ch61 Peripheral Nerve and Spinal Cord Problems

Neuropathy of cranial nerve 5 with intense pain in CN-5 dermatome distribution. Abrupt onset of paroxysms of excruciating pain, burning, knife-like, or lightning-like shock in the lips, gums, cheek, forehead, or side of nose. Twitching, grimacing, blinking, and tearing may occur during an attack.

Chewing, toothbrushing, hot/cold blast of air to face, washing face, yawning, talking, and especially touch and tickle.

• Antiseizure drugs such as carbamazepine (Tegretol), phenytoin (Dilantin), valproate (Depakene), carbazepine (Trileptal), gabapentin (Neurontin), lamotrigine (Lamictal), and topiramate (Topamax).
• Tegretol is first drug of choice, acts on Na+ channels, decreases neuronal repolarization and firing.

Nutrition status, hygiene (especially oral), and behavior (withdrawal). Degree of pain and its effects on lifestyle, drug history, emotional state, and suicidal ideation.

• Disruption of one side of CN-7 facial nerve with absence of any other disease, resulting in one-sided face droop
• Etiology unknown, but virus suspected (HSV around/behind ear)
• Benign, usually full recovery after 6 months
• Residual droop may persist

• Moise heat, gentle massage, electrical stimulation, exercises
• Corticosteroids (prednisone) started immediately; once improvement is demonstrated, taper off over 2-week period
• If HSV (70% of cases), use acyclovir (Zovirax)
• Avoid cold drafts (trigeminal sensitivity/pain)

• Cell-mediated immunologic reaction directed at peripheral nerves
• Often preceded by viral infection, trauma, surgery, viral immunizations, or HIV (stimulation of immune system)
• Affects peripheral nervous system, results in segmental demyelination, edema, and inflammation of nerves
• Loss of neurotransmission to periphery

• Weakness in lower extremities (distally more severe)
• Paresthesias (numbness/tingling) followed by paralysis
• Hypotonia (reduced muscle tone)
• Areflexia (lack of reflexes)
• If autonomic system involvement (e.g., CN-10), orthostatic hypotension, hypertension, bradycardia, heart block, asystole, bowel/bladder dysfunction, diaphoresis, respiratory failure

Decreased reflexes, loss of sensation, flaccid paralysis below level of injury. Lasts days to months, masks postinjury neurologic function.

• Loss of vasomotor tone, hypotension, bradycardia, loss of sympathetic nervous system, peripheral vasodilation, venous pooling, deceased cardiac output. Associated with cervical or high thoracic injury
• Atropine for bradycardia
• Dopamine for hypotension

• Mechanism of injury - flexion, hyperextension, flexion-rotation, extension-rotation, compression; flexion-rotation most unstable (ligament tears)
• Level of injury - skeletal (vertebral) level, neurologic (cord) level
• Degree of injury - 1st affects vertebral column (fracture/dislocation); 2nd affects anterior or posterior ligaments, compression of spinal cord; 3rd affects spinal cord and roots, concussion,contusion, compression, laceration by fracture/dislocation, penetrating missiles

• C1-C4: Tetraplegia, loss of all motor and sensory function neck down, loss of respiration, no bowel or bladder control
• C5: Tetraplegia, can control head, shoulders, clavicle, portions of forearms, not intercostal muscles, no bowel or bladder control
• C6: Tetraplegia, can control head, shoulders, arms, palms of hands and thumbs
• C7-C8: Tetraplegia, triceps and grasp present
• T1-T6: Paraplegia, control shoulders, upper arms, chest, hands, no bowel or bladder function
• T7-L4: Paraplegia, can use leg braces and crutches, swing gait; lower levels have increased balance

• Cause: Rise in blood pressure, sometimes fatal; occurs with cord lesions above T6; sympathetic nervous system (fight/flight) sends signals to brain, brain cannot return signal stating to turn off sympathetic response; can result in stroke, MI, or status epilepticus
• Signs & symptoms: Severe HTN, severe HA, bradycardia, sweating above injury, goosebumps, blurred vision, nausea, vomiting
• Interventions: Raise head of bed; remove possible source of stimulation; monitor BP, administer antihypertensives (per MD orders); call MD if needed

• Maintain optimal respiratory function
• Maintain optimum CV function
• Maintain F & E balance
• Maintain immobilization & spinal cord alignment
• Prevent immobility complications
• Prevent urinary complications
• Maintain bowel elimination
• Monitor temp
• Observe for/prevent infection
• Observe for/prevent stress ulcers