BRAIN TUMORS Is a localized intracranial lesion that occupies space within the skull.

In adults, most brain tumors originate in glial cells. The highest incidence of brain tumors in adults occurs between the fifth and seventh decades with a slightly higher incidence in men. Brain tumors rarely metastasize outside the central nervous system, but cause death by impairing vital functions. Brian tumors are classified as:

Those arising from the coverings of the brain i.e. dural meningioma. Those developing in or on the cranial nerves i.e. acoustic neuroma. Those originating in the brain tissue i.e. various gliomas Metastatic lesions originating elsewhere in the body.

Tumors of the pineal gland and pituitary and of cerebral blood vessels are also included in the types of the brain tumors. Tumors may be benign or malignant. A benign tumor may occur in a vital area and have effects as serious as a malignant tumor. SPECIFIC TUMORS Gliomas, the most frequently brain neoplasm, cannot be totally removed because they spread by infiltrating into the surrounding neural tissue Pituitary adenomas may cause symptoms due to mass (pressure) effects on adjacent structures or to hormonal changes Angiomas are found in or on the surface of the brain, may never cause symptoms, or may give rise to symptoms of brain tumor. The walls of the blood vessels in Angiomas are thin, increasing a risk for cerebral vascular accident (stroke). Acoustic neuroma is a tumor of the eighth cranial nerve (hearing and balance). It may grow slowly and attain considerable size before it is correctly diagnosed.

CLINICAL MANIFESTATIONS INCREASING INTRACRANIAL PRESSURE SYMPTOMS Headache Vomiting Seldom related to food intake Papilledema Mental changes

LOCALIZED SYMPTOMS Conclusive movements localized on one side of the body Contralateral homonymous hemianopia Dizziness Personality disorder Changes in emotional state and behavior Disinterested mental attitude.

DIAGNOSTIC EVALUATION

History of the illness and manner the symptoms evolved Neurologic examination indicates areas involved CT imaging MRI Computer- assisted stereotactic (three- dimensional) Biopsy Cerebral angiography Electroencephalogram Cytologic studies of the cerebral spinal fluid

MANAGEMENT

Is to remove all of the tumor or as much as possible without increasing the neurologic deficit (paralysis, blindness) or to achieve relief of symptoms by partial tumor removal (decompression), radiation therapy, chemotherapy, or a combination of these. Evaluation of treatment should be done as soon as possible before irreversible neurologic damage occurs. Most patients undergo neurosurgical procedure, followed by radiation and possibly chemotherapy.

NURSING MANAGEMENT

Evaluate gag reflex and ability to swallow preoperatively. Teach patient to direct food and fluids toward the unaffected side, placing the patient upright to eat, offering a semisoft diet, and having suction readily available if diminished gag response. Reassess function postoperatively, as changes can occur. Perform neurologic checks: monitor vital signs, maintain a neurologic flow record, space nursing interventions to prevent rapid increase in ICP. Reorient patient when necessary to person, time, and place. Use orienting devices (personal possessions, photographs, lists, clock), supervise and assist with self-care, and monitor and intervene for prevention of injury Carefully monitor patients with seizures Check motor function at intervals: assess sensory disturbances Evaluate speech; assess eye movement, pupil size, and reaction.