1. BRAIN TUMOURS
A brain tumor is a localized intracranial lesion. It occupies space within the skull. These tumors usually
grow as a spherical mass but can grow diffusely infiltrating tissue. Tumors of the brain can be primary
arising from tissue in the brain or secondary resulting from metastasis from malignant neoplasm
elsewhere in the body.
Brain tumors are generally classified according to tissue from where they originate, if malignant tumor is
graded according to general cancer staging procedures.
CLASSIFICATION OF BRAIN TUMORS
GLIOMAS are a malignant gliomas and most common brain Neoplasm accounting for about 45% of all
brain tumors.
ASTROCYTOMA these are the most common type of glaucoma. They arise from supportive tissue glial
cells and atrocities. Usual location is white matter of frontal and temporal lobes in adult’s lateral and
cerebella lobes in children. There is mild and moderately malignant grades I and II.
GLIOBLASTOMA MULTIPOROMEET
This arises from primitive stem cell (gliobalist) usual location is cerebral usual location are cerebral
hemispheres. This is highly malignant and invasive and grade iii and IV.
OIGODENDROGLIOMA
Arises from glial cells and dendrites usual location is cerebral hemisphere most in frontal lobe, some in
basal ganglion and cerebellum. Most are benign (encapsulation and calafication)
EPENDYMOMA
This arises ependymal epithelium usually occurs in lateral and fourth ventricles in children and young
adults. They are benign to highly malignant most benign are encapsulated.
MEDULLOBLASTOMA
These arise from supportive tissue usually at the posterior fossa, fourth ventricle brain stem in children.
They are highly malignant and invasive, metastasis to spinal cord and remote areas of the brain.
2 MENIGIOMA
Arises from endothelial cells, fibrous tissues elements, transitional cells and angioblasts usual location
are arachnoids, villi Dura half over convexity of Hemisphere and half at base of hemisphere. They are
usually benign encapsulation outside brain substance.

2. 3 ACCOUTIC NEUROMA (NEUROFIBROMA)
They arise from Schwann cells inside auditory meatus on vestibular occurs at the site between the Pons
and the cerebellum. They are usually benign or low grade malignancy encapsulation
4. PITUITARY ADENOMA
Arises from pituitary glandular tissue located at pituitary gland usually benign.
5 VASCULAR TUMOURS (HEMAGIOBLASTOMA ARTERIO VENOUSE MALFORMATION)
Arises from over growth of arteries and veins enlarging from vessels. Location is parental cortex near
middle cerebral vessels. They are benign.
6 METASTATIC TUMOURS
These arise due to cancer cells spreading to the brain via circulating system from lungs, breasts ,kidney,
thyroid and prostate . Usual location is cerebral cortex and they are malignant.
CASAUSES
1. Idiopathic
2. Genetically acquired
3. Hereditary
4. Defective immune system
5. Viruses
6. Head injury
PATHOPHYSIOLOGY
The physiology of brain tumors’ depends on the part of the brain that is affected. Eg
PITUITARY ADENOMAS
Functioning pituitary tumors can produce one or more hormones normally produced by anterior
pituitary. The hormones may cause prolactin secreting pituitary adenomas (prolactinomas) growth
hormone secreting pituitary adenomas; it produces acnomegally in adults and adrenocortropic
hormone in female patients whose pituitary gland is secreting excessive quantities of prolactin with
Amenorrhea or glactorrhea (Excessive or spontaneous flow of milk) male patients with prolactoma
may present with impotence.
CLINICAL MANIFESTATION
Symptoms are generalized as well as specific the tumor location and structure of the brain are
compressed.
 Pressure headache (generalized or peri orbital)


3.  Nausea and vomiting unrelated to food intake
 Symptoms of intracranial pressure
 Visual changes
 Blurred vision
 Diplopia (iii,iv,and vi nerve compression)
 Visual field alteration
 Enlarged black spots related to papilla edema
 Seizures
 Speech difficulty( when the tumor affects language area in dominant hemisphere)
 Weakness( when tumor affects motor cortex)
 Alteration in the level of consciousness
 Personality changes( when tumor affects frontal lobes)
TUMOUR LOCATION AND ASSOCIATED PRESENTING SYMPTOMS
CEREBRAL HEMISPHERE
Frontal lobes (unilateral hemiplagia) : seizures, memory deficit, personality and judgment changes
,vision disturbances.
FRONTAL LOBES
Bilateral symptoms associated with frontal lobes and ataxic gait aphasia (motor dysfunction)
PARIETAL LOBES
Speech disturbance if tumor is in dominant hemisphere, inability to write. Inability to replace pictures,
loss of right –left discrimination, seizures.
OCCIPITAL LOBE
Visual disturbances, blindness, headache and seizures
TEMPORAL LOBE
Complex or partial seizures with automatic behavior, hallucination.
METASTATIC TUMORS
Headache, nausea or vomiting because of intracranial pressure other symptoms depends on location of
tumor.
THALAMUS SELLAR TUMORS UMOUR
Headache, nausea or vomiting and diabetes inapedus may occur.
FOUTH VENTRICLE AND CEREBELLAR TUMORS

