12.1 Headache, Seizure, Brain Infection Flashcards
Headaches
- Most common source of pain that can originate from intracranial or extracranial sources
Tension-Type Headache
- Bilateral pressing/tightening pain
- No prodromal (early symptoms)
- Possible photophobia
- May occur intermittently for weeks, months, years
Diagnosis
- History/Physical
- Electromyography
Treatment
- Short term aspirin or Tylenol with muscle relaxants
Short Term Medications
- Fiorinal
- Fioricet
- Midrin
Migraine Headache
- Neurovascular disorder
- Dilation/inflammation of intracranial blood vessels
- Begins with a neural event that triggers vasodilation which causes pain that furthers neural activation which amplifies pain generating signals.
Symptoms
- Unilateral/Bilateral throbbing pain that may have a prodrome/aura
- There is neurological and ANS dysfunction during the headache
Trigger factors
- Calcitonin gene-related peptide (GGRP) and Serotonin may play a part.
Manifestations
- Steady throbbing pain
- Edema
- Irritability
- Pallor
- N/V and Diarrhea
- Sweating
- Dizziness
- Sensory/Motor Dysfunction
Diagnosis
- History/Physical
- Neuro exam
- CT/MRI to rule out other sources of pain
- Headache diary
Treatment
- ASA/Tylenol is the first line of defense
- Triptans - Imitrex, Zomig, Relpax
- Topomax (for prevention)
Possible Triggers
- Alcohol, caffeine, skipping meals, physical exertion, bright lights, excessive noise, smells, lack of sleep, stress, weather
Cluster Headache
- Periods of repeated headache’s followed by remission (occurs for weeks then stops)
- Can be triggered by smoking or alcohol
S/S
- Sharp, stabbing pain lasting more than one hour
- Pain around the eye radiating to temple, forehead, cheek, nose, or gums
Diagnosis
- History/Physical
- MRI (to rule out other causes)
Treatment
- High flow O2 and Imitrex
- Verapamil, lithium, Depakote, NSAID’s (prevention)
Seizures
- Paroxysmal, uncontrolled electrical discharge of neurons in the brain that interrupt normal function.
Epilepsy - Spontaneous recurring seizures secondary to a chronic condition.
Causes
- Birth injury
- Congenital defects
- CNS infection
- Issues with metabolism
- Lesions
- Trauma
- Tumors
- Vascular Disease
- Idiopathic
Generalized Seizures
3 Classifications
- Tonic-Clonic
- Typical Absence
- Atypical Absence
Manifestations
- Change in LOC
- Falling
- Stiffening of body
- Jerking of extremities
- Sleep after seizure
- Staring
- Confusion
Partial Seizures
2 Classifications
- Simple Partial
- Complex Partial
Manifestations
- Unilateral
- Paresthesia
- Tingling
- Lip-Smacking
- Automatisms (involuntary actions)
Diagnosing Seizures
- History/Physical
- Seizure History
- EEG (within 24 hours of seizure) - determines what type of focus and focus area the seizure is.
Labs
- CBC, CMP, UA
- CT/MRI to check for lesions
Acute Care for Seizures
Assessment
- Record details of the seizure
- Was it witnessed
- What happened before the seizure
- Where did it start
- How did it progress
- How long did each phase last
- What part of the body was affected
- Sequence of body involvement
During Seizure
- Try to turn patient to their side
- Maintain airway and safety
- Place oxygen on patient
- Suction mouth if needed (BUT DO NOT INSERT ANYTHING INTO MOUTH)
- DO NOT RESTRAIN
- Monitor Pulse Ox
- Assess type/length of seizure
Post-Ictal
- LOC
- VS
- Memory loss
- Muscle Soreness
- Speech Dysfunction
- Weakness
- Length of Sleep
Long Term Management of Seizures
- Phenytoin (for tonic/clonic and partial)
- Carbamazepine, Phenobarbital, Depakote, Clonazepam, Gabapentin, Topiramate, Levetiracetam
- MEDICATION COMPLIANCE IS A MAJOR ISSUE
Surgery
- Used for epileptic patients
- Remove/interrupt the focus
- Resect the area of the brain where the focus lies or remove the area completely.
- GOAL IS TO REDUCE OR CEASE THE NUMBER OF SEIZURES
Other Therapy
- Vagal Nerve Stimulation (electrical intermittent stimulation to the brain. NEW BATTERY EVERY 5 YEARS)
- Biofeedback (electrical readings of brain)
Meningitis
- Brain infection where there is inflammation of membranes and fluid surrounding the brain and spinal cord (pia-mater, arachnoid, CSF, subarachnoid)
- Caused by strep or meningitidis (septic) or viral infection secondary to cancer/weak immune system (aseptic).
- Meningitidis is spread through secretions, aerosol contamination and is commonly spread in dense community areas like college campuses.
Manifestations
- Headache
- Fever
- Changes in LOC, Behavioral changes
- Nuchal Rigidity (Stiff neck) (VERY COMMON) - Making flexion of neck difficult due to neck spasms.
- Positive Kernig and Brudzinski sign
- Photophobia (Common)
Kernig Sign
- BILATERAL pain in hamstring which prevents straightening of leg when flexed to 90 degrees
Brudzinski’s Sign
- Flexing the neck elicits flexion of hips and knees.
- BACTERIAL MENINGITIS IS MOST COMMON IN PEOPLE LESS THAN 5 Y/O. TREAT EARLY
Meningitis Diagnostic Tests
- HEAD CT (PRIORITY)
(If there is a space occupying lesion, a lumbar puncture may cause a downward shift of the brain and herniation through the foramen magnum) - Lumbar Puncture
(If there is a bacterial infection CSF may be cloudy (due to bacteria) with high protein and low glucose)
(If there is a viral infection CSF will be clear with normal glucose and high protein) - CBC
Medical Management
- Meningococcal vaccine at 11-12 years old then booster at 16 and first year of college.
- Early administration of antibiotics IV
- Dexamethasone
- Treat dehydration, shock, and seizures
- Droplet precautions for meningitis
Nursing Intervention
- Frequent VS, LOC, pain/fever assessments
- Protect patient from injury due to seizure/altered LOC
- Monitor daily weight, serum electrolytes, urine volume, specific gravity, osmolarity
- Prevent complications with immobility
- Infection control precautions
- Supportive care
- Provide coping skills
Viral Meningitis
- Supportive care
- Relief of pain/fever
- Frequent neuro assessments
- Universal precautions
- Respiratory isolation
