 tiny gap at this junction is called
Care of CLIENT with neurologic problems
gudecena
Major Divisions of the Nervous System
A. CENTRAL NERVOUS SYSTEM (CNS), consisting
of the brain and spinal cord,
B. PERIPHERAL NERVOUS SYSTEM (PNS), the
vast network of spinal and cranial nerves linking
the body to the brain and spinal cord.
The PNS is subdivided into:
AUTONOMIC NERVOUS SYSTEM
involuntary control of:
• internal organs
• blood vessels,
• smooth and cardiac muscle
A. SYMPATHETIC NERVOUS SYSTEM
B. PARASYMPATHETIC NERVOUS SYSTEM
Structures Protecting the Brain
1. Meninges
covers the brain
provides protection, support and nourishment
to the brain and spinal cord
LAYERS:
1. Dura Mater
2. Arachnoid- contains the choroid plexus
3. Pia Mater
2. CerebroSpinal Fluid
a clear and colorless fluid produced in the
choroid plexus at the lateral 3rd & 4th ventricles
Contains minimal wbc and no RBC
3. Blood-Brain Barrier
Formed by the endothelial cells of the brain
capillaries
All substances entering the CSF must filter
through these barriers
Dyes, medications and anitibiotics are examples
of substances that cannot reach the CNS
Synapse [SIN-aps]
 junction between the axon tip
of the sending neuron and the
dendrite or cell body of the
receiving neuron
the synaptic gap or clef
Neurotransmitters
 chemical messengers that
traverse the synaptic gaps
between neurons
 when released by the sending
neuron, neuro-transmitters
travel across the synapse and
bind to receptor sites on the
receiving neuron, thereby
influencing whether it will
generate a neural impulse
Neurotransmitters
There are approximately 50 neurotransmitters
identified
are chemicals located and released in the brain
to allow an impulse from one nerve cell to pass
to another nerve cell.
Nerve cells communicate messages by secreting
neurotransmitters.
Neurotransmitters can excite or inhibit neurons
Cranial Nerves
are composed of twelve pairs of nerves that
emanate from the nervous tissue of the brain.
Neurodiagnostic Studies
1. Lumbar Puncture/Spinal Tap- for CSF
analysis
- CSF should be clear and colorless
- Obtained for cell count, culture, glucose
and protein testing
- Also used to measure CSF fluid or
pressure, or instill air, dye or meds
- A spinal needle is inserted into the
subarachnoid space between 3rd and 4th
or 4th and 5th lumbar vertebrae
Nursing Management in Assisting with Spinal
Tap/Lumbar Puncture
PreProcedure
- Signed consent
- Explain procedure and clarify
misconceptions
During the Procedure
- Position: Back of patient towards MD,
lateral recumbent have client draw knees to
abdomen and chin to chest
- Pillows on patient’s head and between legs
- Maintain position to prevent trauma
resulting to a bloody tap
During Procedure
- Instruct patient to breathe normally and
relax; hyperventilation may lower an
elevated pressure altering accurate
pressure reading
- Assist in cleansing lumbar area with
betadine sol’n and draping (observe
strict aseptic technique)
- MD will inject a local anesthetic to
numb puncture site
- A specimen is collected usually in 3
tubes; MUST be labeled in order of
collection. Pressure reading may also be
obtained.
Post Procedure
Patient must lie PRONE for 2-3 hours to reduce
leakage of CSF
Monitor for complications of Lumbar tap
Force fluid intake to prevent post-procedure
headache
Monitor intake and output
Post Lumbar Tap Complications
Post Lumbar Puncture Headache
Temporary voiding problems
Slight elevation of temperature
Backache or spasms
Stiff neck
Rare but serious: herniation of spinal
intracranial contents, spinal epidural abscess,
meningitis
Radiographic
1. Skull and Spinal Radiography
- X-ray of the skull reveal the size and shape of
the skull bones, suture separation in infants,
fracture or bony defects, erosion or calcification
2. CT Scan
- Images provide cross-sectional view of
the brain, distinguish differences in
tissue densities of the skull, cortex, sub
cortical structures and ventricles
- Image is displayed on an oscilloscope or
TV monitor and is photographed
digitally
- Performed FIRST without contrast
before imaging with contrast
CT Scan Nursing Intervention
Patient needs to lie still during the entire
procedure; essential to be instructed to patient
Teach relaxation techniques
Sedation maybe necessary if patient is
confused, agitated or restless
Will require monitoring all through out
If a contrast agent/dye will be used:
Assess allergy to iodine/shellfish
4hour fasting is required prior to test
Monitor post procedure dye reaction such as
vomiting, nausea, flushing
Assess dye injection site for bleeding or
hematoma, and monitor presence of distal
pulses
Provide fluid replacement because diuresis from
dye is expected
3. Magnetic Resonance Imaging
Uses magnetic field to create an image
Provides info about chemical changes w/in the
cell to monitor an organ’s response to
treatment
Maybe used with or without dye
MRI Nursing Intervention
Assess patient for claustrophobia
Patient instructions: relaxation technique;
microphone is provided inside the scanner so
patient may speak to staff
4. Cerebral Angiogram
Injection of contrast through the femoral artery
into carotid arteries to visualize arteries and
assess for lesions
Used to investigate vascular disease, aneurysms
Frequently performed before craniotomy to
assess patency and adequacy of cerebral
circulation
May use brachial artery to inject dye or a direct
puncture of carotid or vertebral artery
alternatively
Angiography Nursing Intervention - Stupor- Awakens to vigorous shake or
Preprocedure painful stimuli but returns to
Signed Consent unresponsive sleep
4-6hours NPO - Coma- Remains unresponsive to all
Obtain baseline neuro assessment stimuli; eyes stay closed; decorticate or
Patient must be well hydrated 2days prior to the decerebrate
exam. Patient will be asked to void before going
to the x-ray department GLASGOW COMA SCALE:
Explain procedure to patient. - Developed to predict recovery from a
Patient has to be immobile during the entire head injury
procedure. - Used also to assess the LEVEL OF
A brief feeling of warmth in the face, behind the CONCIOUSNESS (LOC)
eyes, or the jaw, teeth, tongue, lips will be felt. a. EYE RESPONSE
A metallic taste after the injection of the b. MOTOR RESPONSE
contrast agent will be experienced. c. VERBAL RESPONSE
Mark peripheral pulses Maximum points/score: 15
Angiography Nursing Intervention Lowest possible score: 3
During Procedure State of coma: 7 and below
The groin will be shaved and prepared, injected Mental Status Assessment
with a local anesthetic to numb as catheter is B. Appearance and Mood
inserted Posture
Catheter will be flushed with heparinized saline Gait- smooth, coordinated
Post Procedure Motor Movements
- Observe for Dress; hygiene
signs of altered cerebral blood Facial Expression- good eye contact
flow due to minor or major arterial Speech- clear with moderate pace
blockage caused by thrombosis, Mental Status Assessment
embolism or hemorrhage producing C. Mood
neurologic deficits such as: Observe mood when asked, “How are you
 a. Altered feeing?” or “What are your plans for the
level of responsiveness and future?”
