Outline of the review

Degenerative disorders- demyelinating

Multiple sclerosis
Amyotrophic lateral sclerosis
Guillain-Barre’ syndrome
Degenerative disorders- NON-demyelinating
Alzheimer’s disease
Parkinson’s disease
Outline of the review
Motor dysfunction- CNS
Epilepsy
Motor dysfunction- cranial nerve
Bell’s palsy
Trigeminal neuralgia
Motor dysfunction- peripheral
Myasthenia gravis
Degenerative disorders- DEMYELINATING
Multiple sclerosis
Amyotrophic lateral sclerosis
Guillain-Barre’ syndrome
MULTIPLE SCLEROSIS
An auto-immune mediated progressive demyelinating disease of the
CNS
The myelin sheath is destroyed and replaced by sclerotic tissue
(sclerosis)
CAUSE- unknown
Multiple factors- viral infection, environmental factors, genetic
predisposition

MULTIPLE SCLEROSIS
CLINICAL MANIFESTATION
1. visual problems such as diplopia, blurred vision and nystagmus
2. motor dysfunction
3. Fatigue
4. Mental changes like mood swings, depression
5. spasticity
MULTIPLE SCLEROSIS
DIAGNOSTIC TESTS
1. MRI- primary diagnostic study
2. CSF Immunoglobulin G
MULTIPLE SCLEROSIS
NURSING INTERVENTIONS
1. Promote physical mobility
Exercise
Schedule activity and rest periods
2. Prevent injuries
Wide stance walking
Use of walking aids
MULTIPLE SCLEROSIS
3. Enhance bladder and bowel control
Set a voiding schedule
Intermittent bladder catheterization
Use of condom catheter
Adequate fluids, dietary fibers and bowel training program
4. manage speech and swallowing difficulties
Careful feeding, proper positioning, suction machine availability
Speech therapist

MULTIPLE SCLEROSIS
5. Improve Sensory and Cognitive function
Vision- use eye patch for diplopia
6. Strengthen coping mechanism
7. improve self-care abilities
8. promote sexual functioning
Guillian-Barre’ Syndrome
An auto-immune attack of the peripheral nerve myelin
Acute, rapid segmental demyelination of peripheral nerves and some
cranial nerves
CAUSE: post-infectious polyneuritis of unknown origin commonly
follows viral infection
Guillian-Barre’ Syndrome
CLINICAL MANIFESTATIONS
1. Ascending weakness and paralysis
2. diminished reflexes of the lower extremities
3. paresthesia
4. potential respiratory failure
Guillian-Barre’ Syndrome
NURSING INTERVENTIONS
1. Maintain respiratory function
2. Enhance physical mobility
3. Provide adequate nutrition
4. Improve communication
5. Decrease fear and anxiety
6. Monitor and manage complications

Degenerative disorders-
NON-DEMYELINATING
Alzheimer’s disease
Parkinson’s disease

ALZHEIMER’S disease
A progressive neurologic disorder that affects the brain resulting in
cognitive impairments
CAUSES:
Unknown
Family History and Down’s Syndrome are very important risk
factors!
Potential factors- Amyloid plaques in the brain, Oxidative stress,
neurochemical deficiencies
ALZHEIMER’S disease
PATHOPHYSIOLOGY
decreased Acetylcholine
Neurofibrillary tangles
senile neuritic plaques
ALZHEIMER’S disease
CLINICAL MANIFESTATIONS
1. Forgetfulness
2. Recent memory loss
3. Difficulty learning
4. Deterioration in personal hygiene
5. Inability to concentrate
ALZHEIMER’S disease
LATE CLINICAL MANIFESTATIONS
6. Difficulty in abstract thinking
7. Difficulty communicating
8. Severe deterioration in memory, language and motor function
9. repetitive action- perseveration
10. personality changes
ALZHEIMER’S disease
Remember the “A”
Amnesia
Apraxia
Agnosia
Aphasia
ALZHEIMER’S disease
DIAGNOSTIC TEST
Neurologic examination
PET scan
EEG, CT and MRI
Other tests to rule out Vit B deficiencies and hypothyroidism
Autopsy is the most definitive test!
ALZHEIMER’S disease
Drug therapy
1. drugs to treat behavioral symptoms- antipsychotics
2. anxiolytics
3. Donepezil
4. Tacrine
ALZHEIMER’S disease
Nursing Interventions
1. Support patient’s abilities
2. Provide emotional support
3. Establish an effective communication system with the patient and
family
Use short simple sentences, words and gestures
Maintain a calm and consistent approach
Attempt to analyze behavior for meaning

