Neuro

Cerebrum

• Frontal lobe
• Occipital lobe
• Parietal lobe
• Temporal lobe

Frontal

Left hemisphere of the Frontal lobe

The frontal lobe

Occipital lobe

Parietal lobe

Temporal

Comprehension of speech.

Cerebellum

Involuntary aspects of voluntary movement like coordination and maintenance of posture and balance.

Cerebellum involvement

Thalamus and hypothalamus

Gateway for every sensation traveling to the cerebral cortex

Area that regulates the ANS and the release of hormones from the pituitary gland.

• Midbrain
• Pons
• Medulla oblongata

Controls motor coordination, visual and auditory reflexes

Contains the respirator centers

Regulates hr, bp, sneezing, swallowing, vomiting, coughing.

Meninges

• 1. Dura mater
• 2.arachnoid mater
• 3. Pia Mater

Thicker outer layer of the meninges

The middle, weblike layer of tissue in the meninges

Inner most layer of the meninges. Very thin tissue on the brain and spinal cord.

31

The area where CSF circulates

Fat and blood vessels

White matter.

The grey matter

Cell body/soma

Dendrites

One or thousands.

Axon

One

Electrical insulation formed by Schwann cells covering axons.

Nodes of ranvier

Synaptic knob

Sensory (afferent) neurons.

Somatic Sensory neurons

Visceral sensory neurons

Motor (efferent) neurons

Interneuron pathways

Brain and spinal cord

Autonomic nervous system

The Parasympathetic nervous system and the Sympathetic Nervous System

• Think Peaceful!
• It dominates during RELAXED situations to promote NORMAL functioning.

Rest and Digest!

• Decreases HR, relaxes muscles.
• Increases urine and salivation

Acetylcholine

FIGHT OR FLIGHT

• Dominates during stressful situations. Responses prepare body for physical activity.
• Increases hr, vasodilation, O2 and glucose supply.
• Decreases salivation and urine output

Norepinephrine

Slower reflexes, slower reaction time, slower movements

Level of Consciousness for someone who have been involved in trauma

• LOC
• GCS
• VS
• Pupil Response
• Extremity strength and movement
• Sensation

Assess if they have a patent airway.

Deaf or mute pts.

• Legs rotate inward
• Elbows and fingers flexed
• Indicates impairment of the cerebral function
• (Can survive the trauma )

• Forearms pronated
• Wrist and fingers flexed
• Indicates damage to the brainstem
• (Likely will not survive trauma)

• Metal status
• Intellectual function
• Thought content
• Perception
• Language ability
• Memory
• Pain

When the toes of an adult fan out after the sole of the foot has been stroked firmly. This identifies neurological dysfunction.

Children 6mo or less.

Swaying and leaning to one side after closing your eyes for 20 seconds.

Unequal pupils

• A needle is inserted into the L3-4 or L4-5 vertebrae withdrawing 8-10 ml of csf.
• Should NOT be done on pts with IICP because it can cause MORE ICP.
• Post op pt needs to lay flat for 6-8 hrs to prevent a spinal headache

• Allergies to dye
• Bun/creatin levels

• If pt needs to be sedated before
• If pt has thick hair that can interfere-document it.
• If dye should be diluted or if a pt need a prophylactic antihistamine before to lessen allergic reactions (benefits outweigh the risk)

Warm, flushed feeling.

• Check for pacemakers or metal implants in pts. (Cannot have MRI)
• Admin sedatives if ordered
• Teach pt to relax and stay calm and still if no sedative is used.

Cerebral arteries and detects vascular lesions

Yes.

Bun/cr, pt, ptt

(Kidneys and clotting)

Encourage fluids! Helps flush out dyes that are hard on the kidneys.

• Stay flat for 4-6 hrs
• Have sandbag for 3-4 hrs on insertion site to stop bleeding
• Encourage fluids
• Check pulses****** could cause clotting.

Injection of Due or air into subarachnoid spaces to detect abnormalities in spinal cord or vertebra.

Yes

• Check allergies to shellfish or contrast
• Hx or seizures
• Verify consent

Similar to lumbar puncture except HOB 30 DEGREES.

