University of Perpetual Help System Laguna

Dr. Jose G, Tamayo Medical University Sto Nino, City of Binan, Laguna

COLLEGE OF NURSING

MENINGIOMA
Submitted By:

Aguilar, Dan Joseph V.

BSN4A- Group1

Submitted To: Sally A. Peralta RN, MAN

Meningiomas are a diverse set of tumors arising from the meninges, the membranous layers surrounding the central nervous system. They arise from the arachnoid "cap" cells of the arachnoid villi in the meninges. These tumors are usually benign in nature; however, a small percentage are malignant. Many meningiomas are asymptomatic, producing no symptoms throughout a person's life, and require no treatment other than periodic observation. Symptomatic meningiomas are typically treated with either radiosurgery or conventional surgery.

Meningiomas are most common in people between the ages of 40 and 70. They are more common in women than in men. Among middle-aged patients, there is a marked female bias, with a female: male ratio of almost 3:1 in the brain and up to 6:1 in the spinal cord. Meningiomas are very rare in children, with pediatric cases accounting for only 1.5% of the total.

Many individuals have meningiomas but remain asymptomatic (no symptoms) for their entire life, so the meningiomas are not discovered until after an autopsy. One to two percent of all autopsies reveal meningiomas that were unknown to the individuals during their lifetime, since there were never any symptoms. Tumors causing symptoms were discovered in 2 out of 100,000 people, while tumors discovered without causing symptoms occurred in 5.7 out of 100,000, for a total incidence of 7.7/100,000.

PATIENT PROFILE
Patients Name Gender Age Religion Nationality Date of Birth Civil Status Address Admission Time Date of admission Attending Physician Admitting Diagnosis : K.J.J : Female : 24y.o : Roman Catholic : Filipino : October 29, 1989 : : Brgy. Langkiwa, Binan Laguna : 10:10 pm : February 26, 2014 : : To consider Meningioma

A. History of Present illness 8 hours PTA, patient experienced low of consciousness. consciousness after two minutes. No consult done. 6 hours PTA, patient noted to have stiffening of both upper and lower extremities, accompanied by upward rolling of eyeballs and drooling of saliva which lasted about 10 minutes, patient was brought to the hospital where CBC with platelets was done. Patient was observe another episodes of seizure while in hospital. Diazepam amp IM was given. Patient then referred in this institution for further management. Patient regain

Chief Complain:

Loss of consciousness

Vital signs (upon admission) BP Temperature Pulse Rate Respiratory Rate B. Past Medical History (+) HPN (-) DM (-) Bronchial asthma (-) COPD Diagnosed 2011 no maintenance : 180/100 : 39.0 Co : 86bpm : 26cpm

(-) Allergy (+) Measles Family history February 2014

(+) HPN both parents (-) CVA (+) DM both parents (-) PTB

(-) Thyroid Disease (-) Kidney Disease (-) Cancer (-) Heart Disease

Pagamutang Bayan ng Carmona, Carmona Cavite

Chief Complain:

Loss of consciousness

Initial diagnosis: To consider Encephilitis

History of Present Illness 7 days PTA, (+) undocumented fever with associated headache, productive cough with yellowish phlegm, 3x persistent vomiting. No consult was done, patient took paracetamol which afforded relief of fever and headache. 5 days PTA, still with above symptoms, now with maculopapular rashes beginning in the face, patient was seen at a government hospital where she was diagnosed with measles. No laboratory exam done. She was given unrecalled mediations. Patient still with headache and vomiting 3-5 episodes per day, persistent until few hours. PTA, patient was seen by neighbor unconscious. She was noted to have 3 episodes of convulsion described as upper rolling of eyeballs with stiffing of extremities lasting 6 minutes each. Patient was awake but agitated in between attack. She was brought to a government hospital where she had another episode of seizure of the same characteristic hence was transferred to one institution.

Past Medical History (+) HPN

(-) DM, Asthma, PTB (+) Measles 1 weak PTA

Patient Social History: (-) Smoker (-) Alcoholic beverage drinker (-) Allergy to food and drug

Journal A Handful of Mutations Explain Most Meningiomas, March 2013 - Volume 13 - Issue 5 - p 4244 -Samson, Kurt Two new studies bring the total number of meningioma mutations identified thus far to five; the researchers believe that these account for most of these tumors. Mutations governing signal pathways in just five genes may be responsible for many meningiomas, according to two new studies by independent teams of researchers who used genome sequencing to probe for specific genetic alterations in nearly 400 tumors. The findings may offer potential targets for therapeutic intervention, and certain cancer drugs are already available or in clinical trials that address some of these defects. Surgery and radiation are the only current treatments. Meningiomas, the most common nervous system tumors, develop on the meninges, the layers of tissue surrounding the brain and spinal cord. Approximately 80 percent are low-grade, slow growing tumors, but they can exert pressure on adjacent cranial nerves and blood vessels as they grow. Up to 20 percent recur despite surgery, and their growth can cause disability and even death. Prior research has shown that the tumor suppressor gene NF2 (neurofibromin 2), on chromosome 22, is disrupted in about one-half of all cases, but the full range of other genetic changes has been unknown. However, taken together, the two new studies bring the total number of meningioma mutations identified thus far to five, and the researchers believe that these account for most of these tumors. In a Jan. 20 research letter published online in Nature Genetics, scientists at Harvard Medical School and the Dana-Farber Cancer Institute in Boston, reported the results of whole-genome analysis of 17 meningiomas using whole-genome sequencing or just the protein-coding regions (exomes), with focused sequencing in an additional 48 tumors. The researchers were able to confirm NF2 inactivation in 43 percent of the meningiomas studied, while changes in other genetic modifiers of cell growth were found in 8 percent. A larger international study, led by researchers at Yale University's Program in Brain Tumor Research, analyzed mutations in 300 meningiomas and found mutations in four new genes, each influencing the origin of meningiomas from different brain regions, in addition to the known defects in NF2. The study was published Jan. 24 in an online advance edition in Science.