 Expression
consciousness D. Thought Processes & Perceptions
b. Hemiparesis - Clarity and content
c. Speech disturbances - Perceptions- follows directions
Angiography Nursing Intervention accurately
Post Procedure - Judgment- answers to questions are
Monitor Neuro status and V/S until stable based on
Monitor for swelling in the neck and for - sound rationale
dysphagia and NOTIFY MD if these occur Mental Status Assessment
Maintain bed rest for 12hrs as prescribed E. Cognitive Abilities
Mental Status Assessment Orientation
A. Level of Consciousness Length of concentration
- Awake– oriented to time, place and Memory
person Abstract reasoning
- Obtunded- opens eyes to loud voice, Ability to make sound judgment
responds slowly with confusion Ability to identify similarities
Sensory perception and coordination
CSF Circulation/ Pathway
CSF is produced in the choroid plexus (approx.
50-70%), and the remainder is formed around
blood vessels and along ventricular walls.
It circulates from the lateral ventricles to the
foramen of Monro
third ventricle, aqueduct of Sylvius (Cerebral
aqueduct), fourth ventricle, foramen of
Magendie (Median aperture) and foramina of
Luschka (Lateral apertures)
subarachnoid space over brain and spinal cord
CSF is reabsorbed into venous sinus blood via
arachnoid granulations.
Surgical Intervention
Craniotomy
Complications:
- Increased ICP from cerebral edema
- Hemorrhage
- obstruction of the normal flow of CSF
Surgical Intervention
Preoperative Intervention
Explain procedure to client and family
Ensure informed consent has been obtained
Prepare to shave clients head as prescribed
Stabilize client before surgery
Surgical Intervention
Avoid neck or hip flexion and maintain head in
midline neutral position
Provide quiet environment
Monitor head dressing frequently for signs of
drainage
Mark areas of drainage at least once/shift
If on ventriculostomy maintain suction of drain,
record amount and color; notify MD if drainage
is greater than 30-50ml
Record strict measurement of I&O hourly
Monitor electrolyte values
Apply ice pack or cool compresses as prescribed
for periorbital edema and ecchymosis
Positioning of Patient after Craniotomy
varies
Incorrect positioning may cause serious and
possibly fatal complications
A. Infratentorial Surgery
Flat position without head elevation or may
order head of bed at 40-35 degrees
Do not elevate the head in the acute phase of
care after surgery w/o MD order
B. Supratentorial Surgery
Head of bed elevation 30 degrees to promote
venous outflow through the jugular vein
Do not lower head of bed w/o MDs order
Common Neurologic Manifestations
Headache
(cephalgia),
is one of the most common of all human
physical complaints.
symptom rather than a disease entity
it may indicate organic disease (neurologic or
other disease), a stress response, vasodilation
(migraine), skeletal muscle tension (tension
headache), or a combination of factors
Primary headache
Include migraine, tension-type, and cluster
headaches
Migraine
is a symptom complex characterized by periodic
and recurrent attacks of severe headache.
Caused by primarily a vascular disturbance that
occurs more commonly in women and has a
strong familial tendency.
Clinical Manifestations
MIGRAINE
The migraine with aura can be divided into four
phases: prodrome, aura, the headache, and
recovery (headache termination and
postdrome).
1. Prodrome
Symptoms include depression, irritability,
feeling cold, food cravings, anorexia, change in
activity level, increased urination, diarrhea, or
constipation.
2. Aura Phase
characterized by focal neurologic symptoms,
visual disturbances (ie, light flashes and bright
spots) are common and may be hemianopic
(affecting only half of the visual field).
Other symptoms that may follow include
numbness and tingling of the lips, face, or
hands; mild confusion; slight weakness of an
extremity; drowsiness; and dizziness.
3. Headache Phase.
occur, a throbbing headache intensifies over Sometimes a tender, swollen, or nodular
several hours. temporal artery is visible.
This headache is severe and incapacitating and
is often associated with photophobia, nausea, Medical Management
and vomiting. Triptans
4. Recovery Phase Cause vasoconstriction, reduce inflammation,
- In the recovery phase (termination and and may reduce pain transmission.
postdrome), the pain gradually The five triptans in routine clinical use include
subsides. sumatriptan (Imitrex)
- Muscle contraction in the neck and naratriptan (Amerge)
scalp is common, with associated rizatriptan (Maxalt)
muscle ache and localized tenderness, zolmitriptan (Zomig)
exhaustion, and mood changes. almotriptan
- Any physical exertion exacerbates the
headache pain. Nursing Management
Relieving pain
Tension headaches comfort measures
is characterized by a steady, constant feeling of application of local heat or massage.
pressure that usually begins in the forehead, Additional strategies may include the use of
temple, or back of the neck. analgesic agents, antidepressant medications,
It is often bandlike or may be described as “a and muscle relaxants as prescribed.
weight on top of my head.” Increased Intracranial Pressure
The rigid cranial vault contains brain tissue
Cluster headaches (1,400 g), blood (75 mL), and CSF (75 mL)
are unilateral and come in clusters of one to It can result from head injury, brain tumor,
eight daily, with excruciating pain localized to hydrocephaly, meningitis, encephalitis, or
the eye and orbit and radiating to the facial and intracerebral hemorrhage.
temporal regions. Increased ICP should be treated as a medical
The pain is accompanied by watering of the eye emergency
and nasal congestion.
