Cerebral Dysfunctions
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Transcript Cerebral Dysfunctions
Aseptic
meningitis—NONbacterial
Most commonly viral in etiology.
Associated with mumps, measles, herpes, other
viral syndromes
Signs and Sx—generally gradual in onset, but may
be sudden.
Headache
Fever—low-grade, usually
GI sx—nausea and vomiting may be R/T ICP
General malaise
Maculopapular rash
Symptoms usually disappear in 3-10 days
Acute
inflammation of meninges & CSF
caused by bacterial infection
Haemophilus influenzae type B (vaccine)
Streptococcus pneumoniae
Neisseria meningitidis
Risk
factors: immunosuppression,
preexisting CNS anomalies, chronic
diseases
Organisms may come from infections in
teeth, sinuses, tonsils, lungs, skull
fracture
Etiology
by age of incidence:
Neonate-3 months: Group B Beta Strep and E.Coli
3 months-3 years:
Haemophilus Influenzae Type B
Streptococcus pneumonieae
Neisseria meningitidis (meningococcal)
Staphylococcus aureus
School-age and beyond: Meningococcal due to
high transmissibility through droplet form.
Hx
of URI or ear infection
Irritabilitiy, restlessness
Severe HA, fever, chills, vomiting
Stiff neck (nuchal rigidity) can progress to
point of opisthotonos
Alterations in sensorium
High pitched cry in infants; bulging
fontanel
May begin w/seizure or develop later
Photophobia
Kernig’s and Brudzinski’s sign
Dx: Hx/physical and lumbar puncture
CSF cloudy; culture done **KNOW CSF FLUID RESULTS!!
Management:
Begin IV antibiotics and fluids IMMEDIATELY
Respiratory isolation till on meds for 24hrs if bacterial,
longer if viral
NPO
Freq VS & neuro checks
I&O
Assess for ↑ICP; Keep HOB elevated
Assess for SIADH – may need to restrict fluids
Keep room/environment quiet, darkened; ↓stimuli
Pain meds as ordered; uninterrupted rest periods
Seizure precautions
Reportable to local Health Dept.
Complications
of meningitis:
epilepsy
neuro damage (brain damage to learning
disabilities)
hearing or vision loss – hearing most common
hydrocephalus
10-15% mortality
Acute
toxic encephalopathy w/other
organ involvement; fatty changes in liver
Sudden change in LOC, fever, vomiting
Progresses rapidly; ↑ICP; death
Risk factors: triggered by a mild viral
illness like chickenpox or flu and use of
salicylates especially Aspirin
Children <18; most bet 4 – 14 yrs
Liver Bx is final clinical Dx
Quiet,
lethargic, vomiting
Confusion, combativeness, hyper-reflexia
Obtunded, seizures, decorticate rigidity
Deepening coma, fixed pupils
Coma, loss of deep tenden reflexes, flaccid,
respiratory arrest
ICU
– monitor for cerebral edema; ICP
Assess resp status, CVP, arterial pressure
Oxygen; intubation if needed
Accurate and frequent I & O
Tx: shock (fluids, electrolytes,
vasopressors)
Tx: for ↑ICP –keep ↑HOB, airway support,
administer mannitol as ordered)
Treat hyperthermia(cooling & meds)
Supportive care & ongoing info for family
Malfunction
in the electrical system of the brain;
alterations in the firing of the neurons by group of
hyper-excitable cells
Epilepsy: chronic DO w/recurrent seizures
Partial – begins local in one hemisphere
Simple partial or partial complex
Generalized
– both hemispheres
Immed loss of consciousness
Tonic clonic and petit mal
Simple
partial: No loss of consciousness;
alterations in motor function, autonomic
signs, sensory symptoms
Partial
complex: consciousness impaired;
staring, lip smacking, chewing, unusual hand
movements
Petit
mal or Absence: lack of awareness,
unresponsive; lasts less than 15 secs;
abrupt onset and cessation
Tonic clonic: Aura does NOT precede
seizure. Postictal period after seizure:
relaxation, confusion, amnesia,
unresponsiveness
Tonic: sudden loss of consciousness, cry out &
muscles get rigid; jaw clenched
Clonic: alternate contraction and relaxation of
extremities
Prolonged
seizures: > 20 min or recurrent
OR postictal period > 30 min
Medical emergency → resp failure,
hypotension, hypoxic brain damage,
hypoglycemia
ICU – need IV benzodiazepine
Diazepam or Lorazepam
If IV access is difficult, EBP has shown that anticonvulsants administered rectally via a 5-8
French feeding tube with syringe is very
effective.
When
to call 911
If no history of previous seizure
Not breathing
Seizure lasting > 5minutes
Turn
child to side; put NOTHING in mouth
Do not restrict movement
Protect head – maintain safe environment
Observe, record, and report seizure
activity
Provide information/teaching to family
Anticonvulsants:
Phenobarbital
Phenytoin (Dilantin): gum hyperplasia SE
Carbamazepine (Tegretol)
Valproic acid (Depakene)
Primidone (Mysoline)
Ethosuximide (Zarontin)
Clonazepam (Klonopin)