• Hair has to be clean before procedure for adhesive to stick
• And has to be washed post procedure to prevent adhesive from hardening.

Pt cannot have stimulants or depressants preprocedure.

• Maintain FUNCTIONAL positioning. (Hand rolls, trochanter rolls, bunny boots)
• Avoid injury
• Prevent contractures (rom)
• Mobilize ASAP

Difficulty speaking

Inability to EXPRESS self.

Inability to understand others

Inability to express self or understand others

• Use care with yes/no questions
• Correct substituted words
• Anticipate their needs
• Use gestures
• Most importantly *Be patient *

Stop them from continuing and notify the MD and/or speech therapist.

• Thicken liquids
• Position upright to eat
• Monitor meals/provide several small meals
• Provide tube feedings

Independence

• Infection/inflammation of the brain and spinal cord
• Can be bacterial or viral
• Has flu like symptoms and can last 1-2 weeks.
• Can be caused by URI.

• Sever Headache (initial s/s)**
• Fever
• Photophobia
• Petechiae rash
• Nuchal rigidity (stiff neck. Pain with flexion)
• Nausea and Vomitting
• Encephalopathy
• Positive Kernigs and Brudzinskis. (Pain with flexion of leg or neck)

• Seizure
• Nerve damage
• Permanent neuro deficits

• Lumbar puncture (cloudy fluid=infection)
• C&S
• CT and MRI.

Pt is able to touch chin to chest

• Antibiotic/pyretics
• Cooling blankets
• Dark,quiet environment with little stimuli
• Pain meds and steroids
• Antiemetics
• Isolation
• Hob 30 degrees
• Monitor for IICP and seizures
• Neuro checks

• Inflammation of the brain tissue that causes nerve damage, edema, and necrosis.
• Can be caused by different viruses like west Nile, mono, and herpes

Headache and Fever *** most common

• N/v
• Nuchal rigidity
• Confusion
• Decreased LOC
• Seizures
• Photophobia
• *ataxia
• *hemiparesis
• *tremors
• *coma
• *DEATH

(*... Indicates s/s different from meningitis)

• Cognitive disabilities
• Personality changes
• Ongoing seizures
• Motor deficits
• Blindness

• Think brain damage.
• Families should assess the pts own functional abilities and the families ability to care for pt because complications are serious.

Ct, mri, eeg, lumbar puncture and csf analysis

• Pain meds, anti:convulsants/pyretics/virals, steroids,sedatives.
• Symptomatic care
• Neuro assessment

Trauma, brain tumor, hemorrhage

• Decreased loc****** earliest symptom. Report immediately
• Irritability
• Hyperventilation
• Pupil changes
• .....................
• Late symptoms(cushings or triad):
• Bradycardia, irregular resp, arterial hypertension.

• Symptom progression:
• Restlessness>confusion>coma

Raise hob 30-45 degrees

Hob 30 degrees, avoid hip flexion, avoid straining (stool softeners), stop coughing , avoid pain meds if possible to be able to assess loc.

Catheter into the ventricle allowing CSF to drain while monitoring ICP

Easily placed monitor that can be occluded just as easily.

Placed directly into brain tissue and is the most accurate way to measure ICP but it doesn’t allow for the drainage of csf.

Yes, from next of kin.

0-15 mm/Hg

• Headache caused by cerebral vasoconstriction followed by vasodilation.
• Can be triggered by specific foods, noise, lights, alcohol, or stress

Pts may have an Aura and throbbing on one side of the head.

• Headache caused by persistent contraction of scalp and facial muscle resulting in stress and sustained muscle constrain.
• Can be related to pms, anxiety, emotional distress and depression
• To treat use relaxation techniques, massage, rest, heat, pain medications.

• Headaches occurring in cluster over a period of days or weeks caused by anxiety, stress, visual disturbances. They are worsened by alcohol use.
• Headache usually begin suddenly at the same time of night unilaterally.
• To treat: quiet dark room with cold compress. Use NSAIDS or antidepressants

• Pain assessment
• W-where
• H- how does it feel
• A- aggravating or alleviating factors
• T-timing
• S-severity of pain
• U-other useful data
• P-pts perception of pain

• Keep diary with a recording of triggers, timing, and symptoms
• Teach relaxation techniques and stress reduction
• Educate on medications

Abnormal electrical discharge in the brain related to injury, high fever, substance abuse, metabolic disorder and other health conditions.