Each attack lasts 30 to 90 minutes and may have MANIFESTATIONS OF INCREASED ICP
a crescendo–decrescendo pattern Headache
often described as penetrating and steady Change in level of consciousness
Irritability
Secondary Headache Increased systolic BP
Associated with an organic cause, such as a Decreased HR (early)
brain tumor or an aneurysm. Increased HR (late)
Serious disorders related to headache include Decreased RR
brain tumors, subarachnoid hemorrhage, stroke, Hemiparesis
severe hypertension, meningitis, and head Loss of oculomotor control
injuries. Photophobia (light sensitivity)
Vomiting (with subsequent decreased
Other type of headache headache)
Cranial arteritis Diplopia (double vision)
often begins with general manifestations, such Decreased RR
as fatigue, malaise, weight loss, and fever. Hemiparesis
Clinical manifestations Loss of oculomotor control
MANAGEMENT OF INCREASED ICP Diagnostics
1. Elevate head of bed 15 to 30 degrees. Amniocentesis (to det increased levels of alpha-
Keep head in neutral alignment. Do not fetoprotein
flex or rotate neck. alpha-fetoprotein level – increase suggests a
2. Establish IV access. NTD)
3. Insert Foley catheter. Urine estriol level
4. Meds that may be used include osmotic Pre-pregnancy serum folic acid
diuretics, sedatives, neuromuscular Fetal ultrasound
blocking agents, corticosteroids, and MRI
anticonvulsants. CT scan
5. Restrict fluids.
6. Closely monitor vital signs and perform Types:
neuro checks. A. Anencephaly– large skull defect with
7. Monitor fluids and electrolytes no cortex. many are stillborn and other
8. Schedule all procedures (including bathing die within days of birth
and especially suctioning) to coincide with
periods of sedation. B. Encephalocele– projections of cranial
9. Discourage patient activities that result in use content through a bony skull defects, usually
of Valsalva’s maneuver. occipital region.
10. Keep environment as quiet as possible. C. Spina Bifida - CNS defect that occurs as a
11. Ventilator may be used to maintain PaCO2 result of incomplete closure of one or more
between 35-45. vertebrae.

Neurological Dysfunctions TYPES OF SPINA BIFIDA

• Depends on the spinal cord
Neural Tube Defects involvement
Closure of the neural tube occurs during the 3 rd • Visible spinal defect
and 4th week AOG. • Flaccid paralysis of the legs
Etiology • Altered bladder and bowel function
It is UNKNOWN, only associated with the • Hip and joint deformities
following Nursing Management:
Inadequate folic acid • Evaluate sac and measure lesion
Medications – antimetabolites of folic acid, • Perform neurological assessment
anticonvulsant • Monitor increase in ICP
Pregestational IDDM • Protect sac, using, use aseptic
Maternal hyperthermia technique
Genetics • Place in prone position, head turned to
Amniotic band disruption sequence one side for feeding
Teratogens • Assess for early signs of infection
radiation • Administer medication as ordered
Risk Factors: ( antibiotics, a
Maternal malnutrition
Drug exposure CEREBRAL PALSY
Low socioeconomic group • Non progressive disorder of movement
Older maternal age and posture that results from lesion of
the immature brain
Risk factors:
• Prematurity
 • Birth asphyxia
• Early infection or trauma
Clinical Manifestations
• Tones remains relatively constant
regardless of activity and level of
arousal
• Significant Hyperreflexia
• Stiff and rigid arms or legs
• Persistence of Primitive and pathologic
reflexes
• Extreme irritability and crying
• Feeding difficulties
• Delayed gross development
• Opisthotonus posture
Management
Prosthetics/Orthotics
Surgery
Hyperbaric Oxygen
Therapies: speech, physical, occupational
 Botulinum Toxin A: Botox
 Massage
Nursing Management
Assess child’s developmental level and
intelligence
Encourage early intervention and participation
in school programs
Prepare for using mobilizing devices to prevent
deformities
Communicate with the child on a functional
level, not on chronological age level
Provide safe environment
Provide safe, appropriate toys for age and
developmental level
Position upright after meals
Degenerative Neurological Dysfunctions
MULTIPLE SCLEROSIS
• characterized by small patches of
demyelination in the brain & spinal
cord.
• Aka: Disseminated Sclerosis
Immune-mediated progressive demyelinating
disease of the CNS
A chronic degenerative progressive disease of
the CNS
Diagnostic Methods
• A. MRI
• to visualize small plaques, evaluate
cause & effect of treatment.
• B. Electrophoresis
• - used to study the CSF, abnormal IgG
appears in the CSF
• - a technique widely used to separate &
identify serum proteins & other
substances up to 95% of patients.
C. Fluid- Attenuated-Inversion-Recovery
( FLAIR)
- able to detect two to three times the number
of lesions seen in MRI
D. Magnetic Resonance Spectroscopy
- decreased level of N- Acetylaspartate
(NAA) suggest presence of axonal
damage
- N- Acetylaspartate - is the second-most-
concentrated molecule in the brain after
the amino acid glutamate
Medical Management:
1. Immunomodulating Drugs- slows
disease progression, reduces relapse
Eg. Interferon beta-1a ( Avonex)
2. Immunosuppresant Drugs – same as #1
Eg. Mitoxantrone ( Novantrone)
3. Corticosteroid Drugs- exacerbations
Eg. Corticotropin (ACTH), Prednisone Deltasone
4. Muscle Relaxants- spasticity
Eg. Diazepam (Valium), Baclofen(Lioresal)
Antiepileptic Drugs –neuropathic pain
Eg. Carbamazepine ( Tegretol)
Anti depressants- depression
Eg. Amitriptyline (Elavil)
Stimulant Drugs- fatigue
Eg. Amantadine ( Symmetrel)
Cholinergic- urinary retention
Eg Neostigmine (Prostigmin)
Anti cholinergic- urinary frequency
Eg. Probantin ( Pro- Banthine)
Surgical Management:
Nursing Management
Regular exercise
Warm packs
Muscle stretching
Stretch-hold-relax routine, swimming,
stationary bicycling, progressive weight bearing
Activity and rest
Minimizing effects of immobility
Safety
Enhancing bladder and bowel control
Enhancing communication
Managing swallowing difficulties
Suction apparatus
PARKINSON’S DISEASE
Discovered by Dr. James Parkinson in the 1800
Another name for this illness is Paralysis
Agitans Latin translation of "shaking palsy.”
Is a slowly progressing neurologic movement
disorder that eventually leads to disability
Most common is the idiopathic or
degenerative form
a movement disorder often characterized by
muscle rigidity, tremor, a slowing of physical
movement
The interaction of Dopamine and Acetylcholine
 Acetylcholine stimulates muscle
contraction.
 Dopamine inhibits muscle contraction
 The primary symptoms are due to
excessive muscle contraction, normally
caused by the insufficient formation and
action of dopamine which is produced
in the dopaminergic neurons of the
brain.
 occurs when the effect of dopamine is
less than that of acetylcholine.
 The level of dopamine tends to
continue to fall slowly over time, with
an attendant worsening of symptoms.
