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NEURO
NEURO
4 Stages of Seizure
1. Prodromal
2. Aura
3. Ictal
4. Post Ictal
1. Prodromal Stage
• Happens few days or hours prior to
seizure.
SIGNS & SYMPTOMS
Mood changes
Agitation
Irritability
Depression
2. Aura Stage
• Change of activity few minutes or
seconds prior to seizure.
• WARNING SIGN!
o In any seconds, the seizure will
follow such as:
▪ Flashes of light
▪ Dark spots
▪ Nausea
▪ Numbness
▪ Tingling of the limbs
SIGNS & SYMPTOMS
Olfactory: smelling of burning wires
Optic: photosensitivity
Déjà vu, migraine
1. Generalized Seizure
• Occurs when the abnormal electrical
activity causing a seizure begins in both
halves (hemispheres) of the brain at the
same time.
• INITIAL onset in both hemisphere;
affects both sides of the brain. Involves
loss of consciousness and bilateral
motor activity.
• Types of Seizures:
o Tonic • Tonic-clonic seizures – most common
o Clonic type of generalized seizure.
o Petit Mal/Absence Seizure
o Akinetic Seizure
Tonic Phase Muscles become tense
o Myoclonic
and rigid.
o Tonic-Clonic (Grand Mal) Clonic Phase Muscles rapidly
contract and relax.
A. Tonic
• Muscles suddenly become stiff and C. Petit Mal / Absence Seizure
flexed arms, or trunk. • Nonorganic brain damage.
• Lasts about 20 seconds • Sudden onset, with twitching or rolling
• May cause person to fall if he is standing. of eyes ; lasts a few seconds.
• After seizure he may feel tired and • Minimal or no alteration in muscle tone.
confused. o When walking they suddenly
stand still, may loss and regain
consciousness "spaced out."
• Brief LOC with or without movement of
the eyes, head and extremities.
• Regain of consciousness is rapid and
lasts for 10-20 seconds.
• They may go unrecognized because the
behavior changes very little.
• Atonic – “drop attacks or drop seizures.” • May follow: trauma, hypoxia, drug
o Loss of muscle tone abuse.
o LOC may be brief • Purposeful but inappropriate, repetitive
• Related to organic brain damage. motor acts.
• Sudden loss of muscle strength, tone, • Aura present; dreamlike state.
person is relaxed.
• Can cause person to fall.
• Persons eyes rolls back into their head. B. Simple Partial Seizure
• Patient remains conscious and may not
always fall. • Seizure confined to one hemisphere of
brain.
E. Myoclonic • No loss of consciousness (does not
affect awareness).
• Associated with brain damage, • May be motor, sensory or autonomic
precipitated tactile or visual sensations. symptoms
• Brief transient rigidity or jerking of • Simple partial seizures can be:
extremities, arm extension, trunk o Motor – affecting the muscles of
flexion. the body.
• Single group of muscles affected; o Sensory – affecting the senses.
involuntary muscle contractions;
myoclonic jerks.
C. Complex Partial Seizure
F. Tonic-Clonic (Grand Mal)
• Begins in focal area but spreads to both
• Tonic-Clonic: person experiences tonic hemisphere.
phase and clonic phase. • Associated with impairment in
• LOC lasts 2-5 minutes. consciousness
• Rigidity followed by tonic-clonic • “Focal impaired awareness seizure or
movements. Focal onset impaired awareness
• Loss of bowel and bladder control. seizure.”
• Preceded by an aura.
• Monitor CBC.
o May cause bone marrow
Electroencephalogram (EEG)
depression.
• Rule out • Monitor serum drug levels to prevent
infection. toxicity.
• Child may be o Especially to diabetic patients as
awake or the drug inhibits the release of
asleep. insulin (lowers blood sugar
• Sedation is ordered. levels), causing hyperglycemia.
• May be sleep deprived the night before. • Instruct the client to take
• Stimulation: flashing strobe light, anticonvulsant everyday with food or
clicking sounds. milk.
• NPO (6- 8 hours) o To prevent GI bleeding.
• Consent • Avoid driving or strenuous activity.
• Shampoo head – to remove grease. • Withdraw the drug gradually.
• No stimulants 24-48 hours BEFORE o To prevent status epilepticus.
procedure • Contraindicated in pregnancy:
• Avoid 3 C’s: caffeine, cola, chocolate o Causes fetal anomalies (cardiac
defects, cleft lip and palate)
• Maintain serum drug levels.
