Neuro & Degenerative Disorders – Quick Review Notes

Neurologic Dysfunction:

Altered Level of Consciousness (LOC)

• Etiology: neurologic (head injury, stroke), toxicologic (overdose, alcohol), metabolic (hepatic/renal failure, DKA)

• Key findings: ↓ alertness, pupillary/eye/verbal/motor changes, restlessness → coma

• Glasgow Coma Scale: $3 =$ deep coma, $15 =$ fully awake

• Diagnostics: CT/MRI, EEG, labs (glucose, CMP, ABG, tox screen)

• Management: secure airway (intubation/trach), mechanical ventilation, IV access, nutrition (tube/G-tube), treat cause, prevent complications

Delirium

• Acute, reversible confusion in ICU/older pts; up to $80\%$ of ICU pts

• Risk: dementia, coma history, age, benzos, transfusions

• CAM/DI for screening; reversible causes via labs/imaging

• Interventions: treat cause, minimize psychoactive meds, calm environment, re-orient, early mobilization, O₂ & fluids, sleep hygiene

Dementia (esp. Alzheimer’s)

• Progressive cognitive, functional, behavioral decline; average survival ≈ $10$ yrs

• Risk: age, FH, TBI, female, race

• S/S: memory loss, personality change, wandering, sleep issues, ataxia

• Work-up: history, MRI/CT/PET, labs to r/o other causes

• Nursing: safe routine environment, bowel/bladder schedule, skin checks, cognitive stimulation; meds (donepezil, memantine, cholinesterase inhibitors)

Seizures / Epilepsy

• Patho: sudden, recurrent, uncontrolled neuronal discharges

• Types: tonic-clonic, absence, myoclonic, atonic, partial (simple/complex), status epilepticus ≥$5$ min

• Causes: tumor, stroke, infection, withdrawal, metabolic derangements

• Assessment: aura, episode description, pupils, incontinence, duration, post-ictal state; EEG/MRI

• Nursing (during): airway, side-lying, protect head, no restraints, note time

• Tx: anticonvulsants; status epilepticus = rapid benzodiazepine/anticonvulsant, airway, O₂

Headaches

Migraine

• Phases: premonitory → aura → headache → postdrome

• S/S: unilateral throbbing, photophobia, N/V; with/without aura

• Tx: triptans, NSAIDs, antiemetics; prophylaxis (β-blockers, antiepileptics, antidepressants)

Cluster

• Severe unilateral orbital pain, lacrimation, rhinorrhea; men>women

• Tx: $100\%$ O₂ $15$ min, sumatriptan

Tension

• Band-like bilateral pressure

• Tx: NSAIDs, heat/massage, muscle relaxants

Cranial Arteritis

• Temporal artery inflammation in elderly; risk of vision loss; steroids urgent

• Prevention: avoid triggers (tyramine foods, ETOH), regular sleep, stress control, diary

CNS Infections

Meningitis

• Bacterial (S. pneumo, N. meningitidis) vs viral

• S/S: fever, headache, nuchal rigidity, +Kernig/+Brudzinski, photophobia, rash

• CSF: ↑WBC/Protein, ↓glucose; CT/MRI

• Tx: IV penicillin G + cephalosporin, dexamethasone, droplet isolation $\le$ $24$ h post-ABX; vaccine & rifampin prophylaxis contacts

Herpes Simplex Encephalitis

• HSV-1; fever, confusion, focal seizures; MRI, PCR

• Tx: IV acyclovir $\approx$ $3$ wks; neuro monitoring

Creutzfeldt–Jakob (prion)

• Rapid dementia, ataxia; no inflammation; fatal <$1$ yr (CJD) / $14$ mo (vCJD)

• Supportive care; standard precautions

Autoimmune Neurologic Disorders

Multiple Sclerosis (MS)

• Immune demyelination of CNS; forms: RRMS, SPMS, PPMS, PRMS

• S/S: fatigue, weakness, vision issues, ataxia, spasticity, bowel/bladder dysfunction

• MRI plaques; CSF oligoclonal bands

• Tx: interferon-β, glatiramer, fingolimod, IV methylprednisolone; symptom meds (baclofen, carbamazepine, docusate, propranolol)

• Nursing: energy conservation, mobility, prevent UTIs, skin care

Myasthenia Gravis (MG)

• Autoantibodies destroy ACh receptors → fluctuating muscle weakness (ocular, bulbar, respiratory)

• Dx: edrophonium (Tensilon) or ice test, AChR antibodies, EMG, thymus MRI

• Tx: pyridostigmine, corticosteroids, azathioprine, IVIG, plasmapheresis, thymectomy

• Myasthenic crisis: infection-triggered respiratory failure → vent support; hold cholinesterase inhibitors

Guillain–Barré Syndrome (GBS)

• Post-infectious autoimmune demyelination of peripheral nerves; ascending paralysis

• S/S: bilateral limb weakness, paresthesia, autonomic dysfunction, resp failure

• Tx: plasmapheresis or IVIG; ICU resp monitoring; prevent immobility complications

Degenerative Disorders

Muscular Dystrophies

• Inherited muscle wasting (e.g., Duchenne); ↑CK, cardiomyopathy, ↓resp reserve

• Care: PT, braces, pulmonary support, genetic counseling

Huntington’s Disease

• Autosomal dominant; chorea + dementia + behavioral changes; dx via CAG repeat

• No cure; tetrabenazine for chorea, SSRIs; planning for progressive decline

Amyotrophic Lateral Sclerosis (ALS)

• Loss of motor neurons; progressive limb weakness → dysphagia/resp failure

• No cure; riluzole, edaravone; NIV or trach, PEG; multidisciplinary support

Degenerative Disc Disease

• Herniated discs causing radicular pain

• MRI/EMG; conservative therapy then surgical decompression if deficits persist

Cranial Nerve Disorders

Trigeminal Neuralgia (CN V)

• Sudden unilateral facial pain; triggers minimal

• Carbamazepine first line; gabapentin/baclofen; decompression/ablation if needed

• Nursing: oral hygiene during pain-free periods, soft food, postop neuro checks

Bell’s Palsy (CN VII)

• Acute unilateral facial weakness; thought viral

• Prednisone within $72$ h; eye protection, facial exercises; recovery $3–5$ wks

Peripheral Neuropathy

• Bilateral distal sensory/motor loss (e.g., diabetic, chemo)

• S/S: numbness, pain, ↓reflexes, muscle wasting

• Management: control cause, fall/skin injury prevention (footwear, temp checks)