Surgical Management
1. Thalamotomy
- stereotactic electrical stimulator destroys part
of the ventrolateral portion of the thalamus in
an attempt to reduce tremors
2. Pallidotomy
- involves destroying part of the ventral aspect
of the medial globus pallidus through electrical
stimulation
3. Neural Transplantation
- surgical implantation of adrenal medullary
tissue in the corpus striatum to establish normal
dopamine release
4. Deep Brain Stimulation
• electrode placed in the
thalamus and connected to
pulse generator, blocks nerve
pathways that cause tremors
Nursing Care
Improving mobility
Enhancing self care activities
Improving bowel eliminations
Improving nutrition
Enhancing swallowing
Encouraging the use of assistive device
Improving communication
Supporting coping abilities
Trigeminal neuralgia
- (TIC DOULOUREUX)
- is a condition of the fifth cranial nerve
characterized by paroxysms of pain in
the area innervated by any of the three
branches
- most commonly occurs in the second
and third branches of the trigeminal
nerve
Causes/ risk factors
Multiple sclerosis
Swollen blood vessels or tumor
Most often before 35 years old
More common in women
Manifestations
pain that ends as abruptly as it starts and is
described as a unilateral shooting and stabbing
sensation.
Associated involuntary contraction of the facial
muscles can cause sudden closing of the eye or
a twitch of the mouth
Factors that trigger
Paroxysms can occur with any stimulation of the
terminals of the affected nerve branches such
as washing the face, shaving, brushing the
teeth, eating, and drinking.
Medical Management
PHARMACOLOGIC THERAPY
 1. Antiseizure agents, such as
carbamazepine (Tegretol)
relieve pain by reducing the transmission of
impulses at certain nerve terminals.
 S/E: nausea, dizziness,
drowsiness, and aplastic
anemia.
 Monitor for bone marrow
depression during long term
therapy.
2. Gabapentin (Neurontin) and baclofen
(Lioresal) - used for pain control.
3. Phenytoin (Dilantin) may be used as
adjunctive therapy
Surgical Management
Microvascular Decompression of the
Trigeminal Nerve.
used to decompress the trigeminal nerve.
relieves facial pain while preserving normal
sensation, but it is a major procedure, involving
a craniotomy.
Percutaneous Radiofrequency Trigeminal
Gangliolysis.
radiofrequency interruption of the gasserian
ganglion, in which the small unmyelinated and
thinly myelinated fibers that conduct pain are
thermally destroyed
Nursing Management
Preventing Pain
Providing cotton pads and room-temperature
water for washing the face
Instruct to rinse with mouthwash after eating
when tooth-brushing causes pain, and
performing personal hygiene during pain-free
intervals
Instruct to take food and fluids at room
temperature, to chew on the unaffected side,
and to ingest soft foods.
PROVIDING POSTOPERATIVE CARE
Postoperative neurologic assessments
If the surgery results in sensory deficits to the
affected side of the face, the patient is
instructed not to rub the eye, because pain will
not be felt if there is injury.
The eye is assessed for irritation or redness.
Artificial tears may be prescribed to prevent
dryness in the affected eye.
The patient is cautioned not to chew on the
affected side until numbness has diminished.
The patient is observed carefully for any
difficulty in eating and swallowing foods of
different consistency.
MYASTHENIA GRAVIS
Medical Management
1. Anti cholinesterase
• increase the relative
concentration of available
acetylcholine at the neuro
muscular junction
• Eg. Pyridostigmine bromide
(Mestinon)
Neostigmine bromide (Prostigmin)
2. Immunosuppressive therapy
• Eg. Corticosteroid
3. Cyto toxic medications
• decrease the circulating anti
acetylcholine receptor
• Eg. Cyclophosphamide
(cytoxan )
Surgical Management
Nursing Care
Improving respiratory function
Increasing physical mobility
Improving communication
Providing eye care
Preventing aspiration
ALZHEIMER’S DISEASE
Epidemiology
- 4 million affected in the US
- Statistics will double by 2020
- Women and men are affected
equally
- 10% of the population older
than 65 are affected
 a neurodegenerative disease
 most common cause of dementia
 characterized clinically by progressive
cognitive deterioration together with
declining activities of daily living and
neuropsychiatric symptoms or
behavioral changes.
ETIOLOGY
A. Brain atropy
B. Distortions in cortical neurofibrils
(Alzheimer's fibrils)
C. Aluminum toxins
D. Alteration in acetylcholine
E. Reduction in norepinephrine, GABA
F. Altered immune functionining
G. Genetics
Pathophysiology
Assessment Findings:
 History of progressive degeneration of
mental, emotional & physical abilities
 History of progressive memory loss &
regressive behavior, physical &
emotional status in relation to needs
associated with nutrition, fluid &
electrolyte status, & safety
 History of premorbid personality from
family members
 History of medications used by the
client
Pharmacological Management
Nursing Management
Exercise and Physical Therapy
Decision making process
Speech Therapy
 Health teaching
 Address physical, emotional
and social aspect
 Medication regimen
 Safety measures
 Signs and symptoms of
disease progression
 Nutrition
 Supplemental feedings may
be required
 Monitor weight
 Consider difficulty in
swallowing
Nsg Mgt
Do not push too fast or pressure elderly (threat
to self-image, new environment, or direct
confrontation). This will result in combative
behavior.
Provide basic human needs and SAFETY
Listen to what the person is NOT saying (NON-
VERBAL CUES)
Encourage periodic rest and sleep
Assist in ADLs
Nsg. Mgt
Sing and dance, as necessary
Engage in reminiscing activities (look at old
photos, allow to share stories of the past)
Call the person by name and always introduce
yourself at the start
Actively involve the person in activities and
simple decision making
Redirect inappropriate behavior like anger
CEREBROVASCULAR DISORDERS
Stroke is the primary cerebrovascular disorder
in the United States and in the world.
2nd leading cause of death.
