NEUROLOGIC

ICP – 0-15 mmHg CEREBROVASCULAR ACCIDENT

Brain – Meningitis, Encephalitis  Decrease cerebral perfusion/cerebral hypoxia  brain
CSF – Hydrocephalus damage
Blood – hematoma, TBI
REASONS OF CVA
Major cause of hemorrhagic stroke – Aneurysm rupture
1.
Presence of clots (obstruction)  Ischemic Stroke
o Thrombus  thrombotic stroke
Increase ICP
 Cerebral hypoxia  Brain damage o Embolus – moving clots (atrial flutter (200-400
 Brain stem herniation – Cushing’s triad bpm) and atrial fibrillation (300-600 bpm) – cause
o Mid brain: vision, hearing emboli stroke)  embolic stroke
o Pons – apneustic center (depth of respiration)  Management:
o Medulla oblongata – blood pressure, cardiac center, a. Anticoagulants – risk for clots
b. Thrombolytics – to dissolve clots
reflexes
c. Aspirin
o Reticular formation – sleep and wake cycle
2. Rupture of Artery  hemorrhagic stroke
o Fibrin
MENINGES
Skin  Periosteum  Skull  Dura  Arachnoid  Pia  Management:
a. Fibrin stabilizer
MENINGITIS 1. Tranexamic acid (Hemostan)
2. Aminocaproic acid (Amicar)
 Inflammation of the meninges of the brain and spinal cord
 Causative agent – Neisseria Meningitidis: droplet and
contact precaution (Strep, Haemophilus)  Diagnostic
 Culture and sensitivity – for bacteria a. CT SCAN
b. MRI – contraindicated to metal, pregnant, above
200 kg weight
HEPARIN WARFARIN  Assessment
Parenteral Oral 1. Face
aPTT – 25-35 secs (normal) PT-INR – 11-13 secs 2. Arm
aPTT – 50-70 secs (if taking PT-INR – 22-26 secs 3. Speech
heparin) Vitamin K/Aquamephyton, 4. Time
Protamine sulfate Phyto menadione/  Signs and Symptoms
Menadione/Spinach/Green
R CVA L CVA
Damage: right hemisphere Damage: Left hemisphere
Affected: left side of the body Affected: right side of the body
 Left hemiparesis  Slow, cautious
(weakness)  Aphasia
 Left hemiplegia  Depression
(paralysis)
 Impulsive
 Denial
 Neglect syndrome

L frontal lobe – broca’s are: speech

L temporal – wernickes area: comprehensioin

Receptor  control  effector

5 senses  thalamus (relay station of 5 senses) 
 Multiple Sclerosis GBS
Demyelination Demyelination
- CNS (brain and spinal cord) - PNS (extremities)
1. Afferent/Sensory: 5 1. Sensory – touch
2. Cognition 2. Motor – weakness and
3. Emotion paralysis (bilateral and
4. Motor: weakness and paralysis (bilateral and ascending paralysis)
descending paralysis) 3. Diaphragmatic paralysis 
5. Diaphragmatic paralysis  breathing breathing

Signs and Symptoms Signs and Symptoms

Earliest sign: eye problems Earliest sign: clumsiness
a. Diplopia – double vision  late sign:  Paresthesia of legs
blindness  Paraparesis
b. Ptosis – drooping of eyelid  Paraplegia
c. Nystagmus  Bladder and bowel dysfunction
Charcot’s Triad  DOB
a. Scanning speech  Bladder/bowel retention
b. Intentional tremors a. Increase BP, HR – HPN
c. Nystagmus crisis  AUTONOMIC
Sensory DYSREFLEXIA –
a. Blindness massive SNS simulation
b. Sensorineural hearing loss b. AUTONOMIC
c. Anosmia DYSREFLEXIA – earliest
d. Ageusia sign: piloerection, nasal
e. Paresthesia ‘pins and needles’ stuffiness, diaphoresis
f. Pain

Cognitive Rule out

a. Dementia – loss of memory a. SCI – by XRAY/Myelogram
b. Impaired mentation b. Potassium imbalance
Emotional
a. Depression
Motor
a. Weakness and paralysis
b. Urinary incontinence
1. Reflex – cough, sneeze, laugh
2. Urge – uncontrolled bladder muscle
contraction
3. Functional – assoc with disease
4. Overflow – urine retention
Anticholinergic – oxybutymin

