Neurological disorders

Is a special high fat, low carb diet with special measurements of calories, fluids and proteins. 

Usually prescribed by a physician when epilepsy is not responding to seizure medications. Body uses fat as main source of energy and it has been proven to help prevent seizures.

• Smoking
• age
• sex
• ethnicity
• drinking too much alcohol
• sedentary 
• HTN
• High cholesterol
• diabetes

Acute numbness/weakness of arm, face, leg, confusion, dysphasia/aphasia, vision changes and dizziness.

• eat healthy-decrease saturated fats
• Maintain healthy weight-exercise
• Don't smoke
• limit alcohol use
• Manage other health conditions-diabetes/cholesterol/HTN

• 10-20mm hg
• CSF: 75ml
• Blood: 75ml

• Increased brain volume: tumors,
• Increased cerebral blood volume: hemorrhage, trauma/hematoma
• Obstruction of CSF outflow: build up of CSF in ventricles-requires a shunt
• Cerebral edema: too much water/low sodium, hypertensive crisis, cytotoxic/hypoxic event may trigger inflammation and lead to further swelling.(meningitis/stroke)

• Brady cardia
• widening pulse pressures Systolic increases/ dystolic decreases.
• Cheynes-stokes respirations

• AMS
• Visual changes
• motor weakness
• anisocoria 
• restlessness

• Coma
• hyperthermia
• decorticate/decerebate posturing 
• loss of brain stem reflexes
• Positive Babinski sign: big toe flexes other toes fan out.

• Brain stem herniation
• diabetes insipidus-decreased ADH
• SIADH-Too much ADH

• CSF drainage-sedation-chemical paralysis-hyperosmolar therapy
• Hyperventilation PAco2 <35 -hypothermia 33-35 celcius-barbs-decompressive craniotomy

• Assess: pupils, LOC, motor and sensation, respiratory pattern.
• Monitor: ABG
• Maintain: HOB at 15-30 degrees.
• Administer: medications appropriately for condition (mannitol / furosemide)

elevated PaCO2 leads to cerebral vasodilation due to lack of O2 going to brain-this increases cerebral blood flow leading to further ICP.

• Decreased PaCO2 leads to hypocapnoeic Vasoconstriction due to a change in PH. This causes a decrease in blood flow to the brain that decreases ICP, but can cause some cerebral ischemia. 
• Intermittent hyperventilation for ICP

Ischemic: thrombotic (atherosclerosis) or an embolism

Hemorrhagic: Aneurysum, AVM-arteriovenous malformation, bleeding from injury, HTN, anticoagulant.

• transient ischemic attack- "mini" stroke
• lasts 1-2 hours depending
• Does not cause tissue to die

Fibrinolytic therapy: tPA-tissue plasminogen activator-within 4.5 hours 

endovascular interventions: stents, embolectomy, endarterectomy

• Monitor for ICP
• maintain BP within acceptable range (140-150 systolic)
• ongoing pharm therapy: anticoagulants, smooth muscle relaxants, calcium channel blocker, antiseizure medications.

congenital absence of capillary networks leading to leakage of blood to surrounding tissue.

• Surgery (microsurgery)
• Radiosurgery (sterotactic radiotherapy) Beams of radiation to choke off blood supply to AVM
• embolization (endovascular surgery) same procedure as diagnostic angiogram-they close one or more of the blood vessels, normally used in conjuction with microsurgery. 
• conservative medical management.

• trauma 
• falls
• coumadin
• aspirin
• liver disorder with decrease in clotting factors.

• CT or CT w/ Angiograph
• bleeding times
• ECG  for cardiac issues

• 30-40% chance of death initially
• treated with neurosurgery or neurosurgery with interventional radiology
• Control BP

Monitor for ICP, signs of hemorrhage

Provide O2 and post-op care

• Slow-cautious 
• anxiety w/ new tasks
• depression
• sense of guilt/ worthleness

• impulsiveness
• lack of awareness
• consistent smile
• overestimation of abilities

Brocas area of the brain-difficulty speaking or trouble finding words

Wernickes area of the brain-difficulty understanding spoken or written words

Difficulty articulating a sentence: meaningless speech

helps to find blockages in blood vessels of the neck and head. They will inject a contrast dye in order to get a better picture.

Checks for abnormal brain activity-checks brain waves. Mainly used to diagnosis seizure activity.

Uses x-rays to create cross sections of the body.

Uses a magnetic field and pulses of radio wave energy to create images of organs and structures within the body. Gives different information then a CT/x-ray/ ultrasound.

