week 14

• ensure that pt has no cerebral tumor
• before start of procedure that could result in herniation with the removal of CSF

• Pt assumes & maintain lateral
• recumbent position.

• Ensure maintenance of strict aseptic
• technique.

• Ensure labeling of CSF specimens in
• proper sequence.

Encourage fluids.

Monitor neurologic signs & VS

Administer analgesia as needed

• electrical activity of brain is recorded by scalp electrodes to evaluate seizure disorders, cerebral disease, CNS effects of systemic diseases, brain death
• inform pt that procedure is noninvasive & w/o danger of e- shock
• determine whether any meds (tranquilizers, antiseizure drugs) should be withheld
• resume meds & instruct pt to wash electrode paste out of hair after test

• serial x-ray visualization of intracranial & extracranial blood vessels is performed to detect vascular lesions & tumors of brain. contrast medium is used
• assess pt for stroke risk b4 procedure as thrombi may be dislodged during procedure. 
• withhold preceding meal
• pt may have hot flush of head & neck when medium is injected
• stay absolutely still during procedure
• monitor neurologic signs & VS every 15-30 for first 2hr, q1hr for next 6hr, then every 2 hr for 24hr
• maintain bedrest until pt is alert & VS is stable
• report any neurologic status change

• computer-assisted x-ray of multiple cross sections of body parts to detect problem such as hemorrhage, tumor, cyst, edema, infarction, brain atrophy, & other abnormalities. may use contrast media
• assess for allergy of fish, iodine, dye
• remain still during procedure

• imaging of brain, spinal cord, & spinal canal by means of magnetic energy. used to detect strokes, multiple sclerosis, tumors, trauma, herniation, & seizures. noninvasive. may use contrast media
• screen pt for metal parts & pacemaker in body
• lie very still for 1 hr
• may need sedation

• measures metabolic activity of brain to assess cell death of damage. uses radioactive material that shows up as a bright spot on the image
• 2 IV lines will be inserted
• not take sedatives, tranquilizers
• empty bladder b4 procedure
• glucose monitoring due to injected venous scan material

loss the sense of taste

loss the ability to interpret sensory stimuli

loss the ability to write

loss of control of voluntary muscle movenments

unequal size of pupils

loss the ability to name objects

suppression of vision in one area only

lack of sense of smell

lack of awareness or denial of neurologic defect

partial or total loss of ability to communicate either verbally or in writing

loss the ability to perform physical activity which the pt is physically and willing to do

lack or loss of strength and energy

loss of the ability to coordinate muscle movements

 repetitive involuntary, slow, sinuous, writhing movements, especially severe in the hands.

A subjective sensation or motor phenomenon that precedes and indicates the onset of a neurological episode, such as a migraine or an epileptic seizure.

mechanical, repetitive, and undirected behavior that is not consciously controlled, as seen in psychomotor epilepsy, hysterical states, and such acts as sleepwalking

an uninhibited and exaggerated response of the autonomic nervous system to stimulation, as seen in many patients with high spinal cord injuries

a reflex action of the toes, indicative of abnormalities in the motor control pathways leading from the cerebral cortex. A normal reaction is slight flexion of the toes. In a positive sign, the toes extend; seen with upper motor neuron lesions. Called also Babinski sign.

prolapse or drooping of a part (eyelid)

Difficulty in articulating words, caused by impairment of the muscles used in speech.

difficulty swallowing

A fracture involving the base of the cranium Clinical May be asymptomatic; raccoon eyes, Battle sign, hemotympanum, CSF rhinorrhea Imaging Plain skull film may not reveal fracture; CT or MRI is more reliable.

unilateral facial paralysis of sudden onset due to a lesion of the facial nerve, resulting in characteristic facial distortion.

abnormal slowness of movemen

An indication of meningitis in which passive flexion of the leg on one side causes a similar movement in the opposite leg.

holes drilled in the skull during surgery to drain and irrigate an abscess

Brain swelling due to increased volume of the extravascular compartment from the uptake of water in the gray and white matter.