Medical Management
Therapeutic serum level: 10-20 mcg/ml
1. Hydantoin More than 20 mcg/ml = Toxicity
a. Phenytoin (Dilantin) Less than 10 mcg/ml = Prone to seizure
b. Mephenytoin (Mesantoin)
c. Ethotoin • Toxic Effects:
o Difficulty speaking
o Drowsiness
Phenytoin
o Lethargy (LOC)
• Often used with phenobarbital for its o Rapid eye movements
potentiating effect. • Ensure adequate nutrition.
• Inhibits spread of electrical discharge. o Causes anorexia, N/V
• Avoid driving and performing
hazardous activities.
BARBITURATES (BARBITAL)
1. Amobarbital • Status Epilepticus
(Amytal)
2. Mephobarbital • Grand Mal
(Mebaral) • Petit Mal
3. Phenobarbital • Grand Mal • Divalproex Na (Depakote)
(Luminal) • Petit Mal o Used for treatment of manic
• Status Epilepticus associated with bipolar
4. Primidone • Grand Mal disorder.
(Mysoline) • Psychomotor
Seizures
Watch Out For: Respiratory Depression
Hemispherectomy
Collaborative Management
BATTLE’S SIGN
A crescent-shaped
• Break is an incomplete fracture and the
bruise that appears
broken bone is not completely separated.
behind one or both ears
• Comminuted: The break is in three or
(mastoid process). It is
more pieces.
retroauricular or mastoid
ecchymosis that is 2. Closed Head Injuries
typically the result of
head trauma. A. Concussions
RACOON’S EYES
Pooling of blood
around the eyes.
Periorbital ecchymosis
is a sign of basal skull
fracture.
Primary Assessment
Airway
Assess for:
• Vomitus
• Bleeding occurs directly into the brain, • Bleeding
ventricles, or subarachnoid space. • Foreign objects
Pathophysiology or Etiology of TBI Breathing
Assess for:
• Caused by blunt or penetrating injury. • Abnormally slow or shallow
respirations
Blunt Trauma
• Elevated partial pressure of carbon
• Injury of the brain / body by forceful
dioxide (PCO2) can worsen cerebral
impact, falls, or physical attack.
edema.
Penetrating Injury
Circulation
• Object piercing the skin causing open
wound Assess for:
• Pulse
• Neurologic deficits result in shearing of • Bleeding
white matter, ischemia and mass effect
from hemorrhage, cerebral edema of
surrounding brain tissue. Diagnostic Evaluation
Assessment CT Scan
• Identifies and localize lesions, edema,
• Disturbance in consciousness:
bleeding.
o CONFUSION TO COMA
o Signs and symptoms of
Skull and Cervical Spine Films
increased ICP
• Changing neurological signs in the client • Identifies fracture, displacements.
• Changes in level of consciousness
• Airway and breathing pattern changes Neuropsychologic Tests During
• Vital signs changes reflecting increased Rehabilitation
ICP Headache, nausea, and vomiting
• To determine cognitive defects.
• Visual disturbances, pupillary changes,
and papilledema
Test Fluid for Glucose
• Nuchal rigidity (not tested until spinal
cord injury is ruled out) • CSF is positive for glucose.
Diagnosis
• Traumatic brain injuries other than blunt • X-rays
head trauma. • CT Scan
• A wound in which a projectile breaches • MRI
the cranium but does not exit it. o Only used when the penetrating
• MOST SEVERE form of traumatic object is not made of metal
brain injuries.
• SIGNIFICANT CAUSE of mortality in Treatment
young individuals.
o The morbidity and mortality • Surgery done to:
associated with this condition o Remove skull pieces that broke
remain high. off.
o Remove any objects, such as
Causes bullets.
o Remove part of the skull to ease
• Being hit by a bullet/shrapnel. pressure from swelling.
• Being hit by a weapon: hammer, baseball o Make holes in the scalp and
bat, knife. skull to drain blood.
• Head injury that causes a bone fragment o Place a tube into the brain to
to penetrate the skull. drain fluid.
• The injury may be from any object or
outside force, such as: Medications
o A fall, which could cause a piece
of the skull to break off and enter • Anticonvulsants
the brain. • Antibiotics
o Motor vehicle accident • Mannitol
o Gunshot
o Stab wound
o Sports injury
o Abuse, such as being struck on
the head with an object.