3.

TRIGEMINAL NEURALGIA (Tic Douloureux) -Involving the 5th cranial nerve by paroxysms of sharp, stabbing excruciating pain in one or more branches of the trigeminal nerve o Facial expressions are affected o -Very sensory (sensitivity reactions even to small stimulation) even gush of air o -Distribution of trigeminal nerve (sensory and motor distribution) Sensory distribution: Ophthalmic (raise eyebrows), Maxillary division (smile frown), mandibular division Motor distribution: Muscle of chewing (along jaw area) chewing problem Clinical manifestations: 1. Sudden & severe pain; flashes of pain o -Without warning o -Usually entails one side of the face 2. Attacks predicted by pressure on trigger point o -Sensory and motor points (pic) o -Talking, chewing, yawning swallowing, sighing (stimualtions that trigger the point) Management: 1. Carbamazepine (TEGRETOL) or phenytoin (DILANTIN) o -Pain relievers that act as anticonvulsant for abnormal movt of pain o Stabilize the increase in influx of sensory and muscular movt over the area o -Causes drowsiness Causes ataxia 2. Alcohol or Phenol Block o -Injectable o -concentrated on trigeminal (branches)l nerves o -mos-up to 2 yrs before it can be treated 3. Percutaneous Radiofrequency Trigeminal Gangliolysis o -use if low voltage frequency (electrical current) o -relief of pain o -effectiveness by asking pt to chew on affected side (achievement return if mast) 4. Microvascular Decompression of trigeminal nerve o -surg tx (mgt of choice) o -Removal of pressure o -clots, fats 5. Open surgical retrogasserian rhizotomy -surg remedy tx of choice -division or transection of the nerve root -either within or outside if spinal cord Nursing interventions: 1. Recognize factors that aggravate excrutiating pain -too much cold or heat (extreme temp)

-too much showing -too much opening of mouth 2. Anxiety, depressions and insomnia may accompany pain -resolve whatever prob they experience 3. Post-operative interventions -artificial tears (methylcellulose) -slow facial exercise -frequent dental checkup -jaw exercises (slow talking, exercise) -soft candy (no gums) 4. CEREBROVASCULAR DISEASE- interference with normal blood supply to the brain. -classification of hemorrhage: aacdg to areas -extradural (outside dura mater) -subdural (beneath dura) -subarachnoid (beneath arachnoid) -intracerebral (within brain substance itself) 4.1 TRANSIENT ISCHEMIC ATTACKS (TIAs)-transient episodes of cerebral dysfunction by sudden loss of motor, sensory or visual function, lasting minutes up ton an hour or more but not longer than 24 hrs. -simple stroke or slight stroke -compared to RIND IS TIME -how many attacks. -loss of consciosness (most impt determinat) no longer than 24 4.2 REVERSIBLE ISCHEMIC NEUROLOGIC DEFICIT (RIND) -neurologic deficits longer than 24 hrs but followed by a return to normal state. -how many attacks 4.3 CEREBRAL THROMBOSIS- from cerebral arterisclerosisand slowing of cerebral circulation -distinguish by CT, MRI, Hx -primarily theres findings -speech (aphasia) and vision problems 4.4 CEREBRAL EMBOLISM- c/b heart dse pulmonary emboli, arteriosclerosis plaque in carotid artery. -previous surgery, procedure or accidents is most likely -circulatory disruption not only in the brain Gen manifestations of CVD 1. Atherosclerosis 2. Cerebral microcirculation (embolus) 3. Hx of platelet aggregation (bleeding hx) 4. Taking antocoagulants Treatment: Surgery (intracranial or extracranial anastamosis) -sx of choice -only possible via craniotomy

5. STROKE (CEREBRAL VASCULAR ACCIDENT)- is the onset of neurologic dysfunction resulting from disruption of the blood supply to the brain. -interruption c nerve impulse or electrical conduction in coritcospinal CAUSES: 1. Thrombosis -blood clot within b. vessels -hyperlipidemic 2. Cerebral embolism -wandering clot 3. Ischemia -decreased blood suppl -narrowing bc of fat depostion along intima of blood vessels 4. Cerebral hemorrhage -disruption of b. vessels -injury, comppress, burst Risk factors: Previous transient ischemic attack -signals possibility of attcak, cva Heart disease -angina dt streess and tension -mi Diabetes mellitus -blood thickens Red blood cell disorders -hemodynamic -platelet aggregatiom (bleeding/hemorrhagig) Cigarette smoking or substance abuse -carcinogenic content causes sclerosis (hardening of the intima) Clinical manifestations: 1. Sudden severe headache -abrupt, unexplainable -anytime of the day 2. Numbness, weakness, or motor loss, visual -hemiparesis (weakness) plegia(paralysis) -also vision is altered (visual pathway defects) Bilatemporal hemianopsia (visual field affected) Rt homonymous hemianopsia Both suffers half of sight If c macular sparing, with shadows before the eyes -stance or balance perceptual disturbance (prob spdissoating horizontal and verti lines) -frozen shoulder (pic) everything should be custom-made 3. Impairment of mental activity -aphasia (interpretation and expression) Fluent (expression prob)

