Transcript Cerebral Dysfunctions

 Aseptic
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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.
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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
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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:
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Neonate-3 months: Group B Beta Strep and E.Coli
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3 months-3 years:
 Haemophilus Influenzae Type B
 Streptococcus pneumonieae
 Neisseria meningitidis (meningococcal)
 Staphylococcus aureus
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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
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Dx: Hx/physical and lumbar puncture
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CSF cloudy; culture done **KNOW CSF FLUID RESULTS!!
Management:
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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
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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
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Simple partial or partial complex
 Generalized
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– 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
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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
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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
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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:
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Phenobarbital
Phenytoin (Dilantin): gum hyperplasia SE
Carbamazepine (Tegretol)
Valproic acid (Depakene)
Primidone (Mysoline)
Ethosuximide (Zarontin)
Clonazepam (Klonopin)