A seizure is sudden, abnormal, and excessive electrical discharges from the brain that can change motor or autonomic function, consciousness, or sensation

Epilepsy is a chronic neurological disorder characterized by recurrent seizures

Seizures may be a symptom of epilepsy or another neuro disorder

Seizures

Normal stability of neuron cell membrane is impaired

IdiopathicNo Cause IdentifiedUsually onset before age 20

AcquiredUnderlying Neurological DisorderBrain Injury

Etiology

PartialBegin on one side of cerebral cortex, may

progress to other side and become generalizedGeneralized

Both cerebral hemispheres involved

S+S depend on area where abnormal electrical discharges occur

Classification of seizures

AuraVisual distortionOdorSound

Patients may have this warning, allowing time to improve safety

Signs & Symptoms

Partial SeizuresAutomatisms

Repetitive, purposeless movements while in dream-like state

Maintain consciousnessUsually <1 minuteParesthesias if begins in parietal lobeVisual disturbances if occipital lobeInvoluntary movements if motor cortex, usually

begin in arm and hand, progress to leg and face

Signs & Symptoms

Complex Partial/PsychomotorPartial seizure as described, but…Lose consciousnessMay last 2 – 15 minutes

Signs & Symptoms

Generalized SeizuresAbsence (Petit Mal)

Staring that lasts several seconds

http://www.youtube.com/watch?v=z9V2sNmIoJk&feature=related

Signs & Symptoms

Generalized SeizuresTonic Clonic (Grand Mal)

May have aura, usually lose consciousness

Tonic phaseRigidity

Clonic phase Muscle contraction and relaxationIncontinence

Postictal period-recovery period after a seizure

Signs & Symptoms

http://www.youtube.com/watch?v=nV40H_g-NJo&NR=1

http://www.youtube.com/watch?v=H2vH1igOoh0&feature=related

http://www.youtube.com/watch?v=p5U2tpaH3fA&feature=related

http://www.youtube.com/watch?v=VC6HJPZr1VU&feature=related

EEGCan determine site of origin, frequency and

duration, dx subclinicalLook for underlying causeAccurate observation/reporting of seizure

Diagnosis

Correct CauseAnticonvulsant Medication

Taper slowlyCommon side effect-drowsiness

Surgical ResectionIf focus is located in nonvital tissue, resceting

area can prevent spread to other areas of brain

Therapeutic Interventions

Prevent injury Pad side railsKeep away from furniture, wallsDo not restrainLoosen tight clothing, belts, jewelryMonitor airwayTurn on side to prevent aspirationOnce seizure has begun, do not force

airway/suction into patient’s mouthSuction, CPR PRN (suction, oral airway at

bedside)Observe and document

Emergency Care: Seizures

30 minutes of seizure activity without return to consciousness

Therapeutic InterventionsEnsure airway and oxygenation

Intubation and mechanical ventAdminister IV diazepam (Valium) or lorazepam

(Ativan) or phenobarbitol

Status Epilepticus

Characterized by a decrease or loss of sensory and motor function below the level of the injury

Damage results from bruising, tearing, cutting , edema or bleeding into the spinal cordCauses?

Complete injury means no motor or sensory function below the level of the injury

Incomplete means some functioning remains

Spinal Trauma

Injury to C3 or above is usually fatalC4-C5 injuries likely require ventilationQuadriplegia vs. quadriparesisParaplegia vs. paraparesisSpinal Shock

SCI affects autonomic nervous systemLasts from a week to months Immediately after injury, sympathetic NS is disrupted

VasodilationHypotensionBradycardiaHypothermia

Spinal Trauma

See handout

Whiplash

Increased Intracranial Pressure

PathophysiologyIncrease in

BrainBloodCSF

Normal ICP 0-15mm HgAffected by pathologic conditions

Most Common causes of IICP Brain Trauma Brain Tumor Intracranial Hemorrhage

Also affected by positioning, arterial pulsations, increase in intrathoracic pressure