Used to assess the CSF to check for meningitis

• Key differences between Viral and bacterial
• Cloudy appearance vs clear appearance.
• Increased WBC for both
• proteins will be slightly elevated

• Inflammation of the meninges due to viral (herpes, measles, mumps) or bacterial and possible fungal.
• S&S: headache, AMS possible, phonophobia, photophobia, neck stiffness, high fever, N/V, muscle aches. 
• Bacterial may have petechiae on trunk or extremities.

• inflammation of the brain tissue: cerebrum, brainstem, cerebellum.
• Usually caused by viruses that travel to the CNS-causing inflammation which leads to neuronal damage.
• similar S&S as meningitis

• Degeneration of the myelin sheath of the neurons. autoimmune disease-antibodies attack own myelin. 
• Blurred or double vision
• Thinking problems
• Clumsiness or a lack of coordination
• Loss of balance
• Numbness
• Tingling
• Weakness in an arm or leg.
• heat sensitivity
• neuropathic pain
• impaired cognitive ability
• tremors

• Gel surrounding the intervertebral disc bulges or herniates through bands of fibrous tissue.
• This leads to compression on spinal nerve roots, vascular structure and spinal cord. leads to pain a neuro symptoms.

• Risk factors: repetitive bending, twisting, lifting, weak abdominal muscles, poor body mechanics.
• Treatments: Bedrest, PT, TENS unit, pain meds, Laminectomy, fusion of unstable vertebrae

• Complete and incomplete injury one with complete deficits and the other with partial.
• Can lead to Autonomic dysreflexia-which can lead to uncontrolled HTN-and stroke

• Severe headche
• HTN
• bradycardia
• flushing above injury
• pale extremities below injury
• piloerection
• apprehension

defined as 2 or more seizures, chronic. May be caused by an imbalance of neurotransmitters (GABA)

• commonly the result of tumor or trauma.
• Other examples-alcohol withdrawal, high fever, hypoxia, drug intoxication/poisoning, electrolyte imbalance, hypoglycemia.

• partial: starts in a specific part of the brain with focal discharges.
• generalized: affects the whole brain from beginning of seizure to end.

• Simple: patient doesn't lose consciousness (myoclonic)
• Complex: patient has impaired consciousness (absence)

• Temporal: hearing, memory, sound, smell, emotions-emotional changes most common
• Frontal: long-term memory, speech (Brocas), taste-jacksonian march: abnormal movement of hand and it progresses up the arm.
• Parietal: interpret touch, sensation, texture, size, spatial relationships.-tingling of one side of body/warmth
• Occipital: vision-changes or seeing flashing lights.

• impaired consciousness for 1-3 mins (syncope)
• unaware of env; amnesia
• occurs anywhere in brain, but most common in temporal lobe
• characterized by automatisms

A generalized seizure

• non-convulsive: absence (petit mal)
• Convulsive: Tonic-clonic (grand mal)

• change in consciouness 
• rolling eyes, blank stare, day dreaming, slight mouth movements.
• can have up to 100 a day brain return to normal without issue.
• can progress to tonic clonic

• sudden, brief jerking of muscle groups
• aka: akinetic seizure

• syncope-with full body tonic phases and clonic phases as the individual experiences  muscle spasms.
• cyanosis, tongue biting, apnea, incontinence can occur. lasts up to 5 mins commonly

• memory loss
• brain damage if seizure prolonged
• risk for hypoxia, vomiting, aspiration, persistent metabolic disorders

• not time of seizure
• protect head
• maintain airway/O2
• prevent aspiration-lateral recumbent-suction
• use padded rails
• loosen constrictive clothing
• blood draws and check BG/temp.

effects after the seizure-confusion, drowsy, fatigued, muscle pain, weakness, headache. takes mins-hours to regain consciouness

• phenytoin
• klonopin 
• tegretol
• depakote
• neurontin 
• ativan
• no they're ment to control 50-60% efficacy.
• 20-35% of patients with seizure do not get relief from seizures.

phenytoin: nystagmus, ataxia, confusion, nausea, slurred speech and dizziness

phenobabital: confusion, drowsiness, dyspnea, slurred speech, staggering

Gabapentin: confusion, depression, ataxia, drowsiness, altered reflexes, paraesthesia.

• Vagus nerve stimulation
• lobectomy-surgical resection of seizure area in brain
• corpus callostomy: surgeon sections anterior 2/3 of corpus callosum to prevent neuronal discharge.

• degeneration of dopamine receptors in the brain called substantia nigra where dopamine is created. This leads to less dopamine in the brain.
• dyskinesia, dysphagia, unsteady gait, whole body fatigue, impaired speech, tremors, shakiness.

• assessment 
• nursing diagnosis
• planning
• interventions
• evaluate/reassess