a parameter that is related to the amount of blood flow to the brain. It is calculated by subtracting the intracranial pressure from the mean systemic arterial blood pressure

breathing with rhythmic waxing and waning of depth of breaths and regularly recurring apneic periods.

alternate involuntary muscular contraction and relaxation in rapid succession

a state of extreme unresponsiveness, in which an individual exhibits no voluntary movement or behavior. Furthermore, in a deep coma, even painful stimuli (actions which, when performed on a healthy individual, result in reactions) are unable to affect any response, and normal reflexes may be lost

a trauma-induced change in mental status, with confusion and amnesia, and with or without a brief loss of consciousness.

 subjective awareness of the aspects of cognitive processing and the content of the mind.

a reflex action in which stimulation of one body part results in a response in another

pertaining to, situated on, or affecting the opposite side

 bruise; an injury of a part without a break in the skin

 an injury most often associated with a blow to the skull in which the force of the impact is transmitted through the skull bones to the opposite side of the head, where the bruise, fracture, or other sign of injury appears.

Surgical removal of part of the skull to expose the brain

• –increased systolic pressure with a
• widening pulse pressure

• –Bradicardia
• with a full bounding  pulse

–Irregular respiration

the head is arched back, the arms are extended by the sides, and the legs are extended. A hallmark of decerebrate posturing is extended elbows. The arms and legs are extended and rotated internally. The patient is rigid, with the teeth clenched

patients present with the arms flexed, or bent inward on the chest, the hands are clenched into fists, and the legs extended and feet turned inward.

In the brain, where nerve fibers obliquely cross from one lateral part to the other, that is to say they cross at a level other than their origin

is a condition characterized by excessive thirst and excretion of large amounts of severely diluted urine, with reduction of fluid intake having no effect on the latter

double vision, perceive 2 images from 1 object

a motor speech disorder resulting from neurological injury, characterized by poor articulation

a movement disorder which consists of effects including diminished voluntary movements and the presence of involuntary movements,

a neurological movement disorder, in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures

acute inflammation of the brain

a type of traumatic brain injury (TBI) in which a buildup of blood occurs between the dura mater (the tough outer membrane of the central nervous system) and the skull. The dura mater also covers the spine, so epidural bleeds may also occur in the spinal column. Often due to trauma, the condition is potentially deadly because the buildup of blood may increase pressure in the intracranial space and compress delicate brain tissue. The condition is present in one to three percent of head injuries. Between 15 and 20% of patients with epidural hematomas die of the injury.

a common chronic neurological disorder characterized by seizures. These seizures are transient signs and/or symptoms of abnormal, excessive or synchronous neuronal activity in the brain.

"muscle twitch", is a small, local, involuntarymuscle contraction and relaxation visible under the skin arising from the spontaneous discharge of a bundle of skeletal muscle fibers (muscle fascicle). Fasciculations have a variety of causes, the majority of which are benign, but can also be due to disease of the motor neurons.

application of skeletal traction to the head by means of a halo device

Loss of vision in one half of the visual field of one or both eyes.

paralysis of one side of the body

the corresponding vertical halves of the visual fields of both eyes.

an abnormal expansion of cavities (ventricles) within the brain that is caused by the accumulation of cerebrospinal fluid

beneath the tentorium of the cerebellum

Intracranial pressure monitoring uses a device, placed inside the head, which senses the pressure inside the skull and sends its measurements to a recording device.

situated on or affecting the same side

in meningitis, inability to completely extend the leg when sitting or lying with the thigh flexed upon the abdomen; when in dorsal decubitus position, the leg can be easily and completely extended.

a serious inflammation of the meninges, the thin, membranous covering of the brain and the spinal cord.

mental activity

paralysis of a single part

due to the loss of vasomotor tone caused by injury & is characterized by hypotension & bradycardia. loss of sympathetic innervation causes peripheral vasodilation, venous pooling, & a decreased cardiac output

neck stiffness

Rhythmic, oscillating (swing back & forth) motions of the eyes

Mentally dulled; “out of it”

a device placed under the scalp and used to deliver anticancer drugs to the cerebrospinal fluid

a swelling of the optic nerve, at the point where this nerve joins the eye, that is caused by an increase in fluid pressure within the skull (intracranial pressure). Swelling of the optic nerve due to other causes such as infection or inflammatory disease is not called papilledema.