Remission –
Exacerbation
 Triggered by stress, hyperthermia
 DOC – corticosteroids

Management
a. Sensory: safety – bed rest
b. Motor: safety – risk for aspiration,
pneumonia – turn to side, assess breath
sounds, risk for UTI
Medication
a. Ocrelizumab (Ocrevus)
 Monoclonal antibody
 Given during remission
Frontal Temporal Parietal Occipital 1. Sensory problem
 Cognition  Recent  Touch  Visio a. Hemianopsia – one sided blindness
 Abstract memory  Taste n b. Poor hearing
thinking  Smell and  Temperatu c. Anosmia
 Remote hearing re d. Ageusia – loss of taste
memory  comprehensi e. Loss of sense of touch – one sided
 Personalit on
2. Cognitive problem
y 
a. Aphasia
 Intelligen
ce b. Amnesia
 Motor c. Anomia – can’t remember names
activity d. Apraxia – loss of skills
 Speech e. Anhedonia – loss of pleasure
f. Agnosia – forgetting name and functions of objects
 Signs and Symptoms 3. Personality problem
a. Impulsive
 b. Depression
4. Motor problems Myasthenia Gravis Amyotrophic Lateral Sclerosis
a. Hemiparesis Autoimmune, history of viral AKA – Lou Gehrig’s Disease
b. Hemiplegia infection Cause – autoimmune, viral
c. Bradykinesia Cancer – thymus gland  infection, “bucket ice
d. Ataxia – loss of balance thymosin hormone - T cell challenge” – glutamate
maturation (cancer in gland – excitation
increase production of hormone)
 Nursing Management
Thymoma – cancer of thymus Problem – destruction of
a. Secure airway and breathing
anterior neurons  spastic
 Airway – ET, Tracheostomy Decrease acetylcholine paralysis
 Breathing – Mechanical ventilator, ambu bag ACH – Brain: memory –
 Mechanical ventilator – risk for nosocomial Alzheimer’s Paralysis: flaccid (atonic),
pneumonia (HAP) ACH – Efferent: movement – MS spastic (spasm)
b. Secure circulation
 Risk for DVT  Pulmonary embolism Diagnostic: Signs and Symptoms:
c. Security a. Tensilon test a. Muscle spasms
 Hemianopsia – RN approach in the unaffected (Edrophonium) b. Muscle cramps
side b. Tensilon – c. Muscles rigidity
 Belongings, call bell, assistive devices – place in anticholinesterase,
the unaffected side acetylcholinesterase Management:
inhibitor  quick acting a. Corticosteroids
 Scan the environment – head and shouldersn
c. (+) result – relief of b. Plasmapheresis
 Neglect syndrome – RN approach affected side
symptoms (fatigue, c. IV IG
 PROM paralysis) within 5 Medications:
d. Diet minutes a. Riluzole – glutamate
 Check gag reflex antagonist
 1st 24 hours – NPO Signs and Symptoms b. Baclofen – anti
 Soft diet (oatmeal consistency, gelatin Earliest sign: spasm
 NO: sticky foods, peanut butter consistency, a. Ptosis
chunks b. Weakness facial muscle NO TO VETSIN!!
e. Aphasia (bilateral)
 Broca’s – tablet, magic slater board c. Dysarthria
 Wernicke’s - slow and repeated instructions d. Dysphagia
e. Bladder and bowel
problems
 Medication
f. Ataxia
a. Cerebroprotectant – given 1st 24 hour  citicoline via IV Danger: diaphragmatic paralysis
 Maintain 1 year, take orally
 Side effect is seizure Medication:
 Collaboration a. Neostigmine,
a. Speech therapist pyridostigmine – long-
b. PT and OT acting
c. TPN – Dietician acetylcholinesterase
inhibitor  oral med, Sjogren’s Syndrome
everyday  Dry mouth
Autoimmune Disorder b. Overmedication –  Dry eyes
cholinergic crisis PNS
 “Auto attack”
 Decrease BP, HR
 Aging, sensitization (prolong PR interval)
 Decrease suppressor T cells heart blocks, RR
 Due to lymphocytes  Salivation
a. B cells – antibodies  Lacrimation
b. T cells – NK cells  Urinary incontinence
 Plasmapheresis – removal of antibodies and T cells in the  Diarrhea
blood  GI cramps
a. After plasmapheresis – inject IVIG/Interferon  Emesis
 Management – anticholinergic 
atropine sulfate
c. Undermedication –
Myelin sheath – speed up the conduction myasthenic gravis SNS
 Weakness,
 paralysis, fatigue  Pin rolling
 Increase BP, HR,  Mask like facial expression
RR  Dysarthria. Monotone speech
Management – edrophonium then  Problem – decrease dopamine (fine motor movement)
next is Pyridostigmine/neostigmine Basal ganglia – collection of gray matter – substancia nigra