ALZHEIMER’S disease
4. protect the patient from injury by providing a safe and structured
environment
Requests a family member to accompany client if he wanders
around
Keep bed in low position
Provide adequate lightning
Assign consistent caregivers
5. Encourage exercise to maintain mobility
PARKINSON’s Disease
A slowly progressing neurologic movement disorder
The degenerative idiopathic form is the most common form
CAUSATIVE FACTORS: unknown
Potential factors: genetics, atherosclerosis, free radical stress, viral
infection, head trauma and environmental factors
PARKINSON’s Disease
Pathophysiology
Decreased levels of dopamine due to destruction of pigmented
neuronal cells in the substantia nigra in the basal ganglia
Clinical symptoms do not appear until 60% of the neurons have
disappeared

PARKINSON’s Disease
CLINICAL MANIFESTATIONS
1. Tremor- resting, pill-rolling
2. Rigidity- cog-wheel, lead-pipe
3. Bradykinesia- abnormally slow movement
4. Dementia, depression, sleep disturbances and hallucinations
5. excessive sweating, paroxysmal flushing, orthostatic hypotension
PARKINSON’s Disease
Medical management
1. Anti-parkinsonian drugs- Levodopa, Carbidopa
2. Anti-cholinergic therapy
3. Antiviral therapy- Amantadine
4. Dopamine Agonists- bromocriptine and Pergolide, Ropirinole and
Pramipexole
PARKINSON’s Disease
Medical management
5. MAOI
6. Anti-depressants
7. Antihistamine
PARKINSON’s Disease
NURSING INTERVENTIONS
1. Improve mobility
2. Enhance Self- care activities
3. Improve bowel elimination
4. Improve nutrition
5. Enhance swallowing
6. Encourage the use of assistive devices
PARKINSON’s Disease
NURSING INTERVENTIONS
7. improve communication
8. Support coping abilities

Motor dysfunction- peripheral

Myasthenia gravis
Myasthenia gravis
A sporadic, but progressive weakness and abnormal fatigability of
striated muscles which are exacerbated by exercise and repetitive
movements
Pathophysiology:
1. Acetylcholine receptor antibodies interfere with impulse
transmission
2. Follows an unpredictable course of periodic exacerbations and
remissions
Myasthenia gravis
Myasthenia gravis
CAUSE: autoimmune disorder that impairs transmission of nerve
impulses
ASSESSMENT FINDINGS
Gradually progressive skeletal muscle weakness and fatigue
Weakness that worsens during the day
Ptosis, diplopia and weak eye closure
Blank, mask-like facies
Difficulty chewing and swallowing
Respiratory difficulty

Myasthenia gravis
NURSING INTERVENTIONS
1. Administer prescribed medication as scheduled
2. Prevent problems with chewing and swallowing
3. Promote respiratory function
4. Encourage adjustments in lifestyle to prevent fatigue
5.maximize functional abilities
Myasthenia gravis
DIAGNOSTIC TESTS
1. TENSILON(edrophonium) TEST
2. EMG
3. CT scan
4. Serum anti-AchReceptor antibodies
MEDICAL THERAPY
Anticholinesterase drugs- pyridostigmine, neostigmine
Myasthenia gravis
6. Prepare for complications like myasthenic crisis and cholinergic
crisis
7. prevent problems associated with impaired vision resulting from
ptosis of eyelids
8. provide client teaching
9. promote client and family coping

