an individual with a brain tumor has a high survival rate, what should PT focus on?

3x/week for 30-60 moderate to vigorous exercise

for most outcomes, what would the recommended dose of exercise be for patients with cancer when only doing aerobic exercises?

meningitis

inflammation of the meninges of the brain and spinal cord

neck stiffness, headache, high fever

top 3 clinical symptoms of meningitis

high pitched cry and neck stiffness

common way to recognize meningitis in babies

photophobia, nausea/vomiting, confusion and altered mental state

3 advanced symptoms of meningitis

jolt of accentuation of headache (JAH)

headache increased when patient rotates the head two or three times in a second

OUT

Is JAH better for ruling OUT or ruling IN meningitis ?

Kernig's sign, Brudzinski sign

two clinical signs that are good for ruling IN meningits

Kernig's sign

a diagnostic sign for meningitis marked by the person's inability to extend the leg completely when the thigh is flexed upon the abdomen and the person is sitting or lying down

brudzinski's sign

pain with resistance and involuntary flex of hip/knee when neck is flexed to chest when lying supine

lumbar puncture CSF

best diagnostic to confirm meningitis

gram stain

test taken at the same time as a lumbar puncture due to faster results

potentially - may need to rule out tumors, strokes, etc

is it necessary to perform an MRI or CT on an individual with suspected meningitis?

septicemia

bacteria in blood that cause extremely cold hands and feet, limb pain, and mottled skin; IMMEDIATE REFERRAL

MEDICAL EMERGENCY

• Appropriate antibiotic and steroids

• Antibiotic therapy immediately

• Dexamethasone

Treatment for Bacterial Meningitis

decrease inflammation/swelling in the SA space

Purpose of dexamethasone in bacterial meningitis treatment

supportive treatments, corticosteroids reduce morality

Treatment for viral Meningitis

control ICP

general treatment consideration for meningitis

fatal 5-25%, neurologic sequelae 75%

Prognosis for bacterial meningitis

cardiorespiratory failure, sepsis

specific complication seen in 40% of bacterial meningitis cases

blindness, permanent hearing loss, developmental impairments, hydrocephalus, hemiparesis, tetraparesis

long term bacterial meningitis impairments seen in children

age, health

prognosis for bacterial meningitis depends on what two factors?

generally okay

prognosis for viral meningitis

hearing

sometimes, those with viral meningitis will have these impairments which will typically resolve after time

severe disturbance of consciousness, intracranial swelling, cerebral hemorrhage, PNA, age over 60 (death occurring 2 weeks after diagnosis)

indicators of poor prognosis for meningitis

Encephalitis

viral invasion or hypersensitivity initiated by a virus

False

True or False? Viral meningitis typically has more serious symptoms than encephalitis.

ticks & mosquitos (West Nile, Lyme), Herpes Simplex Virus

Common sources of encephalitis

brainstem, thalamus, cerebella

West Nile virus attacks neurons in what part of the brain?

limbic, frontal, temporal

Herpes Simplex virus attacks neurons in what part of the brain?

headache, nausea, vomiting, loss of consciousness if untreated

General symptoms of encephalitis

paresis, aphasia, ataxia, seizures, hallucinations, memory issues

Neurologic signs/symptoms that accompany encephalitis

look at CSF, MRI

How so we diagnose encephalitis

IgM antibodies, viral particles

what will be found in CSF when an individual has encephalitis?

cerebral swelling, vascular damage, activity in brain tract

what will MRI show for encephalitis?

only show damage until damage is already severe

Why are CT scans not good for diagnosing encephalitis?

"it depends"

Treatment for encephalitis

supportive care (swelling, inflammation management, mosquito control)

Most common encephalitis treatment

Acvclovir

Medication that decreases effects of encephalitis causes by herpes simplex virus

Pro: helps with swelling

Cons: lowers body's immune response, harder to fight infection

pros and cons of using corticosteroids to treat encephalitis

"it depends"

Prognosis of Encephalitis

10-50%

Overall recovery of encephalitis

excellent

Recovery from Mumps Encephalitis

moderate/good

prognosis of west nile virus

fatal 10-20%, remaining neurologic involvement in 50%

prognosis of herpes simplex encephalitis

ataxia, myoclonic jerks, weakness and paralysis, cognitive impairments, emotional disturbances, sleep abnormalities, hallucinations

Clinical symptoms of prion disease

sporadic, inherited, acquired by infection

three types of prion disease

apathy, anxiety, mood changed, decreases ability to want to eat, ability to concentrate

Early symptoms of prion disease

expression of apprehension

constant symptom of prion disease

Postmortem Examination, Western Blot

Diagnosis of prion disease

none, supportive only

Treatment for prion diseases

fatal within 6-12 months

Prognosis of prion disease

early mobility, awareness of lines and tubes, vital sign monitoring, comfort measures

PT implications for progressive lesion patients in the ICE

hospice care

care provided for the dying in institutions devoted to those who are terminally ill

palliative care

supportive medical and nursing care that keeps the patient comfortable but does not cure the disease

Glasgow coma scale

if a patient presents with altered levels of consciousness, what can be used to evaluate the patient?

isolation protocols must be followed, monitor vitals, ID potential infectious agents and ask for referral

Safety considerations for the infectious disorders