CEREBROVASCULAR DISORDER
Types:
A. Ischemic - damage to brain due
to a clogged artery
B. Hemorrhagic-blood vessel burst
leaking blood into brain tissues
Pathophysiology
NEUROLOGIC DEFICIT- MANIFESTATION
Visual Field Deficits
1. Homonymous hemianopsia (loss of
half of the visual field)
• Unaware of persons or objects on side
of visual loss
• Neglect of one side of the body
• Difficulty judging distances
2. Loss of peripheral vision
Difficulty seeing at night
Unaware of objects or the borders of objects
3. Diplopia - Double vision
NEUROLOGIC DEFICIT- MANIFESTATION
Motor Deficits
1. Hemiparesis
Weakness of the face, arm, and leg on the same
side (due to a lesion in the opposite
hemisphere)
2. Hemiplegia
Paralysis of the face, arm, and leg on the same
side (due to a lesion in the opposite hemisphere
NEUROLOGIC DEFICIT- MANIFESTATION
3. Ataxia
Staggering, unsteady gait
Unable to keep feet together;
needs a broad base to stand
4. Dysarthria
Difficulty in forming words
5. Dysphagia
Difficulty in swallowing
NEUROLOGIC DEFICIT- MANIFESTATION
Sensory Deficits
Paresthesia (occurs on the side opposite the
lesion)
Numbness and tingling of extremity
Difficulty with proprioception
NEUROLOGIC DEFICIT- MANIFESTATION
Verbal Deficits
1. Expressive aphasia
Unable to form words that are understandable;
may be able to speak in single-word responses
2. Receptive aphasia
Unable to comprehend the spoken word; can
speak but may not make sense
3. Global (mixed) aphasia
Combination of both receptive and expressive
aphasia
NEUROLOGIC DEFICIT- MANIFESTATION
Cognitive Deficits
Short- and long-term memory loss
Decreased attention span
Impaired ability to concentrate
Poor abstract reasoning
Altered judgment
NEUROLOGIC DEFICIT- MANIFESTATION
Emotional Deficits
Loss of self-control
Emotional lability
Decreased tolerance to stressful situations
Depression
Withdrawal
Fear, hostility, and anger
Feelings of isolation
Time Course in Stroke
Diagnostic Tests
Medical and Surgical Management
Meds:
1. Thrombolytic Therapy – Recombinant t-
PA
• minimum dose is 0.9 mg/kg; the
maximum dose is 90 mg.
• The loading dose is 10% of the
calculated dose and is administered
over 1 minute.
- The remaining dose is administered
over 1 hour via an infusion pump.
- After the infusion is completed, the line
is flushed with 20 mL of normal saline
solution to ensure that all the
medication is administered
Side Effects
Bleeding - most common side effect of t-PA
administration
Nsg. Responsibilities
cardiac monitoring
Vital signs are obtained every 15 minutes for
the first 2 hours, every 30 minutes for the next 6
hours, then every hour for 16 hours.
Blood pressure should be maintained with the
systolic pressure less than 180 mm Hg and the
diastolic pressure less than 100 mm Hg.
Airway management is instituted based on the
patient’s clinical condition and arterial blood gas
values.
Medical and Surgical Management
2. Anticoagulant (IV heparin or low-
molecularweight heparin) for ischemic strokes
3. careful maintenance of cerebral
hemodynamics to maintain cerebral perfusion.
4. Reduce ICP by administering an osmotic
diuretic (eg, mannitol), maintaining PaCO2
within the range of 35 to 45 mm Hg, and
positioning to avoid hypoxia
Other treatment measures include the
following:
Elevation of the head of the bed to promote
venous drainage and to lower increased ICP
Intubation with an endotracheal tube to
establish a patent airway, if necessary
Continuous hemodynamic monitoring
Systolic pressure should be maintained at less
than 180 mm Hg, diastolic pressure at less than
100 mm Hg to reduce the potential for
additional bleeding or further ischemic damage
Neurologic assessment
Medical and Surgical Management
Endarterectomy
surgical reopening of an artery obstructed by
ATHEROMA.
Nursing Management
Improving mobility and preventing joint
deformity
 Changing positions, maintaining skin integrity
Establishing exercise program
Enhancing Self care, activities of daily living
Managing Sensory-Perceptual Difficulties
Nursing Management
Attaining bowel and bladder control
Improving thought process
Improving communication
Improving family coping
Helping pt cope with sexual dysfunction
Continuing care
Hemorrhagic Stroke
Clinical Manifestations
Surgical and Medical Management
Analgesics
Bed rest with sedation
Surgical Evacuation (Craniotomy)
if cerebellar hemorrhage diameter exceeds 3
cm
Glasgow Coma Scale score is below 14
Aneurysm Clipping
Craniectomy
Craniotomy Procedure
Aneurysm Clipping
Nursing Management
Monitor for neurologic deterioration
Implement aneurysm precaution
Monitor and manage complications:
 Vasospasm
 Seizure
 Hydrocephalus
 Rebleeding
Teaching patient self care
Continuing care
DYSFUNCTIONS
OF THE PERIPHERAL NERVOUS SYSTEM
Amyotrophic Lateral Sclerosis
is a disease of unknown cause in which there is
a loss of motor neurons (nerve cells controlling
muscles) in the anterior horns of the spinal cord
and the motor nuclei of the lower brain stem.
 Several theories exist regarding the
cause of ALS, including autoimmune
disease and free radical damage.
 The leading theory held by researchers
is that overexcitation of nerve cells by
the neurotransmitter glutamate leads to
cell injury and neuronal degeneration
Clinical Manifestations
Fatigue
progressive weakness and atrophy of the
muscles of the arms, trunk, or legs, cramps,
Muscle fasciculations (twitching)
Muscle incoordination
Muscle spasticity
brisk and overactive deep tendon stretch
reflexes
Clinical Manifestations
difficulty talking, swallowing, and ultimately
breathing.
Weakness of the posterior tongue and palate
impairs the ability to laugh, cough, or even blow
the nose
The voice assumes a nasal sound, and
articulation becomes so disrupted that the
speech is unintelligible.
Some emotional lability may be present, but
intellectual function is not impaired.
Medical Management
 riluzole (Rilutek), a glutamate
antagonist, slows the deterioration of
motor neurons (dose of 100 mg riluzole
per day)
 Symptomatic treatment and
rehabilitative measures are employed to
support the patient and improve the
quality of life.
 Baclofen (Lioresal), dantrolene sodium
(Dantrium), or diazepam (Valium) may
be useful for patients troubled by
spasticity, which causes pain and
interferes with self-care.
Medical Management
 A patient experiencing problems with
aspiration and swallowing may require
enteral feeding.
 Mechanical ventilation (using negative-
pressure ventilators) is an option when
alveolar hypoventilation develops.
BELL’S PALSY
Pathophysiology
Clinical Manifestations
Management
Nursing Considerations
 • explain to the client that in most cases,
recovery occurs within 2 to 8 weeks.
• teach client to prevent corneal
irritation by using artificial tears,
manually closing the eye & applying an
eye shield
• teach client to keep the face warm
• teach the client to massage face gently
& perform simple exercises such as
blowing
• encourage ventilation of feelings
because self image may be affected.
• support client’s nutritional status by
providing privacy & small, frequent
feedings & encourage the client to
favor the unaffected side while eating.
Guillain-Barre Syndrome
Medical Management
• Plasmapheresis (IVIG) - trials
have proven the effectiveness
of this form of treatment.