Chronic neurological disorder characterized by recurrent seizure activity

Partial, general, idiopathic, and acquired.

Seizure beginning on one side of the cerebral cortex

Seizure including both hemispheres of the cerebrum

Seizure with no cause identified

Seizure caused by an underlying neuro condition or brain injury and is diagnosed by EEG

A tell that warns pts of impending seizures that can include visual distortion, odors, or sounds.

• Automatisms- dreamlike state
• Maintained consciousness
• Lasting less than a minute
• Parenthesis-tingling or numbness
• Visual disturbances.

Loss of consciousness lasting 2-15 minutes

Staring..

• Aura
• Loss of consciousness
• Rigidity followed by muscle construction and relaxation
• Postical period/recovery period

• Correct cause
• Anticonvulsants
• Surgical resection

• Monitor airway**
• Turn on side to prevent aspiration
• Pad side rails
• Prevent injury
• Suction as needed
• Observe and document onset of seizure, triggers, and behavior during.

*** DO NOT RESTRAIN****

30 minute long seizure activity.

Ensure pts airway

Tx: diazepam (Valium) or lorazepam (Ativan)

Caused by sudden withdrawal of anticonvulsant meds

Hemorrhage, contusion, laceration, MVC, falls, assault,sports related injuries.

• Cerebral Edema
• Hyperemia
• Hydrocephalus
• Brain herniation
• Death

• Use Glasgow Coma Scale to assess LOC
• Keep PT immobilized
• Monitor Blood sugar for sudden onset of diabetes insipidus

You are stationary and something hits you.

You are moving and hit something stationary

Something hits you causing twisting or spinning

• Sometime hits you while you are stationary causing you to be flung into something else.
• Example:
• Soccer ball hitting you in the head knocking you down onto the hard ground.

• Mild brain injury with s/s of HA, dizziness, N/V
• Recovery is spontaneous

Bruising

• Subdural- venous bleeding below the dura mattar
• Epidural- Arterial Bleeding (high pressure) in between the dura and the skull. May lead to death.

Iv mannitol (Osmitrol)

• Surgical removal of a hematoma
• Control the ICP with monitoring and osmotic diuretic (mannitol )
• Mechanical ventilation
• Therapeutic coma

HA, visual changes, seizures, motor and sensory changes,n/v

S/S related to location and rate of growth.

• Radiation and chemo
• Symptom control
• Surgery
• Steroids like Decadron

• MRI
• Angiogram
• Magnetic resonance angiogram
• Hormone levels

• Memory impairment
• cognitive changes
• Lethargy
• Coma
• Death
• Hemiparesis
• Aphasia
• Ataxia
• Seizures
• HA

Hematoma, tumor, AV malformation, trauma, seizures

Surgical opening into the skull

Removal of part of the cranial bone

Repair of bone or replacement with prosthesis

• Lab work and anesthesia evaluation
• Pt education to help with anxiety
• Tour of ICU
• Inform surgery may last 2 hrs for a biopsy and 12 hours or longer for some procedures.
• Head will be shaved.

• *monitor for IICP** number one priority
• Vs and resp
• Loc and neuro assessment
• Elevate hob
• Nasogastric suctioning
• Check dressing: bloody fluid with yellow ring around it could be CSF. *notify nurse or md asap
• Monitor ability to grasp and move feet

Disk moves out of normal position, the tough outer ring tears allowing leakage of soft inner portion. That compressed on nerve roots.

Either caused by injury or is unknown origin

Pain, muscle spasm, numbness or tingling of extremity, weakness, atrophy

• Traction
• Muscle relaxants
• NSAIDs
• Epidural/steroid
• Surgery
• Rest
• Pt

• Laminectomy
• Diskectomy
• Spinal fusion
• Artificial disk

• Hemorrhage
• Nerve root damage
• Reherniation
• Herniation of another disk

Damage to nerve fibers infers with communication between the brain and body.

