Chapter 65: Managing Oncologic & Degenerative Neurologic Disorders

Managing Oncologic & Degenerative Neurologic Disorders details the nursing and medical management of patients facing challenging oncologic and neurodegenerative conditions impacting intracranial regulation and mobility. Oncologic disorders are thoroughly examined, starting with primary brain tumors like highly aggressive gliomas (including astrocytomas and glioblastoma multiforme), meningiomas, acoustic neuromas (involving cranial nerve VIII, presenting with hearing loss and vertigo), and pituitary adenomas, which exert pressure effects or cause hormonal hypersecretion, such as prolactinomas or growth hormone excess leading to acromegaly. Tumors cause diverse physiologic changes including increased intracranial pressure (ICP), cerebral edema, headache, and focal neurologic deficits. Diagnosis relies heavily on advanced imaging modalities like MRI and CT scans, alongside procedures like stereotactic biopsy. Treatment strategies involve a combination of surgical resection (craniotomy or microsurgery), various radiation therapies (external beam, brachytherapy, stereotactic radiosurgery), and chemotherapy, notably oral temozolomide, which can cross the blood-brain barrier. Care extends to spinal cord tumors, where rapid intervention is critical for managing extramedullary-extradural compression, often treated as a neurologic emergency. The second major focus is on degenerative neurologic disorders, including Parkinson's disease (PD), resulting from depleted dopamine stores in the substantia nigra, leading to the cardinal symptoms of tremor, rigidity, bradykinesia (abnormally slow movement), and postural instability. Pharmacologic treatment centers on levodopa/carbidopa, though surgical options like Deep Brain Stimulation (DBS) are utilized for select patients. Other degenerative conditions covered include the progressive, hereditary Huntington disease, characterized by the triad of chorea (involuntary, jerky movements), cognitive decline, and psychiatric changes, and Amyotrophic Lateral Sclerosis (ALS), a motor neuron disease requiring aggressive symptomatic management, including respiratory support and specialized feeding (PEG tube placement). The chapter also discusses Muscular Dystrophies and Post-Polio Syndrome (PPS), emphasizing supportive care and maximizing functional independence. Finally, it addresses Degenerative Disc Disease in both cervical and lumbar regions, commonly causing radicular pain and sciatica. Management often begins conservatively with NSAIDs and physical therapy but may progress to surgical interventions such as discectomy, laminectomy, or spinal fusion, requiring specialized postoperative nursing care including strict mobility restrictions like logrolling and patient education regarding proper body mechanics. Across all conditions, nursing management prioritizes pain control, managing aspiration risk, promoting self-care, and providing extensive psychosocial support for both patients and caregivers coping with chronic illness and functional decline.