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Neurological conditions
Stroke
Trigeminal neuralgia
Myasthenia Gravis
What is a Stroke?
 Stroke is a brain injury that affects the
brain’s blood supply
 Stroke is caused by interruption of blood
flow to the brain
 When blood flow to the brain is
interrupted, brain tissue is starved of
oxygen and nutrients
A stroke happens when:
 A blood clot blocks a blood vessel in the
brain
 Called an ischemic stroke
 Or a weakened blood vessel in or near
the brain bursts and bleeds
 called hemorrhagic stroke
Types of stroke
Stroke signs & symptoms
 Sudden weakness or numbness on one side
of the body
 Sudden confusion, trouble speaking or
understanding
 Sudden vision changes in one or both eyes
 Sudden trouble walking, dizziness, or loss of
balance
 Sudden, severe headache
Think FAST
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F=FACE drooping
A=ARM dangling
S=SLURRED SPEECH
T=TIME call 911 immediately
Time is important because some treatments can only be
given within 3-4 hours of the start of the first symptom
Risk Factors stroke
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High blood pressure
Irregular heart beat
High Cholesterol
Smoking
Lack of exercise
Obesity
Excessive alcohol consumption
High salt intake
Stress
diabetes
1. Hemorrhagic stroke
 interruption of blood flow to the brain due to
bleeding
 Usually rupture of a blood vessel in the brain
due to an aneurysm
Hemorrhagic stroke
What is an aneurysm?
 An aneurysm occurs when part of a blood
vessel (artery) swells
 either the blood vessel is damaged
 or there is a weakness in the wall of the
blood vessel
Types of aneurysms
 Localized dilation of
the wall of an
artery or vein
 Berry aneurysms
 Fusiform
aneurysms
Aneurysm treatment
 Aneurysm clipping or coiling
 Surgical intervention to prevent sudden rupture of
blood vessel
 Doctor places catheter into groin and advances
catheter into the brain
 Pt is admitted to the hospital over night for
monitoring and is discharged the next day
Cerebral aneurysm Coiling video
 4:50
 Nucleus Medical media
 http://www.nucleusanimationlibrary.com/animationpreview?ccat=all&clang=English&animationid=76477
Nursing care after procedure
 Monitor for bleeding after procedure
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Bleeding at site of puncture
loss of pulse to extremity
back pain
decreased urinary output
vomiting
fast heart rate
low blood pressure
Neuro checks
Aneurysm Case Study
 83 year old woman with complaints of dizziness while
putting her eye drops in before bed
 Came to the ER and the doctors ordered a CT angio gram
(shows blood flow in the brain)
 Found 3mm aneurysm
 She had a coiling via right groin approach
 After the procedure, she developed right groin bleeding
upon arrival in ICU
 Nurse immediately applied pressure to groin to stop
bleeding
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Was monitored overnight for bleeding
No further bleeding
Right groin with small hematoma
Discharged home
Pt will follow up with Neurosurgeon in 2 weeks
2. Ischemic stroke
Think of the blood
supply to the brain
as branches of a
tree. The bigger
branches supply
more nutrients to the
tree. So it is with the
brain. If larger
vessels are occluded,
more of the brain can
be damaged.
Causes of ischemic stroke
Thrombotic stroke
When a blood clot blocks an artery
going to the brain. A build up of
cholesterol inside the vessel wall can
produce clots.
Embolic stroke
When a traveling blood clot is carried
in the blood stream and blocks an
artery inside or leading to the brain.
