acute neurological disorders (seizures) | NURS240

what are the triggers for headache?

1. diet (haven’t eaten anything or is eating inconsistently)

2. stress

3. hormonal shifts

4. sensory stimulation (e.g., bright light, loud sound, strong odor, etc)

5. changes in the environment (e.g., temperature, seasonal allergies)

what are the key features of a tension headache?

1. most common type of headache

2. feels like pressure, tightness, or band-like pain around the head

3. often affects the entire head (bilateral)

4. pain severity can vary from mild to moderate

5. usually occurs without associated symptoms (no nausea, aura, etc)

what are the common triggers of tension headaches?

1. stress/anxiety

2. muscle tension (neck/scalp)

3. fatigue

4. poor posture

5. eye strain

6. lack of sleep

how is a tension headache different from a migraine?

tension headache:

1. pressure/tightness

2. whole head

3. no nausea or aura

4. mild to moderate

migraine:

1. throbbing/pulsating

2. often one-sided

3. nausea, light sensitivity aura possible

what are the available treatment of tension headache?

1. rest and relaxation

2. pain control (use acetaminophen first, than resort to NSAIDS and ASA if acetaminophen doesn’t work)

3. trigger control

what are the key features of a migraine headache?

1. often unilateral (one-sided)

2. usually frontotemporal location

3. throbbing/pulsating pain

4. moderate to severe intensity

5. can interfere with daily activities

one-side pounding headache

what symptoms are commonly associated with migraines?

1. anorexia (loss of appetite)

2. nausea/vomiting

3. photophobia (light sensitivity)

4. phono-phobia (sound sensitivity)

5. fatigue

how long do migraines usually last for?

usually from 4-72 hours if untreated or not fully relieved

what causes migraines?

exact causes is not fully understood, but linked to:

1. neurovascular changes in the brain

2. changes in neurotransmitters (especially serotonin)

3. genetics/family history

4. triggers (stress, hormones, foods, sleep changes, etc)

how is a migraine different from a tension headache?

1. throbbing (as opposed to tightness/pressure)

2. often one-sided (as opposed to the whole head)

3. nausea/light/sound sensitivity

4. more severe and often can require using medications to relieve symptoms

what are the key features of a migraine without aura?

1. no aura before headache

2. early signs may include mood changes

3. then headache pain + at least one of these: (1) nausea/vomiting, (2) photophobia (light sens), (3) phonophobia (sound sens)

4. common triggers/timing: early morning, stress, PMS/hormonal changes, and fluid retention

what are the three phases of migraine with aura?

prodromal phase (the first 15-60 minutes)

1. early warning symptoms before aura/headache

2. mood changes, fatigue, food cravings, irritability

3. often accompanied with warning signs like visual changes, spot in vision, partial vision loss

second phase (aura phase)

1. temporary neurologic symptoms before headache

2. visual changes (flashing lights, zigzags, blind spots)

3. numbness, tingling, speech difficulty possible

third phase (headache phase)

1. throbbing headache with nausea, photophobia, phonophobia

true or false: migraine with aura are also known as classic migraine

true

what is the difference between a migraine with aura vs. one without aura?

with aura:

1. neurological warning signs before headache

without aura:

1. no neurologic warning signs

both may have:

1. throbbing pain

2. nausea/vomiting

3. light/sound sensitivity

what is an aura in migraines?

an aura is a temporary reversible neurologic disturbance that happens before or during the migraines (e.g., visual disturbances, tingling/numbness, and speech changes)

review the treatment available for migraine…

1. prevent the migraine by identifying triggers

2. medications → preventive therapy may include beta blockers and select AEDs → abortive therapy may include NSAIDs, ditans, triptans, ergotamines (causes vasoconstriction), and anti-emetics → botulism toxin A injections can reduce muscle tension which reduces occurrences of migraine and CGPR monoclonal antibody

3. adjuvant therapy: rest, relaxation, darkened/quiet room, and complementary therapies

what are the key features of a cluster headache?

1. severe unilateral headache

2. usually oculo-temporal or oculo-frontal (around or behind one eyes)

3. sharp, piercing, burning pain

4. very intense but shorter duration than migraine

stabbing pain around one eye

what is the headache pattern of cluster headaches?

1. occur in clusters: 1-3 headaches/day and last for 4-12 weeks then followed by a remission period

2. each episode lasts for about 30-120 minutes

what symptoms are associated with cluster headaches?

usually on the same side as the headache (ipsilateral)

1. tearing

2. rhinorrhea (runny nose)

3. ptosis (drooping eyelid)

4. flushing or pallor

5. patient often feels better walking or pacing

6. onset often related with relaxation, napping, REM sleep

what is the treatment for cluster headache?

