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Neurologic
Infections,
Autoimmune
Disorders &
Neuropathies
By Esperancita A. Ferrer RN MD
Infectious
Neurologic
Disorders
Meningitis
Is an inflammation of the pia
mater, the arachnoid & the
cerebrospinal fluid.
Classification:
Septic Bacteria (N.
meningitidis & S. pneumoniae)
Aseptic Virus MC or lymphoma
(nonpolio enterovirus)
Clinical Manifestations
Kernigs sign
Brudzinskis sign
Petechial rash w/
purpuric lesions
Photophobia
Disorientation
Lethargy
Seizures
ICP sec.
accumulation of purulent
exudate
Diagnostic Evaluation
Prevention
Vaccination
Antimicrobial Prophylaxis rifampin,
ciprofloxacin hcl, ceftriaxone Na (24h)
Medical Management
Antibiotics that cross the BBB
Penicillin antibiotics (Ampicillin,
Piperacillin)
Cephalosphorins (ceftriaxone Na,
cefotaxime Na)
Vancomycin & Rifampin resistant cases
Nursing Management
Assessment & management of meningitis
should be a collaborative effort
Institute infection control precautions until
24h after initiation of antibiotic therapy
(oral & nasal discharge is considered
infectious)
Cooling measures, antipyretics
Rapid IV fluid tx prescribed caution fluid
overload
Observe for ICP
Encephalitis
Inflammation of Cerebral tissue, typically
accompanied by meningeal inflammation
Heres Simplex Virus (HSV) MC
Clinical Manifestations
High
grade fever
Headache
Disorientation
Neurologic deficits
Seizure
Motor weakness hemiparesis
DTR & extensor plantar response
Visual field defects, aphasia, dysphagia,
ataxia & paresthesia
Diagnostic Evaluation
EEG
CSF Examination
MRI
Medical Management
Nursing Management
Assessment & management of encephalitis
should be a collaborative effort
Cooling measures, antipyretics
Observe for ICP
Quiet calm environment
Darken room
Assist on position of comfort
Administer Antiviral agent on time &
Analgesics as prescribed
Reorient
Autoimmune
Nervous System
Disorders
Multiple Sclerosis
An auto-immune
mediated progressive
demyelinating disease
of the CNS
Causes impaired
transmission of nerve
impulses from the
brain to the peripheral
nervous system.
Destruction of myelin
in optic nerve, brain &
SC
Cause:
Unkown
Possibly related to autoimmune
dysfunction, genetic susceptibility, or an
infectious process
Multiple factors
viral infection
environmental factors
geographic location and
genetic predisposition
Sensitized T cells
Pathophysiology
Enters and remains in CNS
Promotes
infiltration of
other agents
Damage to
immune system
Inflammation
s/s depending on
nerve affected
Interruption of impulse
transmission
Relapsing Remitting MS
Primary Progressive MS
Secondary Chronic
Progressive
Progressive Relapsing
Progression of neurologic deficits. But w/ clear
acute relapses w/ or w/o recovery. Problems
appear and gradually worsen over time. Common
problems include spastic paraparesis, cerebellar
ataxia, urinary incontinence.
Increasing Disability
Time
Clinical Manifestations
Symptoms reflect area of demyelination
Visual Disturbances- blurring of vision,
double vision (diplopia), patchy blindness
(scotoma), & total blindness; Retrobulbar
Optic Neuritis
Visual Disturbances
Clinical Manifestations
FRONTAL LOBE MOTOR CORTEX
Spasticity of extremities & loss of abdominal reflexes (motor
pathway, corticospinal tract)
Bladder bowel & sexual dysfunction(corticospinal tract)
Fatigue (most disabling)
Weakness
FRONTAL LOBE
Cognitive (memory) psychsocial problem, Depression
(frontal/parietal lobe)
PARIETAL LOBE
Paresthesia, loss of proprioception (sensory pathway, posterior
column
Pain (lesions on sensory pathways)
CEREBELLAR Signs
Ataxia & tremor
Difficulty in coordination
Loss of balance
Diagnostic Evaluation
MRI
CSF electropheresis
IgG Ab
Pharmacologic Therapy
Interferon
A- B C
Decreases T-cell
proliferation
IM, once a week
Decreases frequency of
relapse
Decreases appearance of
new lesions
SQ, every other day
IV 1g x 3d tapered w/
prednisone po
Shortens duration of relapse
Tx acute relapse
Relieves Sx acute attack
Novantrone
mitoxantrone
Chemotherapeutic
agent
Iv infusion q3m
Reduces frequency of
clinical relapse in px
w/ secondary
progressive %
relapsing remitting
MS
spasticity
Ataxia
Anticholinergics, alpha
adrenergic blockers,
antispasmodics,
Fatigue
Beta adrenergic
blockers, anti-siezure
medication, BZD
Baclofen, BZD,
Dantrolene (centrally
acting ms relaxant)
amantadine
Symmetrel,
fluoexetine Prozac
Ascorbic acid
UTI
Nursing
Interventions
Promote Physical
Mobility
Exercise
Prevent injuries
Wide stance walking
Use of walking aids
Wheelchair, motorizes scooters
If with loss of position sense,
walk while watching feet
Careful feeding,
proper positioning,
suction machine availability
Speech therapist
Fatigue
Extremes of temperature
Exposure to infection
Myasthenia Gravis