Treatment
 Reestablish blood flow
 Consider thrombolytic therapy if onset of
witnessed symptoms is within 3 hours of time
patient was last well
 Thrombolytic therapy is medicine to break up
clot (TPA)
 Remove the clot from the blood vessel
(thrombectomy)
Ischemic stroke video
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Ischemic stroke video
2:30
Nucleus medical media
http://www.nucleusanimationlibrary.com/animationpreview?ccat=all&clang=English&animationid=73789
Ischemic Stroke case study
44 year old man with history of high blood pressure,
high cholesterol and diabetes began experiencing left
sided weakness at 2:30pm
Became non verbal
CT scan showed thrombotic stroke
TPA administered
Agram was done, showed small clot still present, but no
intervention needed
Monitored overnight and discharged in morning
Ischemic Stroke case study #2
 66 year old man with history of diabetes, high blood
pressure, high cholesterol
 Fell down stairs, came to ER, CT scan negative for bleeding
in head
 While in ER developed sudden right sided weakness and
facial droop
 Repeat head CT showed ischemic stroke, pt received TPA
 Pt was monitored for bleeding overnight and had repeat
head CT in morning
 Pt was found to now have bleeding in brain
 Was treated for acute ischemic stroke complicated by
intracranial hemorrhage
 While being monitored, pt was found to have an
irregular heart rhythm
 Cardiologist consulted and suggested that pt go
home with cardiac monitoring to try and determine
the cause of the stroke
Risk Factors stroke
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High blood pressure
Irregular heart beat
High Cholesterol
Smoking
Lack of exercise
Obesity
Excessive alcohol consumption
High salt intake
Stress
diabetes
Trigeminal Neuralgia
Causes
 contact between a normal blood vessel and the
trigeminal nerve
 Aging
 brain tumor
 surgical injuries
 Stroke
 facial trauma
Symptoms
 severe, shooting or jabbing pain that may feel like an electric shock
 Sudden pain triggered by things such as touching the face, chewing,
speaking and brushing teeth
 pain lasts from a few seconds to several minutes
 attacks lasting days, weeks, months or longer — some people have periods
when they experience no pain
 Constant aching, burning feeling
 Pain in areas supplied by the trigeminal nerve, including the cheek, jaw,
teeth, gums, lips, or less often the eye and forehead
 Pain affecting one side of the face at a time
 Attacks that become more frequent and intense over time
Treatment
 The doctor usually will prescribe medications to
lessen or block the pain signals sent to the brain.
 Anticonvulsants: Medications that prevent seizures
tegretol or dilantin
 Antispasmodic agents: Muscle-relaxing agents
baclofen
Surgical options
microvascular decompression
Relocating or removing blood vessels that are in
contact with the trigeminal root.
This eliminates pain most of the time, but pain can recur
in some people. risks include decreased hearing, facial
weakness, facial numbness or stroke
Surgical options
Gamma knife radiosurgery
 surgeon directs a focused dose of radiation to the
root of your trigeminal nerve.
 The radiation reduces or eliminates pain
 Relief occurs gradually and may take several weeks.
 Gamma Knife radiosurgery is successful in eliminating
pain for the majority of people.
 If pain recurs, the procedure can be repeated.
Gamma knife Video
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ADD GAMMA VIDEO
2:30
Nucleus Medical
http://www.nucleusanimationlibrary.com/animationpreview?ccat=all&clang=English&animationid=78926
Myasthenia Gravis
What is Myasthenia Gravis?
grave muscle weakness
 chronic autoimmune neuromuscular disease
characterized by varying degrees of weakness of the
skeletal muscles of the body.
 The muscle weakness increases during periods of
activity and improves after periods of rest.
Causes
 defect in the transmission of nerve impulses to
muscles.
 It occurs when normal communication between the
nerve and muscle is interrupted at the neuromuscular
junction
 Myasthenia gravis is an autoimmune disease because
the immune system—which normally protects the
body from foreign organisms—mistakenly attacks
itself.
Symptoms
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weakness of the eye muscles and eyelid movement
difficulty in swallowing and slurred speech
drooping of one or both eyelids (ptosis)
blurred or double vision (diplopia)
a change in facial expression
shortness of breath
weakness in the arms, hands, fingers, legs, and neck.
Treatment
 Medications include anticholinesterase agents such as neostigmine
which help improve neuromuscular transmission and increase
muscle strength.
 Immunosuppressive drugs such as prednisone. These medications
improve muscle strength by suppressing the production of
abnormal antibodies
 Thymectomy, the surgical removal of the thymus gland (which often
is abnormal in individuals with myasthenia gravis)
 plasmapheresis, a procedure in which serum containing the
abnormal antibodies is removed from the blood while cells are
replaced
 high-dose intravenous immune globulin, which temporarily modifies
the immune system by infusing antibodies from donated blood
Myasthenia gravis crisis
 Plasmaphoresis
 IVIG
 Plasmapheresis and IVIG are rapid immunotherapies
that work quickly but have a short duration of action.
These are usually reserved for certain situations, such
as myasthenic crisis
Plasmapheresis
 Plasmapheresis is a process in which the liquid in the
blood, or plasma, is separated from the cells.
 In sick people, plasma can contain antibodies that
attack the immune system.
 A machine removes the affected plasma and replaces
it with good plasma, or a plasma substitute.
 The process is similar to kidney dialysis.
 A needle or catheter is placed into a vein
 Replacement or returned plasma flows into the
body through a second tube that is placed in the
arm
 Treatments can last between one and three hours.
 A patient can need as many as five treatments per
week.
Plasma exchange machine