• Support of vital function: NGT
insertion, intermittent
catheterization, intubation or
ventilatory support
• Steroids
Nursing Management
Monitor vital signs, vital capacity, breath sounds
& ABG
Keep airway & tracheostomy set at bedside
Suction, provide fluid replacement therapy, &
monitor functioning of the respirator as
required
Provide emotional support to the client &
family
Provide explanations of disease process & care
Refer client & family to a support group or
foundation for additional information &
resources
Prevent complications of Immobility
Skin care, apply antiembolic stockings
Range of motion exercise, position changes
Coughing & deep breathing
The Eye and Vision
• EYES
The eye is the organ of sight, a nearly spherical
hollow globe filled with fluids (humors)
- The outer layer or tunic is fibrous and
protective (sclera, or white, and cornea)
- The middle tunic layer is vascular in
nature (choroid, ciliary body and the
iris)
- The innermost layer – light-sensitive
layer that lines the interior of the eye
and is sensory in nature. (the retina)
• The fluids in the eye are divided
by the lens into the vitreous
humor (behind the lens) and
the aqueous humor (in front of
the lens).
The lens
• allow it to change shape to focus light
on the retina, which is composed of
sensory neurons.
• The eye is like a
camera.
• Light comes in through the cornea, a
clear cover that is like the glass of a
camera's aperture.
• The amount of light coming in is
controlled by the pupil, an opening that
opens and closes a little like a camera
shutter.
• The light focuses on the retina, a series
of light-sensitive cells lining the back of
the eye.
• The retina acts like camera film, reacting
to the incoming light and sending a
record of it via the optic nerve to the
brain.
Other parts of the eye support the main
activity of sight:
• Some carry fluids (such as tears and
blood) to lubricate or nourish the eye.
• Others are muscles that allow the eye
to move.
• Some parts protect the eye from injury
(such as the lids and the epithelium of
the cornea).
• And some are messengers, sending
sensory information to the brain (such
as the pain-sensing nerves in the cornea
and the optic nerve behind the retina).
 • Vision
Is the passage of rays of light from an object
through the cornea, aqueous humor, lens and
vitreous humor to the retina, and its
appreciation in the cerebral cortex.
• Accommodation
The adjustment of the lens to change the focus
of the eye.
• Types of Refractive Errors
• EMMETROPIA
(normal)
• Rays coming from an object at a
distance of 6 meters (20 ft) or more are
brought to a focus on the retina by the
lens
• AMETROPIA
(abnormal)
Rays of light coming from an object at a distance
of 6 meters
(20 ft) or more are brought to a focus in front of
the retina
Correction
Concave Lens
• AMETROPIA
(abnormal)
• AMETROPIA(abnormal)
• Astigmatism occurs when an abnormal
curvature of the cornea can cause two
focal points to fall in two different
locations; makes both near and far
objects appear blurry
• Presbyopia is caused when the center
of the lens in the eye hardens so that it
is unable to focus up close; this
condition generally affects those over
the age of 40.
• Correction
Bifocals (two corrective lenses; one for
near vision or reading, the other for far
vision)
• Corrective Lenses
• Diagnostic Findings
A. Snellen Chart - measures visual acuity.
• The traditional Snellen chart is printed
with eleven lines of block letters.
• The first line consists of one very large
letter, an E. Subsequent rows have
increasing numbers of letters that
decrease in size.
• The smallest row that can be read
accurately indicates the patient's visual
acuity in that eye.
• The fraction 20/20
• The numerator represents the test
distance, 20 feet.
• The denominator represents the
distance that the average eye can see
the letters on a certain line of the eye
chart.
• The biggest letter on an eye chart often
represents an acuity of 20/200, the
value that is considered “legally blind”
• A legally blind person is one who can
read the E with the best possible
glasses.
B. Ishihara Test - Color Blindness Test
• People who are "color blind" cannot
distinguish red from green or blue from
yellow.
• composed of a series of colored cards
on which numbers or lines of equal
shade can be read by a person with
normal color vision but not by someone
with defective color vision.
• Diagnostic Findings
C. Ophthalmoscope
• Ophthalmoscopy requires dilating the
pupils with drops to give the doctor the
best view of the inside of the eye.
Purpose:
• To view the eye’s fundus
• To detect changes in the retina
due to eye disease
• Types of Opthalmoscope
• Diagnostic Procedures
D. Eye Irrigation
• irrigating the eye to help relieve
irritation, discomfort and burning by
removing loose foreign material , air
pollutants (smog or pollen), or
chlorinated water.
COMMON EYE PROBLEMS
CATARACT
Congenital Cataract
• A congenital
cataract involves
clouding of the lens of
the eye that is present
at birth.
Management
• Surgical cataract removal
• Followed by placement of an intraocular
lens (IOL).
• Patching
• Treatment for any underlying disorder
may be needed.
Surgical Management
A. Intracapsular Cataract Extraction (ICCE)
• Involves removing the lens, the entire
lens capsule and its attachments from
the eye.
• Surgical Management
B. Extracapsular Cataract Extraction (ECCE)
• refers to a surgery in which the entire
cataract is removed through a small
hole made in the lens capsule.
• The rest of the lens capsule and all its
attachments are left intact.
C. Kelman Phaco Emulsification
• the use of high frequency sound waves
to liquefy the contents of the lens which
can then be safely remove from the eye
using suction through a 3 mm incision
• Nursing Considerations
• Health Teachings
• STRABISMUS
• refers to misaligned eye
• can be subtle or obvious
• intermittent (occurring occasionally) or
constant
• It can affect one eye only or shift
between the eyes
TYPES:
1. Esotropia
2. Exotropia
3. Hyperropia
4. Hyporopia
Causes
• do not have a well-understood cause
• Usually begins in infancy or childhood
• need glasses for farsightedness
• seems to develop because the eye
muscles are uncoordinated and do not
move the eyes together
• acquired strabismus can occasionally
occur because of a problem in the brain,
an injury to the eye socket, or thyroid
eye disease.
• Signs & Symptoms
Children:
- may hold their heads to one side if they
can use their eyes together in that
position.
- may close or cover one eye when it
deviates, especially at first.
Adults
- have more symptoms
- double vision (see a second image)
- may lose depth perception.
• Treatment
• patch the good eye and wear glasses
before treating the strabismus.
• Surgery to get the eyes close enough to
perfectly straight that it is hard to see
any residual deviation.
• Prisms and Botox injections of the eye
muscles are alternatives to surgery in
some cases.