• Avoid flexion or rotation of the spin.
• Log roll pt
• Can be caused by bruising, tearing, cutting, edema, bleeding into the spinal cord.

• Paralysis
• Paraplegia
• Quadriparesis/paraparesis
• Impaired respiration’s
• Loss of bladder and bowel control

• Injury to c3 and above causes death.**
• Injury to c4-c8 caused no movement or sensation in all 4 extremities
• Injury to the thoracic or lumbar area paraplegia/paresis and altered bowl/urine control—retention

Cord stops functioning below injury

• Vasodilation
• Hypotension
• Bradycardia
• Hypothermia
• Urine and feces retention
• Flaccid paralysis below level of injury

• Increased risk for infection
• Dvt
• Orthostatic hypotension
• Skin breakdown
• Renal complications
• Depression and substance abuse
• Autonomic dysreflexia- life threatening disruption between the SNS and pns. Pns cannot reach affected areas to stop SNS reactions.

• Mechanical vent and trach
• TPN- feeding not started till bowel sounds return
• Foley
• Immobilization, rods, body cast

• Halo brace
• Rods
• Corset
• Brace
• Body cast

• Not a disease but s/s of other disease is characterized by significantly impaired intellectual functioning.
• It impairs normal activities, relationships, problem solving, and emotional control.
• Individuals with higher education, higher socioeconomic status and that engage in stimulating intellectual and leisure activities are at a lower risk.

• Huntington disease
• Parkinson’s
• Alzheimer’s
• Vascular dementia
• Chronic alcoholism’s
• Medications

• Recent memory is affected first
• Forgetting how to perform simple tasks
• Wandering
• Aphasia
• Behavioral problems
• Total dependence

• Meds to delay progression like Cholinesterase inhibitors and NMDA agonists
• End of life decision making

• Finger foods
• Monitor cognitive function
• Provide rest periods to prevent fatigue
• Care giver should be able to identify resources available people to assist with care.

• Temporary mental disturbances with rapid or gradual onset.
• Underlying causes may be pain, hypoxia, medications, or illness/electrolyte imbalance.

• Chronic/degenerative disorder affecting basal ganglia and causes DECREASED dopamine and INCREASED acetylcholine.
• This impairs semiautomatic movement because dopamine transmits impulses.

Is an ANS dysfunction and its cause is unknown. Maybe genetic.

• Muscle rigidly
• Bradykinesia (slow movement )
• Change in posture (stooping over)
• Pill-rolling tremor
• Difficulty initiating movement
• Shuffling and freezing gait
• Soft voiceconstipation
• Frequent urination
• Drooling/dysphagia

• MRI
• Physical Adam
• Pt hx.

• Antiparkinsons drugs: Levodopa/carbidopa combination-converts to dopamine to improve symptoms
• Anticholinergic drugs:Benztropine (cogentin)- works against acetylcholine to reduce pns activity. Can cause dry mouth and urine retention
• Pallidotomy-surgical
• Deep brain stimulation

Autosomal dominate genetic disease causing degeneration of parts of the brain

• Dementia(paranoia and violence)
• Choreiform movement (extreme fidgeting )
• Dysphagia
• Depression
• Death

• Family hx
• MRI
• Ct scan
• Genetic testing

• Antipsychotics
• Antidepressants
• Anti choreic agents
• Stem cell transplant

• Progressive degenerative disease involving neurofibrillary tangles and neurotic plaques.
• Cause is unknown or it could be caused by genetics or Down syndrome.

• 1. Increasing forgetfulness- earliest sign
• 2.memory loss, irritability, depression, aphasia,sleep deprivation, hallucinations, seizures
• 3.complete dependency, loss of bladder and bowl control, loss of emotional control, inability to recognize others,death.

