Disturbances in

Neurologic Function Part

1
NCM 116

Prepared by: Stephanie J. Locsin, RN, MD

References:

Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 15th Ed

Images from Netter’s Atlas of Human Anatomy and Google Images

REVIEW OF THE
NEUROLOGIC SYSTEM
OVERVIEW

Functions to control motor, sensory, autonomic,

cognitive, and behavioral activities

The nervous system consists of two major parts:

Central

Peripheral
 Contains >1B cells that link motor and sensory
pathways, monitor internal and external stimuli,
and maintain homeostasis via complex chemical
and electrical messages
OVERVIEW

Neuron: the basic functional unit of the brain

Nuclei or Ganglia: nerve cell bodies occurring

in clusters

Center: a cluster of cell bodies with the same

function

Glial cells: support, protect and nourish the

 neurons
OVERVIEW

Neurotransmitters: communicate messages from one neuron to another or

from a neuron to a target cell

Manufactured and stored in synaptic vesicles

Can either excite or inhibit activity of a target cell

Assessment Health Dizziness and vertigo Visual
History disturbances Muscle weakness
Pain Abnormal sensation
Seizures
 Language ability

Level of consciousness
Past health, family and social
history
Assessment
Cranial nerves
Physical Examination
Motor ability, coordination
Consciousness and cognition
Muscle strength
Mental status
Sensation
Intellectual function
Reflexes
Thought content

Emotional status
Diagnostic
Modalities
CT scan

MRI

SPECT

PET
 EEG

Noninvasive carotid flow studies

Transcranial doppler

EMG, NCV

Cerebral angiography Lumbar puncture and CSF

examination/ analysis
Myelography

HEADACHE
OVERVIEW
Cephalgia

One of the most common of all human physical complaints

A symptom rather than a disease entity

May indicate organic disease, a stress response, vasodilation, skeletal muscle

tension, or a combination of factors

Primary headache: one for which no organic cause can be identified

Migraine, tension type, cluster headaches

MIGRANE
A complex of symptoms characterized by periodic and recurrent attacks of
severe headache lasting from hours to days in adults

The cause has not been clearly demonstrated

Primarily a vascular disturbance that has a strong familial tendency

Typical time of onset: puberty

F>M

May occur with or without aura

TENSION TYPE HEADACHE
Tend to be more chronic and less sever

Most common type of headache

OTHER HEADACHES

Trigeminal autonomic cephalgia: include cluster headaches and paroxysmal

hemicrania

Cluster headaches: relatively uncommon and seen more frequently in men

Cranial arteritis: a cause of headache in the older population, reaching its

greatest incidence in those older than 70 years old
Secondary headache: a symptom associated with other causes, such as a
brain tumor, an aneurysm, or lumbar puncture
Assessment and Diagnostics

History

CT scan

MRI

EMG

Blood studies
Medical/ Surgical Treatment

Triptans (First line for migraine)

Ergotamine preparations

Migraine prophylaxis: ACEIs, ARBs, beta-blockers, antiepileptics,

antidepressants

100% Oxygen by facemask x 15mins, SC sumatriptan, or intranasal

zolmitriptan (acute attack of cluster headache)

Corticosteroid administration (Cranial arteritis)

Analgesic agents
Nursing
Intervention ???
INCREASED ICP
OVERVIEW

Components of the cranial vault: brain tissue, blood, CSF

The Monro-Kellie hypothesis/doctrine

Because of the limited space for expansion within the skull, an increase in any
one of the components of the cranial vault causes a change in the volume of
the others

Because the brain tissue has limited space to expand, compensation typically
is accomplished by displacing or shifting CSF, increasing the absorption or
 decreasing the production of CSF, or decreasing cerebral blood volume

Without these changes, ICP begins to rise

PATHOPHYSIOLOGY
Key terms:

Autoregulation

CPP

Cushing’s reflex

Cushing’s triad

Herniation
Clinical Manifestations
Clinical changes in level of
consciousness
 Abnormal respiratory and
vasomotor response

Decortication

Decerebration

Flaccidity

Coma
COMPLICATIONS

Brainstem herniation

Diabetes Insipidus

SIADH
Brain death
Assessment and Diagnostics

CT scan

MRI

Cerebral angiography

PET

SPECT

Transcranial doppler

Evoked potential monitoring

Medical/ Surgical
Treatment Goal: maintain cerebral
perfusion

Invasive ICP monitoring

Osmotic diuretics

Fluid restriction

Draining CSF

Maintaining systemic BP and oxygenation

Controlling fever

Nursing
Intervention ???
HEAD INJURIES
OVERVIEW

Head injury: a broad classification that encompasses any damage to the

head as a result of

Does not necessarily mean a brain injury is present

TBI, isolated scalp injury, skull fractures

Traumatic brain injury: craniocerebral trauma; describes an injury that is the

result of an external force and is of sufficient magnitude to interfere with daily
life and prompts the seeking of treatment
OVERVIEW