DEGENERATIVE  Dopamine
 Brain – increase focus, attention, motivation, memory,
1. Alzheimer’s Disease cognition
 Cause:  Muscles – fine motor movement – overall slowing of
 Degenerative movement
 Associated with viral infection  Diagnostic
 Hereditary  Symptomatic diagnosis
 Depression  Management:
 Trisomy 21
a. Tremors (resting) – hands of the pocket
 Hallmark: shrinkage of brain b. Rigidity (neck, hip, knees) – slouch – rock back and
 Signs and Symptoms forth to initiate movement
a. Stage 1 – alert and oriented c. Bradykinesia
 Forgetfulness d. Postural irritability – shuffling gait – assistive devices
 Personal changes e. Pin rolling
 Emotional outburst f. Mask like facial expression
 Irritable g. Dysarthria. Monotone speech
b. Stage 2 – impaired work and ADLs  Medications
 Compromised work status a. Levodopa (carbidopa)
 Poor personal hygiene b. Amantadine (dopamine agonist)
 Sundowning – agitation, restlessness, wandering
c. Stage 3 – total dependency
 Waxy flexibility – assess circulation 3. Huntington’s Disease
 Hallmark – dementia  Cause:
 Diagnostics  Strongly hereditary – autosomal dominant 50%
a. Cerebral biopsy – confirmatory test  Problem – atrophy of basal ganglia
b. PET SCAN – measure metabolism of the brain
 Hallmark sign:
c. EEG
 Chorea – abnormal purposeless jerky movements
d. CSF analysis – to assess for meningitis
 Depression
 Cognitive decline
 Medications
 Psychosis
a. Anticholinesterase
 Bradykinesia
 Donepezil (Aricept)
 Management
 Rivastigmine (Exelon)
 Chorea – thiothixene
Indicated for MILD Alzheimer’s disease
 Depression – tofrani, parnate MAIO
b. Memantine (Namenda) – indicated for severe
 Cognitive decline – donepezil
 Psychosis – haloperidol
 Management
 Bradykinesia – amantadine
a. Do not disarrange furniture
 Irreversible and progressive
b. Write diary everyday
 DNA testing – genetic counselling

CN 5 CN 6
2. Parkinson’s Disease
Trigeminal Facial
 Cause:  Sensory-motor  Sensory-motor
 Degenerative a. Eyes – blinking/corneal a. Eyes – closing
 Associated with viral infection reflex eyelids
 Associated with head trauma b. Face – facial sensation b. Face – facial
 Hallmark: c. Mouth - mastication movement
 Tremors (resting) c. Mouth – taste
 Rigidity (neck, hip, knees) – slouch (anterior 2/3 tongue)
 Bradykinesia Trigeminal Neuralgia/Tic Doloreaux Bell’s Palsy
 Postural irritability  Cause:  Cause:
a. Idiopathic a. Idiopathic
 b. Viral infection b. Viral infection
c. COVID 19 c. COVID 19
 Problem – facial pain  Problem – altered
(unilateral) triggered by: facial nerve function
a. Manipulation of face Signs and Symptoms:
b. Hot foods and a. Inability to close
beverages eyes (uni) – wear
c. Exposed to cold eye patch to prevent
breeze inflammation of
 DOC cornea
a. Carbamazepine Cornea inflamed –
(Tegretol) – keratitis, artificial
tranquilizer  can tears s
cause drowsiness b. Facial paralysis
c. Altered face

 DOC – Steroids