• Pt hx
• Physical exam
• MRI,pet,spect
• Autopsy

• Cholinesterase inhibitors (aricept, expoing,coneg)
• NMDA antagonist (nameda,axura)
• Antidepressants
• Antipsychotics
• Anti anxiety agent

• It’s the temporary impairment of cerebral circulation depriving the brain of glucose and oxygen.
• It may last minutes to hrs. Usually resolves in 24 hrs.
• *may forewarn of a CVA*
• S/S depends on area affected, visual/speech difficulty, weakness/paralysis

• Inadequate blood flow to the brain. Tissue is destroyed.
• Ischemic stroke- death of brain tissue can be thrombotic or embolic
• Hemorrhagic stroke- rupture of a vessel causes bleeding in brain. Can be subarachnoid or intracerebral

• Hypertension
• Smoking, diabetes
• CVD
• A fib
• Tia
• Sickle cell anemia
• Dyslipidemia
• Obesity

• Numbness or weakness
• Confusion
• Changes in vision
• Trouble walking/dizziness
• Severe HA

• Face
• Arms
• Speech
• Time-call 911

• Depends on the area affected
• One sided weakness/paralysis
• Dysphagia
• Changes in loc, numbness, weakness
• Visual/speech disturbances
• Inability of pt to follow nurse around room with eyes.
• HA, N/V,Resp compromise

Double vision

Request an order for eye drops to prevent eye drying and injury.

Ct, ecg, cbc, metabolic panel, inr/pt,carotid Doppler, cerebral angiogram

• Thrombolytic therapy - (tpa) administered within 4.5 hrs of onset of symptoms.**
• Airway management
• Control of hypertension, fever, glucose
• Seizure prevention
• Anticoagulants and anti-platelet (aspirin or clopidogrel/placid)
• Antidysrhythmic and hyperlipidemic (prevastatin/Pravachol)

• Treat cause
• Pt, ot, st
• Antiplatelet, anticoagulants, antihyperlipidemic, antiarrhythmic
• Maintain airway

Maximize remaining abilities

• Control weight, hypertension, and cholesterol
• Smoking cessation
• Aspirin or warfarin
• Early recognition and treatment

• Carotid endarterectomy (roto-rooter)
• Balloon angioplasty with stent

• Impaired motor function
• Impaired sensation
• Dysphagia
• Aphasia
• Pseudobulbar affect - unstable emotions
• Impaired judgment
• Unilateral neglect

Weakness in the artery wall resulting from trauma, congenital defects or disease.

• Collection of blood beneath the arachnoid mater causing irritation of the brain tissue
• Caused by aneurysm, av malformation or head trauma

• HA
• Photophobia
• Vomitting
• Disorientation
• ICP
• Changes in LOC
• Seizures
• Nuchal rigidity
• Pupil changes
• Motor dysfunction

Ct and cerebral angiogram

• Craniotomy (metal clams, wrap it, remove it.)
• Nonsurgical- thrombose it, monitor it, blood pressure control. Below 120/80

• Rebleed
• Hrdocephalus
• Vasospasm

• Loc
• Restlessness
• Dizziness
• Pupil changes
• Vision changes
• Pain
• O2 sat
• Paresthesia
• Weakness
• Paralysis
• Seizures
• Decreased resp status
• Difficulty swallowing

• Monitor neuro stats
• Vs
• O2 sat
• Blood sugar
• Pt and ptt
• Med effects
• Report changes
• Keep head of bed 20-30 degrees to reduce pressure

Degeneration of the myelin sheath that causes inflamed nerves and slows/block impulses

• Muscle weakness
• Numbness
• Fatigue
• Slurred speech
• Vision disturbances
• Vertigo
• Ataxia
• Dsohagia
• Bowel/bladder problems
• Sexual dysfunction
• Mood alterations

• Death
• Immobility
• Exacerbation due to stress or illness/infection

• Hx
• Physical
• CSF analysis
• MRI

• Steroids- me drool, prednisone, decadron
• Immunosuppressants- midrange, cytoxan
• Anticonvulsants-Dilantin, tegretol
• Muscle relaxants-flexaril,zanaflex
• Plasmapheresis
• Pt st

• A condition caused when antibodies destroy aCh receptors causing the loss of voluntary muscle strength.
• Can be caused by autoimmune disorders, thymus disorders,virus, or could be idiopathic

• Hx and physical
• Tension test-inject anticholenergic drug and assess if muscle strength (primarily in the eye lids) improves.
• Anti aCH receptor antibodies
• EMG
• Have pt look up for 2-3 minutes, eye lids will start dropping if positive.