complete loss of strength in an affected limb or muscle group

An altered sensation often described as burning, tingling, or pin pricks

abnormal visual intolerance to light.

an organism having a body temperature that varies with the temperature of its surroundings

the altered state of consciousness that a person enters after experiencing a seizure. It usually lasts between 5 and 30 minutes, but sometimes longer in the case of larger or more severe seizures and is characterized by drowsiness, confusion, nausea, hypertension, headache or migraine and other disorienting symptoms. Additionally, emergence from this period is often accompanied by amnesia or other memory defects. It is during this period that the brain recovers from the trauma of the seizure.

an early symptom (or set of symptoms) that might indicate the start of a disease before specific symptoms occur.

the total character of the unique and changing sensory environments perceived by individuals. These include the sensation, perception, and interpretation of information about the world around us by using faculties of the mind such as senses, phenomenal and psychological perception, cognition and intelligence

altered skeletal muscle performance occurring in disorders of the central nervous system (CNS) impacting the upper motor neuron in the form of a lesion. When there is a loss of descending inhibition from the brain to the spinal cord, such that muscles become overactive, this loss of inhibitory control can cause an ongoing level of contraction, with decreased ability for the affected individual to volitionally control the muscle contraction, and increased resistance felt on passive stretch.

•a state of constant seizure or a condition in which seizures recur in rapid succession without return to consciousness between seizures

•Trauma during seizures can cause severe injury and death

•Permanent brain damage

Psychosocial  problems

the ability to perceive the form of an object by using the sense of touch. In humans, this sense, along with tactile spatial acuity, vibration perception, texture discrimination and proprioception, is mediated by the posterior column-medial lemniscus pathway of the central nervous system. Sterognosis tests determine whether or not the parietal lobe of the brain is intact. Stereognosis is a higher cerebral associative cortical function

 a condition in which the eyes are not properly aligned with each other. It typically involves a lack of coordination between the extraocular muscles, which prevents bringing the gaze of each eye to the same point in space and preventing proper binocular vision, which may adversely affect depth perception.

bleeding into the subarachnoid space—the area between the arachnoid membrane and the pia mater surrounding the brain. This may occur spontaneously, usually from a ruptured cerebral aneurysm, or may result from head injury.

a type of hematoma, a form of traumatic brain injury in which blood gathers within the outermost meningeal layer, between thedura mater, which adheres to the skull, and the arachnoid mater enveloping the brain. Usually resulting from tears in bridging veins that cross the subdural space, subdural hemorrhages may cause an increase in intracranial pressure (ICP), which can cause compression of and damage to delicate brain tissue. Subdural hematomas are often life-threatening when acute, but chronic subdural hematomas are usually not deadly if treated.

the part located above the tentorium cerebelli

loss of consciousness

a neuropathic disorder characterized by episodes of intense pain in the face, originating from the trigeminal nerve. One, two, or all three branches of the nerve may be affected. It is, "one of the most painful conditions known to humans, yet remains an enigma to many health professionals." This pain may be felt in the ear, eye, lips, nose, scalp, forehead, cheeks, teeth, and/or jaw and side of the face; some patients also experience pain in their left index finger

refer to tone in muscle tone

•transient episodes of neurologic  dysfunction__caused by ischemia

•Typically last 1-2 hrs to full day

•Warning sign of impending_stroke__

•1/3 will eventually go on to have a stroke

•1/3 will have subsequent TIAs

a neurosurgical procedure. It is done by surgically placing a tube through the skull such that it terminates in the ventricle of the brain. The place of entrance on the skull is called Kocher's point. Ventriculostomy is done primarily to monitor the intracranial pressure as well as to drain CSF (primarily) or blood to relieve pressure from the CNS.