PATHOPHYSIOLOGY
Clinical Manifestations
Depend on the severity and the anatomic
location Localized pain
Bleeding from the nose, pharynx,
ears or conjunctiva

Battle sign, racccoon eyes

CSF rhinorrhea, otorrhea

Assessment and

Diagnostics CT scan +/- MRI

Medical/ Surgical Treatment

Close observation

Surgical correction

Stabilization of cardiac and respiratory function

Control of hemorrhage and hypopvolemia

Nursing
Intervention ???
BRAIN STROKE
OVERVIEW
Cerebrovascular disorder: an umbrella term that refers to a functional
abnormality of the CNS that occurs when the blood supply to the brain is
disrupted

Stroke is the primary cerebrovascular disorder in the US, and a leading cause
of serious, long-term disability

Can be divided into two major categories: ischemic and hemorrhagic

Transient Ischemic attack: a neurologic deficit that completely resolves in 24

hours; manifested by a sudden loss of motor, sensory, or visual function

Brain imaging will show no evidence of ischemia

Ischemic stroke
Formerly referred to as a cerebrovascular accident or a “brain attack”

A sudden loss of function resulting from disruption of the blood supply to a

part of the brain
PATHOPHYSIOLOGY
Clinical Manifestations
Depend on the location of the lesion
Numbness or weakness of the face, arm, or leg, esp on one side of the body
Confusion or change in mental status

Trouble speaking or understanding speech

Visual disturbances

Difficulty walking, dizziness, or loss of balance or coordination

Sudden severe headache

Motor, sensory, CN, cognitive, and other functions may be disrupted

Assessment and Diagnostics

Careful history

Neurologic examination
Non-contrast CT scan

CT angiography

MRI

Transcranial doppler

Echocardiography
Medical/ Surgical Treatment

Anti-platelet drugs

Anticoagulants

Statins
Antihypertensives (ACEIs)

t-PA

Endovascular therapy
Nursing
Intervention ???
Hemorrhagic stroke

Primarily caused by intracerebral and subarachnoid

hemorrhage and are caused by bleeding into the brain
tissue, the ventricles, or the subarachnoid space

Primary intracerebral hemorrhage from a spontaneous

 rupture of small vessels accounts for approx 80% of
hemorrhagic strokes and is caused chiefly by
uncontrolled hypertension

Intracranial aneurysm: a dilation of the walls of a

cerebral artery that develops as a result of weakness
in the arterial wall
PATHOPHYSIOLOGY
Clinical Manifestations
Depend on the location of the
lesion Severe headache
Nausea or vomiting

Early sudden change in level of consciousness

Seizures

Neurologic deficits may be similar to ischemic stroke

Complications

Rebleeding or hematoma expansion

Cerebral vasospasm

Cerebral ischemia
Acute hydrocephalus

Increased ICP

Seizures
Assessment and Diagnostics

History

CT scan

MRI

Cerebral angiography
Medical/ Surgical Treatment
Bed rest with sedation

FFP and vit K

Anti-epileptic drugs

Intermittent pneumatic compression devices

Analgesic agents

Antihypertensives

LMWH cessation of bleeding is documented

Surgical evacuation via craniotomy

Nursing
Intervention ???
SEIZURE DISORDER
OVERVIEW

Seizures: are episodes of abnormal motor, sensory, autonomic, or psychic activity (or
a combination) that result from sudden excessive discharge from cerebral neurons

Epilepsy: more than one unprovoked seizure

Three main types: generalized, focal, unknown

May have varied etiologies

Status epilepticus: a seizure lasting 5 minutes or longer, or serial seizures occurring

without full recovery of consciousness between attacks

The term has been broadened to include continuous clinical or electrical seizures
lasting at least 30 mins even without impairment of consciousness
PATHOPHYSIOLOGY

Clinical Manifestations
Depends on the location of the discharging neurons
 Intense rigidity followed by
Uncontrollable jerking movements alternating muscle relaxation and
contraction
Staring episode
Epileptic cry
Prolonged convulsive movements
with loss of consciousness Post-ictal: often confused and hard
to arouse
Unintelligible speech
Headache, fatigue, depression, sore
Unusual or unpleasant sights, muscles
sounds, odors, or tastes but without
loss of consciousness
Assessment and Diagnostics

Aimed at determining the type of seizures, their frequency and severity, and
 the factors that precipitate them

MRI

EEG

Blood tests

SPECT
Medical/ Surgical Treatment

Ensure patent airway and oxygenation

IV line

Short-acting barbiturates with general anesthesia

Anticonvulsants

Correction of underlying cause

Nursing
Intervention ???
Other disorders
SPINA BIFIDA
ENCEPHALOCELE
HYDROCEPHALUS
THANK YOU