4. Headache, nausea and papilloedema, mystagamus, occur from intra cranial pressure, ataxic gait and
changes in coordination.
CEREBRELLOPONTINE TUMOUR
Tinnitus and vertigo deafness.
BRAINSTEM TUMOURS
Headache, upon awakening, drowsness, vomiting, ataxic gait, facial muscle, dysphagia, dysaithria,
crossed eyes or other visual changes.
MANAGEMENT
INVESTIGATIONS
HISTORY TAKING and physical exams. History taking of the illness and the manner in which the
symptoms involved are important in diagnosis. This will help to provide data and location. Assess the
level of consciousness, motor abilities, and sensory perception.
CT SCAN
This is done to check the number, size and density of the lesions and the extent of secondary cerebral
edema.
SKULL X-RAYS
This is done to detect fractures, bones erosion, calcification and abnormal vascularity.
MAGNETIC RESONANCE IMAGING (MRI)
This is where internal body parts are visualized by means of magnetic energy. This is used to detect
tumors in the brain stem and pituitary regions where bones interfere with CT scan.
CEREBRAL ANGIOGRAPHY
This involves the injection of contrast medium into the cerebral arterial circulation which assists in
determining etiology of strokes, seizures, headaches and motor weakness. It is used to visualize the
cerebral blood vessels and can localize most cerebral tumors.
ELECTROENCEPHALOGRAM (EEC)
This is used to detect abnormal brain waves in regions occupied by a tumor and is used to evaluate
temporal lobe seizures and assists in ruling out other disorders.
CYTOLOGIC STUDIES OF CSF
Is done to detect malignant cells because tumors of the CNS are capable of shedding cells into CSF.

5. DRUG THERAPY
I. Phenytoin ( Dilantin ) used to prevent seizures.
Dose: as per doctor’s order
Nursing implication: assess for gingiral hyperplasia. Administer drug on schedule and assess for signs of
toxicity and rash.
II. Dexamethasone used to reduce cerebral edema
Dose: as per doctor’s order
Nursing implication: monitor for blood glucose. Taper dosage after long term therapy
III. Laxatives / stool softeners are used to prevent constipation.
Dose: as per doctor’s order
Nursing implication: Monitor fecal impaction and instruct patients not to strain.
IV. Ranitidine or fomatidine used to decrease gastric acid secretion
Dose: As per doctors’ order.
SURGICAL MANAGEMENT
INTRACRANIAL SURGERY
Indications
1. Intracranial infections caused by bacteria.
2. Hydrocephalus due to overproduction of CSF, obstruction to flow defective reabsorption.
3. Intracranial tumors due to benign or malignant growth of cell growth.
4. Intracranial bleeding due to rapture of cerebral blood vessels because of trauma or
cardiovascular accident. (CVA)
5. Artenovenouse malformations due to congenital tangle arteries.
6. The surgical removal tumors which is called craniotomies.
NURSING CARE
PRE OPERATIVE CARE
Collection of baseline data of neurological and physiological states and recording.
Encourage patients’ family to verbalize their fears.
Explain procedures to be done and why

6. Give pre operative medication to allay anxiety and for them to understand.
Shave the head in readiness for the operation.prepare the family and patient on the appearance of the
patient after surgery, head dressings, edema and ecchymosis of the face and possible decrease in
mental status.
POST OPERATIVE CARE
OBSERVATIONS
Assess neurological status including ability to move, level for orientation and alertness of the patients
pupils.
Assess degree and character of drainage, amount and bleeding should be minimized.
Initial head dressing should be reinforced as necessary; often incision is left open to air after first several
days.
Observe for signs of postural hypertension.
PROMOTE MOBILITY
Two hourly turning either side to promote mobility and prevent pressure sore formation.
If supratentional surgery is done, the head of bed is kept elevated at 30 degrees.
Encourage early ambulation to prevent complication of bed rest .eg hypostatic pneumonia and deep
vein thrombosis.
Raise head end of the bed gradual and encourage patient to sit on edge of bed before standing to
prevent further injury.
PROMOTE DECREASED INTRA CRANIAL PRESSURE
Space nursing activities to allow patients to rest between them. Encourage patient to avoid progressive
coughing and vomiting.
Do suctioning only when necessary and the gently and cautiously.
PROTECT SAFETY OF THE PATIENT
Use soft hand restraints if necessary to prevent injury. Use mittens as alternative to restraints, change
mitt fourth hourly and provide range of motion exercises to hands at this time. Cut nails short to prevent
self injury.
PROMOTE ELECTROLYTE BALANCE

7. Perform accurate intake and output with measurement of specific gravity to prevent overload. Do
frequent testing for blood glucose to prevent blood glucose in balance. Have patient resume oral diet as
quick as possible to maintain good electrolyte balance. Assess for difficult in swallowing or absence of
gag reflex before stating oral diet. Monitor electrolytes for presence of abnormality.
PROMOTE COMFORT
Medication for comfort with codeine sulphate or non-carcotic analgesic to relieve pain. Ice cap for
headache may help.
COMPLICATIONS
1. Hydrocephalus- due to obstruction of normal flow cerebral spinal fluid.
2. Respiratory failure- can result from edema in the brain stem, inability to protect the airway and
the cough and gag reflex.
3. Cerebral spinal fluid leak – due to opening into the Dura matter.
4. Corneal abrasion is due to trauma or surgery in the seventh cervical nerve.