ICP

RestlessnessIrritabilityDecreased LOCHyperventilationPupil changes (due to compression of

occulomotor nerve)Cushing’s Response (classic late response)

Body attempts to compensate for IICP caused cerebral perfusion deficits with increased systemic blood pressure

Signs & Symptoms

Monitors are placed thru burr hole drilled thru skull

Cared for in ICU-often ventilated and pharmacologically sedated/paralyzedExternal Ventricular Monitor and DrainSubarachnoid Bolt Monitor-ease of

placementIntraparenchymal Monitor-directly into

brain tissue

ICP Monitoring

Keep HOB elevated 30*Keep head and neck in proper alignment

Avoid neck flexionAntiemetics and antitussives PRNStool softeners PRNMinimize suctioningAvoid hip flexionPrevent noxious stimuliSpace care activities

Interventions to prevent IICP

Traumatic Brain Injury (TBI)Trauma

HemorrhageContusionLaceration

Can CauseCerebral EdemaHyperemiaHydrocephalusBrain

HerniationDeath

MVA most commonFallsAssaultsSports-related injuries

Etiology

Closed or nonpenetrating head injury (blunt)Rapid back and forth movement causing bruising

and tearing of brain tissues and vesselsOpen or penetrating head injury

Break in the skull with brain tissue/vessel damage

AccelerationMoving object hits stationary head

DecelerationHead in motion hits a stationary object

Acceleration-Deceleration/Contra-CoupCombination of two

Mechanisms of Injury

Concussion: see handoutBrief or no LOC, <5 minsHeadache, dizziness, N/V, vertigoMay have amnesia

CT/MRI negative

Rest, fluids, Tylenol, frequent LOC monitoringAvoid narcotics, sedatives, opiods, no drivingConcussion syndrome may last months

Types of Injury

ContusionBruising of brain tissueMay develop hemorrhageSymptoms depend on area(s) and severity

Brainstem-decreased LOC (may be permanent), motor response, pupil reaction, eye movement, elevated RR, fever

CT scan shows tissue swellingTreatment supportive

Types of Injury

Types of InjuryHematoma

Subdural (A)Usually venousBetween dura

and arachnoid membranes

Epidural (B)Usually arterialBetween dura

and skull

Subdural HematomaAcute vs Chronic

If chronic, may be months from injury to S+SForgetfulLethargicIrritableHeadache

Damage to brain tissue as blood accumulatesLOC changesHemiparesisDilated pupilExtremity weakness

Types of Injury

Epidural HematomaOften associated with skull fractureArterial, so usually progresses quicklyLoss of consciousness after injury>regain

consciousness, coherent>then rapid deterioration

Decreased LOC, seizures

Types of Injury

CT-test of choice, rapid resultsMRINeuropsychological Testing

Diagnosis

Surgical Removal of HematomaBurr holes, craniotomy

Control IICPICP Monitoring

Drainage of CSFOsmotic Diuretic

Mannitol (Osmitrol)Mechanical Hyperventilation

Therapeutic Coma

Therapeutic Interventions

Brain HerniationDiabetes Insipidus

Damage to Pituitary=too little ADHAcute Hydrocephalus

Ventriculoperitoneal shuntLabile Vital SignsCognitive and Personality ChangesOften life-long deficits

Complications of TBI

Brain Herniation

PVS-Continual condition of complete unawareness of the environment, there is at least partial preservation of hypothalmic and brain stem functioning

Coma-state of unconsciousness from which one cannot be aroused and is unresponsive

Persistent Vegetative State (PVS)

Ineffective Cerebral Tissue PerfusionIneffective Airway ClearanceIneffective Breathing Pattern Disturbed Thought ProcessesSelf-Care Deficit PainSensory-Perceptual DisturbanceImpaired Physical MobilityRisk for Injury

Nursing Diagnoses TBI

ICU-monitoring ICPMonitor neuro status frequently

Glasgow Coma ScalePupil responseMuscle strengthVital signsMonitor for seizuresPosturing

DecorticateDecerebrate

Nursing Care TBI