1. pain medication (Rx or OTC)

2. oxygen therapy

3. decrease light exposure/glare

4. maintain a consistent sleep/wake cycle

what are the different type of headaches and their descriptions?

1. sinus: pain is usually behind the forehead and/or cheekbones

2. cluster: pain is in and around one eye

3. tension: pain is like a band squeezing the head

4. migraine: pain, nausea, and visual changes are typical of classic form

what is the difference between a seizure and epilepsy?

1. seizure = a single episode of abnormal, excessive electrical activity in the brain

2. epilepsy = a chronic disorder with recurrent, unprovoked seizures

one seizure does not always mean epilepsy

what causes seizures (primary and secondary)

1. primary (idiopathic epilepsy): no clear identifiable cause and are often genetic

2. secondary (acquired seizures): head trauma, stroke, brain tumor, infection, electrolyte imbalance, drug/alcohol withdrawal

what history is important when evaluating seizures?

1. age of onset

2. description of seizure activity

3. duration

4. any precipitating factors

5. presence of an aura

6. post-ictal period (confusion, sleepiness after seizures)

what is the difference between a focal onset and a generalized onset seizures?

1. focal onset: one hemisphere; the patient can have motor or non-motor symptoms with focal to bilateral tonic-clonic; the patient can either be aware or have impaired awareness

2. generalized onset: both hemispheres; the patient presents with a tonic clonic or other motor symptoms with no non-motor symptoms; the patient has impaired awareness

what are the three phases of a seizures?

1. beginning: prodromal (occurs hours or das before involving mood changes, anxiety, lightheadedness, sleep difficulties) → aural (early ictal - the immediate warning signs before the seizures such as strange smells/taste, visual/auditory changes, and fear)

2. middle (ictal - active seizure): last for a few minutes; can occur with loss of consciousness, convulsion (rhythmic jerking/shaking, stiffening (tonic phase), staring spells, or automatic behaviors like lip-smacking

3. ending (post-ictal): followed the end of the seizure with confusion, extreme fatigue, headache, muscle soreness → the person may fall asleep, feel disoriented (reorientation is very important!) or have no memory of the event or retain partial consciousness

true or false: low blood glucose can be a trigger for a seizures

true

what are the 3 main classification of seizures?

1. generalized seizures → involve both hemispheres of the brain

2. focal seizures → begin in one area of the brain

3. unknown onset seizures → start is not witnessed or unclear

what are the features of an absence (petit mal) seizures?

1. common in children

2. brief loss of awareness → seen like they are mentally “absent” or “paused” → looks like they are zoning out

3. blank starting

4. no post-ictal confusion → they seem to just snap back to their previous stage with some memory loss of event happen right before like what they were saying

5. returns to baseline immediately

what are the key features of a tonic-clonic (grand mal) seizures?

1. last 2-5 minutes

2. tonic phase: stiffening, rigidity, LOC

3. clonic phase: rhythmic jerking of extremities

4. post-ictal: fatigue, confusion, lethargy (up to 1 houe)

what are the nursing interventions for patient who is actively seizing?

1. lay the patient down on their side

2. cushion their head and remove glasses

3. time the seizure with a watch

what are the key features of a myoclonic seizure?

1. brief jerking of stiffening of extremities (often the head or the upper extremities)

2. last only seconds → no post-ictal

3. can be symmetrical or asymmetrical

4. have aura

kind of like a sudden muscle jerk

review the pharmacologic treatment for seizures?

1. anti-epilepsy drugs that potentiate GABA action: clonazepan, diazepam, gabapentin, pregabalin, phenobarbital, topiramate

2. AEDs that suppress sodium influx: carbamazepine, lamotrigine, phenytoin, valproic acid (mono-therapy is generally successful with side effects over efficacy but there are many drug and food interaction so be careful!

review the surgical treatment options for seizures…

1. vagus nerve stimulation

2. responsive neurostimulation therapy

3. resective surgery

4. disconnection surgery

what are the features of an atonic seizure?

1. sudden loss of muscle

2. patient may collapse (drop attack!)

3. last seconds

4. may have post-ictal period

this is associated with a high injury risk due to falls potential

what are the features of a focal onset aware seizure (simple focal/partial)?

1. starts in one area of the brain

2. awareness usually preserved

3. may have aura

4. unilateral movement of one extremity

5. unusual sensations (smell, tingling, fear)

what are the features of a focal onset impaired awareness seizure?

1. aura may be present

2. decreased awareness or LOC

3. automatism (lip smacking, picking, repetitive movements)

4. amnesia after seizure

5. post-ictal drowsiness or sleep

what is an unknown onset seizure?