GLAUCOMA
• is a condition where pressure inside the
eye rises to the point of causing damage
to the optic nerve with associated loss
of vision
• It usually affects both eyes, and it is the
leading cause of blindness in the world.
• Pathophysiology
There are two accepted theories regarding how
increased IOP damages the optic nerve in
glaucoma.
1. The direct mechanical theory
• suggests that high IOP damages the
retinal layer as it passes through the
optic nerve head.
2. The indirect ischemic theory
- Suggests that high IOP compresses the
microcirculation in the optic nerve head,
resulting in cell injury and death.
 • stages
1. Initiating events: precipitating factors
include illness, emotional stress,
congenital narrow angles, long-term use
of corticosteroids, and mydriatics (ie,
medications causing pupillary dilation).
2. Structural alterations in the aqueous
outflow system: tissue and cellular
changes caused by factors that affect
aqueous humor dynamics lead to
structural alterations
• stages
3. Functional alterations: conditions such as
increased IOP or impaired blood flow create
functional changes that lead to the fourth stage.
4. Optic nerve damage: atrophy of the optic
nerve is characterized by loss of nerve fibers and
blood supply, and this fourth stage inevitably
progresses to the fifth stage.
5. Visual loss: progressive loss of vision is
characterized by visual field defects.
For all glaucoma cases:
- blurred vision
- eye pain
- red eye
- dilated pupils
- severe pain in the head
- seeing halos around lights
Diagnostic Procedure
• Diagnostic Procedure
• Diagnostic Procedure
Types of Glaucoma
1. Open Angle Glaucoma
- most common type and comprises
about 90% of all cases of glaucoma.
- no symptoms for this glaucoma
• TYPES
3. Pigmentary
- which occurs when pigment from the iris flakes
off and blocks the drainage canal.
4. Secondary Glaucoma
- can develop only from specific things like a
tumor, diabetes, and a medical condition most
likely having something to do with your eye.
5. Congenital Glaucoma. (born with)
- symptoms, which include cloudy eyes,
excessive tearing, and sensitivity to light
• Treatment
• Types of Laser Surgery
1. Laser Peripheral Iridotomy
- used for treating acute angle glaucoma
- The procedure makes an opening in the
iris, which lets the fluid drain more
2. Argon Laser Trabeculoplasty
- used for the open angle glaucoma and
when doctor do this they aim the laser
at the opening of the canal, helping the
drainage system work by making it a
little bigger
- 3. Microsurgery
- - conventional surgery and it is used for
acute, chronic, congenital, and
secondary glaucoma.
3. Selective Laser Trabeculoplasty
- It is a combination of very low frequencies that
treat specific cells and leave the mesh-like
drainage canals intact.
4. Laser Cyclophotocoagulation
-. used for severe glaucoma cases that can’t be
treated with minor surgery, that helps decrease
the amount of fluid made
Nursing Management
• Explain the importance of continued
use of eye medication
• Explain the need for continued medical
supervision
• Teach the client to avoid activities that
can increase intraocular pressure.
• Instruct client to report severe eye or
brow pain & nausea to the physician.
RETINAL DETACHMENT
• four types of retinal detachment
1. Rhegmatogenous detachment
• is the most common form.
• In this condition, a hole or tear develops
in the sensory retina, allowing some of
the liquid vitreous to seep through the
sensory retina and detach it from the
RPE
• People at risk for this type of
detachment include those with high
– myopia or after cataract
surgery
– Trauma
2. traction retinal detachment
 - Cause is Tension, or a pulling force
- patients with this condition have
developed fibrous scar tissue from
conditions such as diabetic retinopathy,
vitreous hemorrhage, or the
retinopathy of prematurity
3. a combination of rhegmatogenous and
traction
4. Exudative retinal detachments are the result
of the production of a serous fluid under the
retina from the choroid.
• Signs & Symptoms
• Management
• Photocoagulation
laser beam through the pupil produces
retinal burn, which causes scarring of
the involved area.
• Scleral buckling
shortening of the sclera to force the
choroid closer to the retina.
• Nursing Intervention
• Provide accurate information; alleviate
anxiety
• Provide a call bell for the client &
answer promptly
• Explain: normal occupational activity
will return after 3 weeks & to a more
active job in 6-8 weeks
• Instruct client to avoid activities that
increase IOP
• Keep the client on bed rest in a position
as ordered
• Maintain protective eye patch
• Diminish lights in the room\Observe for
hemorrhage, postoperatively
Auditory Problems
ANATOMY OF THE EXTERNAL EAR
The auricle
attached to the side of the head by skin
collects the sound waves and directs vibrations
into the external auditory canal.
The external auditory canal
ends at the tympanic membrane
The skin of the canal contains hair, sebaceous
glands, and ceruminous glands, which secrete a
brown, waxlike substance called cerumen (ie,
ear wax).
ANATOMY OF THE MIDDLE EAR
an air-filled cavity, includes the tympanic
membrane laterally and the otic capsule
medially
connected by the eustachian tube to the
nasopharynx and is continuous with air-filled
cells in the adjacent mastoid portion of the
temporal bone.
Tympanic Membrane
The tympanic membrane (ie, eardrum), about 1
cm in diameter and very thin, is normally pearly
gray and translucent.
protects the middle ear and conducts sound
vibrations from the external canal to the
ossicles
consists of three layers of tissue (ectoderm,
entoderm, and mesoderm)
Ossicles
The middle ear contains the three smallest
bones (ie, ossicles) of the body: malleus, incus,
and stapes.
assist in the transmission of sound
ANATOMY OF THE INNER EAR
is housed deep within the temporal bone
The organs for hearing (ie, cochlea) and balance
(ie, semicircular canals), as well as cranial
nerves VII (ie, facial nerve) and VIII (ie,
vestibulocochlear nerve)
Membranous Labyrinth
The membranous labyrinth is composed of the
utricle, the saccule, the cochlear duct, the
semicircular canals, and the organ of Corti.
The three semicircular canals—posterior,
superior, and lateral contain sensory receptor
organs, arranged to detect rotational
movement.
The utricle and saccule are involved with linear
movements.
Organ of Corti
is located in the cochlea,
is located on the basilar membrane stretching
from the base to the apex of the cochlea.
transforms mechanical energy into neural
activity and separates sounds into different
frequencies

Common health problems of Infants & Child
Otitis Media
Mastoiditis
Foreign Bodies
Otitis Media
75% of children experience at least one episode
of otitis media by their third birthday.
Almost half of these children will have three or
more ear infections during their first three
years.
Causes/Diagnosis
Otitis media usually results from a bacterial or
viral infection secondary to a cold, sore throat
or other respiratory problem.
