Neurological Disorders

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single photon emission computed

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3D image that is used to identify cerebral blood flow

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cerebral angiography

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used to view cerebral circulation

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myelography

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x-ray of spinal cord or subarachnoid space with or without dye

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electroencephalography (EEG)

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electrodes placed on scalp to determine conduction time of PNS (for MS, neuropathies, Guillian Barre's)

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electromyography (EMG)

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needle electrodes placed into scalp to determine myopathies (for numbness, tingling, parathesia)

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What diagnostic studies may be done for a pt that had a stroke

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CT scan, EEG, cerebral angiography, MRI (MRI is most effective to pick up hemorrhagic strokes)

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intracranial pressure (ICP)

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normal ICP is about 15mm/Hg. It is the pressure exerted by total volume of 1.brain tissue 2.blood 3.CSF

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what is the Monro-Kellie hypothesis

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any change in volume of the brain tissue, blood, or CSF will cause the other 2 to change

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increased ICP

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when ICP rises above 15mm/Hg

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cerebral response to increased ICP

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Cushings response(severe decrease in cerebral blood flow, HTN, widening BP) and Cushings triad (bradycardia, HTN, bradypnea)

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contributing factors to increased ICP

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edema(head trauma, tumor, surgery, etc); any obstruction of cerebral blood flow (extracranial or intracranial)

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factors that affect blood flow extracranially

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HTN, cardiac output, viscosity of blood

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factors that may affect blood flow intracranially

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CO2, O2, may cause vasodilation leading to decreased blood flow and causing the vessels to vasoconstrict

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How much of the body's O2 is used by the brain

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about 20%; 50mL/min per 100g of brain tissue

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other S&S of increased ICP

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decreased LOC, change in vitals, visual changes (diplopia, difference in pupils), decreased motor function, decordicate positioning, HA, projectile vomiting

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positioning pt w/increased ICP

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keep hob slightly elevated, pt in a neutral position to help promote venous return to cerebrum

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monitoring pt w/increased ICP

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ICP monitor (in ICU)- transducer in ventricles of subarachnoid space to monitor ICP

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Mannitol

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used to help decrease ICP, its a plasma expander, decreases Hct, Hgb, & blood viscosity, thus increasing perfusion to brain
Monitor fluids, lytes, & kidney function

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Why are loop diuretics used for a pt with increased ICP

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decreases Na, Cl, & CSF production,

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what other class of meds may be used for pt w/increased ICP

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corticosteroids for cerebral edema

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intracranial surgery can be performed for what reasons

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1)relieve ICP 2)remove tumor 3)remove clot 4)control bleeding

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postop mgt for intracranial surgery

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reducing cerebral edema, relieveing pain, preventing seizures, monitori ICP, regulate temp, prevent infection, monitor fluid & electrolytes

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causes of seizure disorders

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epilepsy, congenital, trauma, increased ICP

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multiple sclerosis

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disbling disorder w/demyelination of brain/spinal cord

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parkinsons disease

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progressive neurological disorder from degeneration of basal ganglia in cerebrum

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amyotrophic lateral sclerosis (ALS)

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progressive, debilitating disorder of motor neurons

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myasthenia gravis

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neuro disorder of transmission of impulses of voluntary muscles

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Gullain-Barre' Syndrome

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acute progressive form of polynephritis, weakness, and sensory disturbances

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meningetits

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infection/inflammation of meninges from bacteria or a virus

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bells palsy

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unilateral facial paralysis due to bacteria or a virus. It affects CN VII

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cerebral vascular accident

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aka CVA, stroke, brain attack; cerebral circulation interupted or hemorrhage into brain that results in death of brain cells

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modifiable risk factors for CVA

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HTN, A-fib, CAD, MI, heart failure, obesity, increased cholesterol, smoking, drug abuse, birth control pills, alcohol

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unmodifiable risk factors for CVA

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gender (increased risk for males; age (increased risk for >55; race (AA have increased HTN); heredity

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ischemic stroke

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inadequate blood flow to the brain from partial or complex occlusion of an artery resulting in anoxia; about 80% of all strokes. There are 3 types:thrombotic, thromboembolotic, embolic

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thrombotic stroke

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occurs from injury to a blood vessel wall and formation of a clot resulting in decreased blood flow; most common cause of stroke; usually r/t artherosclerois

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thromboembolotic stroke

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clots break from fatty plaque (chol) and travels to the brain

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embolic stroke

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embolus travels from somewhere else in the body ie heart from a-fib and lodges in and occludes a cerebral artery, resulting in infarction

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S&S ischemic strokes ingeneral

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usually peak w/in 72hrs when edema starts to accumulate: motor loss (numbness, weakness, hemiparesis, hemipalegia); communication loss, perceptual disturbances (agnosia, apraxia); emotionally labile

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S&S L sided stroke

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paralysis of R side, usually very slow& cautious, affects speech center-aphasia (expressive, receptive, global); altered level of intellect; R side visual deficit

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S&S R sided stroke

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paralysis of L side; L visual field deficit; often deny anything is wrong; impulsive behavior; increased distractability; poor judgment

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extent of stroke depends on...

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1)how rapid the onset 2)size of infarct 3)presence of collateral circulation

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medical mgt of ischemic stroke

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thrombolytic therapy: TPA w/in 3-6hrs, coumadin (home mgt); aspirin; Plavix; Perzantene; possibly anticonvulsants

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Nrsg Mgt for ischemic stroke

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prevent ocntractures by performing ROM; enchance self care; assist w/sensory/perceptual difficuties; monitor for dysphagia (risk for aspiration); bowel & bladder regime (softener, avoid vagal stimulation); enhance communication

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carotid endarectomy

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surgically remove plaque from the carotids; major complication is stroke

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warning signs of stroke

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sudden numbness or weakness on one or both sides; trouble speaking, swallowing, seeing, walking/balance; confusion; sudden severe HA

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hemorrhagic stroke

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stroke resulting from bleeding into brain tissue, subarachnoid space, or ventricles

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causes of hemorrhagic stroke

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80% caused by intracerebral bleed r/t anticoagulants & HTN; may also be from tumor, substance abuse (crack/cocaine)

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types of hemorrhagic strokes

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intracerebral hemorrhage; intracranial aneurysm; arteriovenous malformations; subarachnoid hemorrhage

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S&S hemorrhagic stroke

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sudden severe HA; variable LOC; pain & neck rigidity r/t meningeal irritation; visual loss; ptosis; tinitis; could lead to coma or death

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how is hemorrhagic stroke dx

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MRI, cerebral angiography, possibly lumbar puncture (but, that could raise intracranial pressure & cause a rebleed)

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surgical mgt of hemorrhagic stroke

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extracranial or intracranial arterial by-pass

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possible complications of cranial surgery

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intraoperative embolism; Korsakoff's syndrome (personality changes: delirium, hallucinations) Fluid & electrolyte imbalance

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nursing mgt of hemorrhagic stroke

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optimizing cerebral perfusion; relieving sensory deprivation & anxiety