Wernickes (how pt speak, no content of the msg), anomic or amnesic (the pt have difficulty finding words provide time), conduct (difficulty repeating spoken words) nonfluent (non verbal) Global -both -initialy fluent then non fluent. Management: 1. Close observation and monitoring of hemodynamic parameters -laboratories -wof further bleeding for pt 2. Support of vital functions -oxygenation (provision of adeq blood supply) 3. Post-stroke rehabilitation program -antihypertensives if needed, and anticovulsant -never dc 4. Antispasmodic agents Diazepam Dantrolene Baclofen Nursing Interventions 1. Positioning -prevent compression neuropathy -proper body alignment 2. Achieving self-care -long term tx goals -rom -custom made (loose clothes velcro) 3. Develop compensating skills for sensory dysfunction -dt homonymous hemianopsia -loss of sensation (strenthen muscles of affected side) like candies popsicles to encourage use of affected side 4. Attaining bladder control -intermittent bladder training -must have sensation 5. Helping family cope -respite care (nsg home) *INTRACRANIAL ANEURYSM- is dilatation of the walls of the cerebral artery . Rupture of an intracranial aneurysm leads to subarachnoid hemorrhage. -similar to cvd -supportive symptomatic -pain mgt -craniotomy (sx of choice) -physical therapy Etiology of ic anurysm 1. Atherosclerosis -diet high fat and chole -substance abuse (smoking)

2. Intracranial arteriovenous -arteries in the brain -if cause is brought about by increasing pressure on major supply of the brain 3. Hypertensive vascular dse -long-term -CHF 4. Head trauma -accidents Cm 1. Sudden onset of new, atypical headache -eye pain (blood supply to optic nerve) -occurs during early morning hrs -ca of brain or neuroblastoma (inborn) headache upon waking up 2. Loss of consciousness -GCS -assess based on level of cerebral functioning 3. Visual disturbances -photophobia -blurred vision/cloudiness (misty vision) -diplopia 4. Fever and neck stiffness -metabolic manifestations (hypothalamus is affected) -thermodynamics problem -spinocortical spine --stiffness 5. Dizziness, nausea and vomiting -metabolic -experience head fullness 6. Hemiparesis Mgt 1. Cardiac monitoring -if cause if hypertensive vascular dse, ECG 2. Manage increased ICP -volume replacement but monitor -i&o monitoring Monitor, vital status, iand o supportive meds -diuretics to remove excess fluid -avoid activities that increase icp (antiemetics), valsalva (stool softener) -antispasmodics -antihypertensive Antipyretics 3. Antifibrinolytic agent -to prevent further bleeding -only prevents further clot formation 4. Ca channel blockers

- for hx of ischemia -prevent further cardiac contraction (to dec cardiac demand) 5. Prophylactic antiseizure therapy -in case pt manifests seizures 6. Surgical interventions -craniotomy (obliterate aneuryms) Nsg interventions 1. Immediate and absoulte bed rest -quiet, nonstimulating envt -no visitors allowed 2. Avoid activities that increase blood pressure or obstruct venous return -val salva 3. Use appropriate psychological interventions and reassurance -realistic goals only 4. Recognize neurologic determination and determine optimum time for surg intervention -lethargic to stuporous - to determinemprognosis -Loc, gcs 5. Monitor f and e disturbance -manifestations of anuria, polyuria -inappropriate secretion of antidiuretic hormone 7. EPILEPSIES- an electrical disturbance in the nerve cells in one section ofthe brain that causes them give off abnormal, recurrent, uncontrolled electrical discharges. -not all seizures (convulsion) are epilepsy -seizure is a general term (some other head trauma or neuro dse, medications) - a more particular term -most cases, inborn - associate devt with low content of fat in the body - common is ketogenic diet (inc Good fat) Causes 1. Genetic factors -inborn 2. Trauma -falls, bumps in earlybstage of devt 3. Brain tumor -neuroblastoma 4. Circulatory disorder - hemodynamic problems -clotting prob 5. Metabolic disorder (not enough nurtition) -hypoglycemia -hypocalcemia

6. Toxicity -drugs taken by mother -alcoholism 7. CNS Infection -meningitis -Encephalitis *consistent siezures dt accidents(asults) 3 stages of seizures: -aura (initial symptoms) Usu flashes of light Trembling sensation in the body -tonic-clonic (rigid flaccid) Only clonic wher pt is breathing--c. Hypoxia Intervals are equal (regularity) -postictal Stage of exhaustions Goes to sleep Types of seizure 1. Grand mal -generaizedl All parts of body 2. Petit mal Short span of loss of consciousness Cannot assess tonic clonic matter of seconds 3. Jacksonian Spreads to other parts of body 4. Status epilepticus Continuous Long term tonic clonic Clinical manifestations: 1. Impaired consciousness -assess level 2. Disturbances in sensation and perception -abruptly discontinued 3. Disturbance of autonomic functions of body - lip smacking autonomic manifestations -sudden localized seizures in some parts of body (aftermath) Management 1. Drug therapy -never dc antispasmodic, antiepileptic drug 2. Biofeedback - meditation, yoga 3. Surgical intervention -craniotomy

Nsg assessment: 1. Seizure hx -Onset, precipitating factor, duration, frequency -stress, alc , drug (p. factors) 2. Prodromal symptoms Insomnia Modd changes 3. Alcohol intake Years Quantiy 4. Effects in life Do work at home 5. Patient coping Pyschologically disabling Nsg interventions: 1. Controlling seizures and preventing occurences -avoid p. factors 2. Learn stress-reduction teachniques -pmr, deep breathing Outdoor Clean area to prevent suffocation Avoid articles resulting head bump Support head In aura, gude pt to lie on floor, put oething in mouth Never open mouth if clench Measure tonic clonic Should have wrist band Cant drive car