Signs & symptoms
unusual irritability,
difficulty sleeping,
tugging or pulling at one or both ears,
fever,
fluid draining from the ear,
loss of balance,
or unresponsiveness to quiet sounds or other
signs of hearing difficulty such as sitting too
close to the television or being inattentive.
diagnostic
Otoscopy
Inflammation of the eardrum indicates an
infection.
There are several ways that a physician checks
for middle ear fluid.
pneumatic otoscope
allows the physician to blow a puff of air onto
the eardrum to test eardrum movement.
An eardrum with fluid behind it does not move
as well as an eardrum with air behind it.
Reasons why more children
are affected than adults
immune systems are still developing.
child's Eustachian tube is shorter and straighter
than adult.
adenoids in children are larger than they are in
adults.
Adenoids are composed largely of cells
(lymphocytes) that help fight infections.
positioned in the back of the upper part of the
throat near the Eustachian tubes.
Enlarged adenoids can, because of their size,
interfere with the Eustachian tube opening.
In addition, adenoids may themselves become
infected, and the infection may spread into the
Eustachian tube.
interventions
Systemic antibiotics
Antibiotic eardrops
Symptomatic relief w/ analgesics,
antihistamines & decongestants
Gentle irrigation to cleanse the ear
Myringotomy
Nursing intervention
Obtain specimen of exudate for culture &
sensitivity
Administer antibiotics & other drugs as
prescribed
Instruct client to administer eardrops
Monitor temperature, drainage, pain & hearing
acuity to evaluate effective effectiveness of
therapy
Teach client to avoid others with respiratory
infections & delay air travel when infection is
present
Face client, minimize distractions, enunciate
clearly, provide written communication if
hearing is diminished
Instruct client to report headache or stiff neck
immediately, since this may indicate
complications of meningitis.
Mastoiditis
It is rarely seen today because of the use of
antibiotics to treat ear infections.
This child has noticeable swelling and redness
behind his right ear.
Causes & risk factors
usually a consequence of a middle ear infection
(acute otitis media).
The infection may spread from the ear to the
mastoid bone of the skull.
The mastoid bone fills with infected materials
and its honeycomb-like structure may
deteriorate.
Symptoms & Signs
ear pain or discomfort
earache
pain behind the ear
redness of the ear or behind the ear Assessment:
fever, may be high or spike (have sudden high 1. Rinne Test
increases) Rinne Test
headache Management
drainage from the ear Medical:
diagnostics 1. Well-fitting hearing aid
An examination of the head Stapedectomy -involves removing the stapes
A skull X-ray superstructure and part of the footplate and
head CT scan inserting a tissue graft and a suitable prosthesis.
CT of the ear
may show an abnormality in the mastoid bone. Nursing care (post-op)
A culture of drainage from the ear may show Position pt in the first 24 hr. post-op as desired
bacteria. by the physician
interventions Antimotion medication and sedatives for
Antibiotics: eardrop or systemic vertigo, nystagmus or nausea
Cleansing of the ear Assist pt in ambulation
Surgical intervention Pain medication
Mastoidectomy Observe for:
Tympanoplasty 1. Fever
Eardrum repair 2. Headache
Nursing intervention 3. Vertigo
Obtain specimen for culture & sensitivity 4. Ear Pain
Instruct client to seek treatment for ear Patient Education
infection Advise pt that there maybe temporary hearing
Observe for facial paralysis loss for a few weeks after surgery due to tissue
Instruct client to report headache & stiff neck, edema and packing
this may indicate meningitis. Packing to be removed by the surgeon in 5-6
Utilize safety precautions to prevent injury for days post-op.
those who are experiencing vertigo Protect ear by placing cotton ball in outer ear
Position on unaffected side post operatively and changing it BID
Common health problems of adults Instruct pt to:
Otosclerosis a. Avoid sudden pressure changes in the
Meniere’s disease ear
OTOSCLEROSIS 1. Do not blow nose
A term applied to a form of progressive
deafness caused by the formation of new Patient Education
spongy bone in the labyrinth which locks the 2. Do not wet head (in showers or swimming)
footplate of the stapes in a fixed position for about 6 wks.
preventing sound transmission by the vibrating 3. Avoid sudden head movements
ossicles to the inner ear fluids. 4. Avoid flying for several mos.
S/Sx: 5. Stay away from people with URTI
Insidious hearing loss b. Do not smoke.
Ringing or buzzing in the ear c. Protect ear when going outdoor for the first
Own voice sounds unusually loud wk
Inability to hear a whisper or somebody talking d. Advise pt to report s/sx of complications:
@ a distance - Return of tinnitus, vertigo
Can hear fairly well on telephone and in noisy - Fluctuation of hearing ability
environment.
 Meniere’s Syndrome - Butter, cream, honey, jellies, jam,
A chronic disease involving the middle ear sugar and candy (except chocolates) as desired
characterized by fluid distention of the Foods to be avoided:
endolymphatic spaces of the labyrinth - Salted meats and fish
accompanied by destruction of cochlear hair - Bread, crackers and butter prepared
cells. with salt
DIAGNOSTIC EVALUATION - Carrots, Spinach, Clams, Oysters,
1. Caloric Test - “nystagmus test” Raisins,Cheese, condensed milk
Instillation of water @ 30 degrees Foods that can be taken no more than twice
Celsius or ice water weekly:
2. Electronystagmography (ENG) -Pumpkin, Cauliflower, Radish, Strawberries,
A graphical record of the labyrinthine Limes, Peaches, Dried coconut, Buttermilk,
function measuring the electropotential of the Peanuts, Mustard
eye movements when nystagmus is produced.
3. MRI/CT Scan
Caloric Test
Electronystagmography (ENG)
Management
Surgery
1. Cryosurgery
2. Endolymphatic Shunt
3. Total labyrinthectomy
4. Cochlear implantation
Medical:
1. Low-salt diet for 2-3 mos. (Furstenberg
Diet)
2. Vasodilating Drugs for tinnitus
- Nicotinic Acid
- Tolazoline Hydrochloride
- Methantheline Bromide
3. Antivertiginous
- Dymendydrinate (Benadryl and
Dramamine)
- Phenobarbital
Furstenberg Diet
1. Fluids not restricted, however excessive
quantities of water is discouraged
2. Proteins unrestricted or forced; calories
permitted as indicated; Na allowance
low
3. Foods to be eaten daily (2-3 mos.)
- Eggs, meat, fish as desired
- Bread as desired, cereal
- Potato and at least one of the ff:
macaroni, spaghetti, rice, corn, plums, prunes or
cranberries
- Milk as desired