A
Muscle contraction
Pathophysiology
Antibodies attack
receptor sites
Transmission of nerve
impulse impaired
Voluntary ms weakness
Pathophysiology
Etiology
Autoimmune
Thymoma
Women
suffer at an earlier
age and are more affected
MYASTHENIA GRAVIS
Clinical
Manisfestations:
Diagnostic Tests
EMG
Serum
Acetylcholinesterase
Inhibitor Test:
TENSILON TEST (Edrophonium)
TENSILON TEST
(Edrophonium)
Tensilon
mg)
30 sec after injection, facial weakness
and ptosis should resolve for 5 min
Atropine sulfate should be available to
counteract side effects
Bradycardia
Sweating
cramping
Medical
Management
ANTICHOLINESTERASE
DOC: Pyridostigmine bromide (Mestinon)
Neostigmine bromide (Prostigmin)
Immunomodulating Drugs
Corticosteriods
Suppress
Plasmapheresis
Plasma exchange
Patients plasma and
plasma components
are removed through a
centrally placed largebore double lumen
Blood cells and
antibody-containing
plasma are separated
Cells and plasma
substitute are
reinfused
Effects is temporary
Surgical Management
Thymectomy
Myasthenic Vs
Cholinergic Crisis
Cause
S/S
Myasthenic
Cholinergic
Disease
exarcerbation
Precipitating events
Generalized muscle
weakness
Sudden inability to
swallow, speak or
maintain a patent
airway( needs
artificial ventilation)
Anticholinergic
overmedication
Generalized
muscle weakness
Myasthenic
Response Improvement
to
Tensilon
Test
Treatment Neostigmine
methylsulfate
IV, IM
Cholinergic
Deterioration
No improvement
D/C all
anticholinergic
Atropine sulfate
DANGER:
Respiratory muscle weakness
Bulbar muscle weakness
Inadequate cough and gag
Respiratory muscle
weakness
Nursing
Interventions
Tape eyes
Artificial tears
Eye patching
Guillain Barre
Syndrome
Polyradiculoneuritis
Definition
Antecedent Events:
Viral Infection (C. pneumoniae, CMV, EBV,
H. Influenzae)
Influenza Vaccination
Infectious Diarrheal Illness
(Campylobacter)
Schwann cells-produce
myelin
Myelin- fatlike subs, that
sheaths around certain
nerve fibers
Demyelinationdegeneration of myelin
Insulation
Axons conduct impulses
rapidly
Dysfunction in conduction of
impulses
Somatic carrying
information about pain,
temperature, touch,
position sense
(proprioception) from
tendons, joints, and
body surfaces
Visceral carrying
information from the
internal organs
Somatic
Visceral includes
autonomic fibers that
control the cardiac
muscles and glandular
secretions
Pathophysiology
Infectious organism contains amino acid that
mimics the peripheral nerve
Antibody cannot distinguish
between the 2 proteins
Clinical Manifestations:
Symmetric ms weakness beginning in the
LE ascending to involve the trunk, UE &
facial ms. Paralysis may develop
Hyporeflexia Areflexia
Paresthesia
Dyskinesia
Pain
Blindness
Difficulty w/ swallowing, speech, chewing
Autonomic Dysfunction (or BP, HR)
Decreased Vital Capacity, depth of respirations
& breath sounds
Diagnostic Tests:
Lumbar
Electrophysiologic
Studies - nerve
conduction velocity conduction
Medical Management:
Plasmapharesis
Intravenous
Reduction of circulating Ab
ECG
Ig
monitoring
Intubation
Sequential Compression
Boots
Mechanical Ventilator
Nursing
Interventions
Maintain respiratory
function
Chest
physiotherapy
Incentive spirometry
Elevate HOB
Monitor for signs of respiratory
failure: Tachycardia, Tachypnea
Monitor for Respiratory Fatigue:
Breathlessness when talking, VC,
PaO2 <70 mmHg, Bulbar weakness
Mechanical ventilator
Suction
extremities functional
positions
PROM 2x/d
Prevent DVT & PE
Prevent
Pressure Ulcers
Improve communication
Use
retention
Pulmonary embolism
Respiratory failure
Cranial Nerve
Disorders:
Trigeminal Neuralgia
A.k.a Tic
Douloureux
Condition of the
fifth cranial nerve
Characterized by
paroxysms of pain
in the area
innervated by any
of the three
branches of
trigeminal nerve
Cause:
Not certain
May be due to
chronic
compression or
irritation of the
trigeminal nerve
Clinical Manifestations:
Associated symptom:
Washing of face
Shaving
Brushing of the teeth
Eating
Drinking
Draft of cold air
Direct pressure on the nerve
Medical Management
Antiseizure agents
CARBAMAZEPINE (Tegretol)
Nausea
Dizziness
Drowsiness
Aplastic anemia
Mgt Pain
Surgical Management
Intracranial approach
Relieve contact between cerebral vessel
& trigeminal nerve root
Relieves pain while preserving normal
sensation
Percutaneous Balloon
Microcompression
Nursing Interventions:
Prevent pain
Help recognize precipitating/aggravating
factors
Chew on the unaffected side
Ingest soft foods
Provide emotional support
Encourage to express feelings
Provide adequate nutrition in small frequent
meals at room temperature
Post-op
BELLS PALSY
Pathophysiology
Inflammation
Damage
Bells smile
Clinical Manifestations:
Medical Management
Recovery 3-5 wks
Prednisone
Artificial Tears
Analgesics
TENS
Nursing Intervention