A seizure is sudden, abnormal, and excessive electrical discharges from the brain that can change motor or autonomic function, consciousness, or sensation Epilepsy is a chronic neurological disorder characterized by recurrent seizures Seizures may be a symptom of epilepsy or another neuro disorder

Normal stability of neuron cell membrane is impaired Idiopathic No Cause Identified Usually onset before age 20 Acquired Underlying Neurological Disorder Brain Injury

Partial Begin on one side of cerebral cortex, may progress to other side and become generalized Generalized Both cerebral hemispheres involved S+S depend on area where abnormal electrical discharges occur

Aura Visual distortion Odor Sound Patients may have this warning, allowing time to improve safety

Partial Seizures Automatisms Repetitive, purposeless movements while in dream-like state Maintain consciousness Usually <1 minute Paresthesias if begins in parietal lobe Visual disturbances if occipital lobe Involuntary movements if motor cortex, usually begin in arm and hand, progress to leg and face

Complex Partial/Psychomotor Partial seizure as described, but… Lose consciousness May last 2 – 15 minutes

Generalized Seizures Absence (Petit Mal) Staring that lasts several seconds NmIoJk&feature=related NmIoJk&feature=related

Generalized Seizures Tonic Clonic (Grand Mal) May have aura, usually lose consciousness Tonic phase Rigidity Clonic phase Muscle contraction and relaxation Incontinence Postictal period-recovery period after a seizure

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EEG Can determine site of origin, frequency and duration, dx subclinical Look for underlying cause Accurate observation/reporting of seizure

Correct Cause Anticonvulsant Medication Taper slowly Common side effect-drowsiness Surgical Resection If focus is located in nonvital tissue, resceting area can prevent spread to other areas of brain

Prevent injury Pad side rails Keep away from furniture, walls Do not restrain Loosen tight clothing, belts, jewelry Monitor airway Turn on side to prevent aspiration Once seizure has begun, do not force airway/suction into patient’s mouth Suction, CPR PRN (suction, oral airway at bedside) Observe and document

30 minutes of seizure activity without return to consciousness Therapeutic Interventions Ensure airway and oxygenation Intubation and mechanical vent Administer IV diazepam (Valium) or lorazepam (Ativan) or phenobarbitol

Characterized by a decrease or loss of sensory and motor function below the level of the injury Damage results from bruising, tearing, cutting, edema or bleeding into the spinal cord Causes? Complete injury means no motor or sensory function below the level of the injury Incomplete means some functioning remains

Injury to C3 or above is usually fatal C4-C5 injuries likely require ventilation Quadriplegia vs. quadriparesis Paraplegia vs. paraparesis Spinal Shock SCI affects autonomic nervous system Lasts from a week to months Immediately after injury, sympathetic NS is disrupted Vasodilation Hypotension Bradycardia Hypothermia

See handout

Pathophysiology Increase in Brain Blood CSF

Normal ICP 0-15mm Hg Affected by pathologic conditions Most Common causes of IICP  Brain Trauma  Brain Tumor  Intracranial Hemorrhage Also affected by positioning, arterial pulsations, increase in intrathoracic pressure

Restlessness Irritability Decreased LOC Hyperventilation Pupil changes (due to compression of occulomotor nerve) Cushing’s Response (classic late response) Body attempts to compensate for IICP caused cerebral perfusion deficits with increased systemic blood pressure

Monitors are placed thru burr hole drilled thru skull Cared for in ICU-often ventilated and pharmacologically sedated/paralyzed External Ventricular Monitor and Drain Subarachnoid Bolt Monitor-ease of placement Intraparenchymal Monitor-directly into brain tissue

Keep HOB elevated 30* Keep head and neck in proper alignment Avoid neck flexion Antiemetics and antitussives PRN Stool softeners PRN Minimize suctioning Avoid hip flexion Prevent noxious stimuli Space care activities

Trauma Hemorrhage Contusion Laceration Can Cause Cerebral Edema Hyperemia Hydrocephalus Brain Herniation Death

MVA most common Falls Assaults Sports-related injuries

Closed or nonpenetrating head injury (blunt) Rapid back and forth movement causing bruising and tearing of brain tissues and vessels Open or penetrating head injury Break in the skull with brain tissue/vessel damage Acceleration Moving object hits stationary head Deceleration Head in motion hits a stationary object Acceleration-Deceleration/Contra-Coup Combination of two

Concussion: see handout Brief or no LOC, <5 mins Headache, dizziness, N/V, vertigo May have amnesia CT/MRI negative Rest, fluids, Tylenol, frequent LOC monitoring Avoid narcotics, sedatives, opiods, no driving Concussion syndrome may last months

Contusion Bruising of brain tissue May develop hemorrhage Symptoms depend on area(s) and severity Brainstem-decreased LOC (may be permanent), motor response, pupil reaction, eye movement, elevated RR, fever CT scan shows tissue swelling Treatment supportive

Hematoma Subdural (A) Usually venous Between dura and arachnoid membranes Epidural (B) Usually arterial Between dura and skull

Subdural Hematoma Acute vs Chronic If chronic, may be months from injury to S+S Forgetful Lethargic Irritable Headache Damage to brain tissue as blood accumulates LOC changes Hemiparesis Dilated pupil Extremity weakness

Epidural Hematoma Often associated with skull fracture Arterial, so usually progresses quickly Loss of consciousness after injury>regain consciousness, coherent>then rapid deterioration Decreased LOC, seizures

CT-test of choice, rapid results MRI Neuropsychological Testing

Surgical Removal of Hematoma Burr holes, craniotomy Control IICP ICP Monitoring Drainage of CSF Osmotic Diuretic Mannitol (Osmitrol) Mechanical Hyperventilation Therapeutic Coma

Brain Herniation Diabetes Insipidus Damage to Pituitary=too little ADH Acute Hydrocephalus Ventriculoperitoneal shunt Labile Vital Signs Cognitive and Personality Changes Often life-long deficits

PVS-Continual condition of complete unawareness of the environment, there is at least partial preservation of hypothalmic and brain stem functioning Coma-state of unconsciousness from which one cannot be aroused and is unresponsive

Ineffective Cerebral Tissue Perfusion Ineffective Airway Clearance Ineffective Breathing Pattern Disturbed Thought Processes Self-Care Deficit Pain Sensory-Perceptual Disturbance Impaired Physical Mobility Risk for Injury

ICU-monitoring ICP Monitor neuro status frequently Glasgow Coma Scale Pupil response Muscle strength Vital signs Monitor for seizures Posturing Decorticate Decerebrate