1. beginning of seizure is not known

2. often not witnessed

3. can later be reclassified if more info becomes available may be motor or non-motor

how do I quickly distinguish seizure types?

1. absence = stare

2. tonic-clonic = stiff + jerk

3. myoclonic = quick jerk

4. atonic = drop

5. focal aware = conscious

6. focal impaired = confused + automatisms

what are the essential patient teaching for seizures?

1. identify triggers

2. inform the patient about their medications

3. ID card/bracelet

4. state law regarding driving and operating machinery while living with seizure conditions

what are febrile seizures?

1. transient seizures associated with fever

2. usually occur during a rapid rise in the body internal temperature

3. often happen with URI (upper respiratory infection) or GI infections

4. common age: 3 months to 3 years

what causes febrile seizures?

1. high fever, especially with infection such as: upper respiratory infections (URI) and gastrointestinal (GI) infection → it is often the fever itself, not the infection directly, that triggers the seizure

2. It is often the fever itself, not the infection directly, that triggers the seizures

are febrile seizures dangerous?

1. most are brief and benign

2. usually children can recover fully

3. evaluate if seizure is prolonged, repeated, or child appears very ill

what is status epilepticus? what causes status epilepticus?

1. a seizure that last for more than 5 minutes or repeated seizures over 30 minutes without full recovery between them

2. this is a medical emergency

3. these following can cause status epilepticus: medication nonadherence/abrupt withdrawal, alcohol withdrawal, infection, head trauma, cerebral edema

how is status epilepticus treated?

1. priority = ABCs

2. airway protection

3. oxygen

4. IV access

5. rapid anticonvulsant medications: diazepam, lorazepam, phenytoin

why is status epilepticus dangerous?

prolonged seizures can cause:

1. hypoxia

2. brain injury

3. acidosis

4. hyperthermia

5. death if untreated

true or false: febrile seizure are often found in children?

fever in toddlers

what are the key features of viral meningitis?

1. peak season: summer/fall

2. often caused by enteroviruses

3. may also occurs with mumps, measels, herpes simplex, herpes zoster

4. causes meningeal swelling

5. CSF negative for organisms

6. usually self-limiting (3-10 days)

what are the key features of bacterial meningitis?

1. more common in fall/winter

2. common causes: streptococcous pneumoniae, neisseria meningitidis

3. causes severe inflammation + exudate

4. can damage the brain tissues

5. CSf positive for organisms

6. this is MEDICAL EMERGENCY

what skin findings may occur with meningococcal meningitis?

1. petechial rash = small red/purple pinpoint spots from microhemorrhages under the skin from tiny broken capillaries

2. caused by vascular injury and bleeding associated with neiserria meningiditis

3. can progress rapidly and may indicate meningococcemia/sepsis

what are the most common signs of meningitis?

1. headache

2. fever

3. changes in mental status

4. photophobia

5. nausea/vomiting

6. seizures

what signs suggest meningeal irritation?

1. nuchal rigidity (stiff neck)

2. brudzinski’s sign (flex the patient’s neck forward while lying flat → a positive signs would be the patient’s hips and knees flex involuntarily) → neck flexions stretches inflamed meninges, causing the legs to bend to reduce pain

3. Kernig’s sign (the patient lies flat and flex hip and knee to 90 degrees and as they try to straighten the knee, there would be pain, resistance, or inability to extend the knee at all)

what serious complications can occur with meningitis?

1. increased intracranial pressure (ICP)

2. vascular dysfunction

3. seizures

4. brain injury

5. septic shock (especially meningococcal disease)

what laboratory tests are used to assess meningitis?

1. CSF analysis (most important) → cell count, protein, glucose, cultures

2. CBC

3. electrolytes

CSF helps identify viral vs. bacterial meningitis

why is CSF analysis important in meningitis?

a lumbar puncture checks cerebrospinal fluid for:

1. WBC count → infection/inflammation

2. protein → often elevated with meningitis

3. glucose → often low in bacterial meningitis

4. culture → identifies organism causing infection

what imaging studies may be used in meningitis assessment?

1. chest X-Ray (CXR) → look for respiratory infection source

2. sinus X-Rays → evaluate sinus infection source

3. CT head → assess swelling, complications, or contraindications before LP

what are the key nursing interventions for a patient with meningitis

1. frequent neuro checks (q2-4 hr)

2. assess cranial nerves

3. assess vascular system

4. seizure precautions

5. manage pain

detect complications early and support brain functions

why are frequent neurological checks important in meningitis?

1. monitor level of consciousness

2. detect worsening infection or increased ICP

3. identify new neurological deficits early

changes in neuro status can signal deterioration