• Progressive muscle weakness**
• Fatigue with activity***
• Pros is-drooping eye lids****
• Difficulty chewing, swallowing
• Difficulty breathing
• Exacerbated by stress.

• Aspiration,
• Respiratory infection and failure
• Myasthenia crisis-not enough drugs causes rapid fatigue and droopy eye lids. Just increase amount of drugs
• Cholinergic crisis-too much drug- medical emergency**: causes muscle rigidity and increased BP. SLUDGE
• (Salivation, lacrimation, urination, diarrhea, gi cramping, emesis. )

• Thymectomy- thymus produces actecycholine so remove it
• Anti Cholinesterase agents-neostigmine- makes more neurotransmitters available so that muscle can contract. Should be taken exactly as prescribed at the same time every day.
• Steroids-prednisone
• Plasmapheresis-remove them antibodies from the blood.

• Methods to conserve energy
• Avoid infection
• S/s of crisis
• Medications to avoid
• *time medications so that the action is peaking during the most active part of the day for the most energy.

Lou Gehrigs

• Disease where motor neurons degenerate causing blocked nerve impulse transmission resulting in muscle weakness and atrophy.
• Cause is unknown or related to genetic predisposition.

• Progressive muscle weakness and atrophy ****
• Decreased coordination***
• Muscle spasms**
• Difficulty chewing and swallowing
• Emotional lability
• Speech difficulty
• Pulmonary compromise

Death usually within 3-5 years due to pulmonary compromise******

• Hx and physical
• Lumbar puncture with csf analysis
• EEG
• Nerve biopsy
• EMG

• Muscle relaxants
• Riluzole(Rilutek) decreases damage to motor neurons
• Pt, ot, st
• Pain control
• Enteral feeding-directly to gi
• Prevention of infection
• Augmentative alternative communication

**goal is to improve function as long as possible**

Inflammation of spinal and cranial nerves caused by segmental demyelination in an ascending pattern. Also causes Remyelination in a descending pattern. Can result lymphocyte infiltration.

Cause is either unknown or autoimmune response to a virus

• Lumbar puncture
• EMG
• Nerve conduction velocity
• Pulmonary testing

• Stage 1: 24hr to 3 weeks
• *abrupt onset weakness and paralysis
• *may affect respiration’s
• *ans effects

• Stage 2:2-14 days
• *plateau
• *progression stops

• Stage 3: 6-24 months
• *recovery

• Resp failure
• Infection
• Depression
• Pneumonia
• URI
• Complications of immobility

• Supportive care
• Oxygen/monitor vital capacity and abgs (important to determine if illness has progressed to lungs)*
• Mechanical vent
• Manage pain
• Maintain nutritio/assess swallowing
• Assist with communication
• Rehab
• Plasmapheresis

• Affects polio victims 10-40 years later
• S/s
• Muscle weakness
• Fatigue
• Pain
• Respiratory compromise

An imbalance in dopamine and serotonin that can be caused by kidney failure, iron deficiency, diabetes, Parkinson’s, neuropathy, family hx.

Feelings of creepy crawly thing, throbbing, pulling, pins and needles.

• Patient report of symptoms
• Sleep hx
• Lab for iron deficiency
• Med hx

• Applications of heat or cold
• Leg massage
• Warm baths
• Meds
• Smoking cessation
• Regular sleep schedule
• Alcohol avoidance
• Exercise routine

Irritation of the trigeminal nerve that affects the sensory portion of the nerve. It’s caused by chronic compression

Dx by ct or mri

• Intense pain on one side of the face
• Triggered by touch, talking, cool breeze or other stimulants

• Anticonvulsants
• Nerve blocks
• Surgery to block pain
• Soft foods at body temp
• Wash face with Luke warm water and cotton balls

• Inflammation and edema of facial nerves causing the loss of motor control.
• Unknown cause
• Diagnosed by hx, EMG, and by ruling out a stroke

• One sided facial pain and weakness
• Speech difficulty
• Droooling
• Tearing of eye
• Inability to blink.

• Prednisone -steroid
• Pain meds
• Antivirals
• Moist heat
• Gentle massage
• Facial sling
• Nutrition
• Address eye dryness to prevent eye damage