Motor dysfunction- CNS

Epilepsy
EPILEPSY
A group of syndromes characterized by recurring seizures
CAUSES
1. idiopathic 6. brain tumors
2. Birth trauma 7. head Injury
3. perinatal infection 8. metabolic disorders
4. infectious disease 9. CVA
5. ingestion of toxins
EPILEPSY
Recurring seizures may be classified as GENERALIZED or PARTIAL
SEIZURES
Generalized Seizures- cause a generalized electrical abnormality within
the brain
Partial seizures- these seizures arise from a localized part of the brain
and cause specific symptoms
GENERALIZED SEIZURES
1. General Tonic-Clonic seizure (Grand mal) - characterized by loss of
consciousness and alternating movements of the extremities
2. Absence Seizure (Petit mal)- common in children, begins with a brief
change in the LOC, indicated by blinking, rolling of eyes and blank
stares

GENERALIZED SEIZURES
3. Myoclonic seizure- characterized by brief, involuntary muscular jerks
of body extremities
4. Akinetic seizure- general loss of postural tone and a temporary loss
of consciousness- a drop attack
PARTIAL SEIZURES
1. Simple partial seizure- typically limited to one cerebral hemisphere
2. Complex partial seizure- begins with an aura, then with impaired
consciousness, with purposeless behaviors like lip-smacking,
chewing movements
Epilepsy
DIAGNOSTIC TESTS
1. EEG
2. CT
3. MRI
4. LP
5. Angiography
Epilepsy
Medical treatment
1. Anticonvulsants- most commonly phenytoin, phenobarbital and
carbamazepine
Ethosuximide and valproic acid for absence seizure
2. surgery
Epilepsy
Nursing Intervention
1. Care of patients during seizure
2. care of patients after seizures
3. patient teaching
Motor dysfunction- cranial nerve
Bell’s palsy
Trigeminal neuralgia
BELL’S PALSY
Causes
1. infection
2. hemorrhage
3. tumor
4. local traumatic injury
BELL’S PALSY
MANIFESTATIONS
1. Unilateral facial weakness
2. Mouth drooping
3. Distorted taste perception
4. Smooth forehead
5. Inability to close eyelid on the affected side
6. Incomplete eye closure
7. excessive tearing when attempting to close the eyes
8. Inability to raise eyebrows, puff out the cheek
BELL’S palsy
Diagnostic tests
EMG
Medical management
1. Prednisone
2. Artificial tears
BELL’S palsy
Nursing Interventions
1. Apply moist heat to reduce pain
2. Massage the face to maintain muscle tone
3. Give frequent mouth care
4. protect the eye with an eye patch. Eyelid can be taped at night
5. instruct to chew on unaffected side

Trigeminal neuralgia
Also called Tic Douloureux
Painful disorder that affects one or more branches of the fifth cranial
nerve

CAUSES: repetitive pulsation of an artery as it exits the pons is the

usual cause
Trigeminal neuralgia
ASSESSMENT
1. Pain history
2. Searing or burning jabs of pain lasting from 1-15 minutes in an area
innervated by the trigeminal nerve
DIAGNOSTIC TESTS
Skull x-ray or CT scan
Trigeminal neuralgia
NURSING INTERVENTIONS
1. provide emotional support
2. encourage to express feelings
3. provide adequate nutrition in small frequent meals at room
temperature
Infectious Disease
Meningitis
Encephalitis

Meningitis
Infection or inflammation of the meninges covering the brain and
spinal cord.
Caused by bacterial, viral and fungal agents

Meningitis
Brain Abscess
A free or encapsulated collection of pus in the brain parenchyma
Causes: usually secondary to another infection like- sinusitis,
meningitis, dental abscess, mastoiditis, bacteremia and trauma
Encephalitis
Intense inflammation of the brain tisssue with lymphocytic infiltration,
cerebral edema, degeneration of brain cells and diffuse nerve cell
destruction
CNS infections
ASSESSMENT FINDINGS
Meningitis
1. fever, headache, vomiting
2. positive meningeal signs
Brain abscess
1. headache, N/V, seizures, changes in LOC
2. Focal neurologic deficits

CNS infections
DIAGNOSTIC TESTS
1. CT scan
2. MRI
3. EEG
MEDICAL TREAMENT
1. Antibiotics
2. Surgical drainage
3. Drugs to reduce increased ICP
CNS infections
NURSING INTERVENTIONS
1. Frequent monitoring of neurologic status
2. Monitor intake and output
3. Administer antibiotics
4. Administer mild laxative to prevent constipation
5. maintain quiet environment
Dementia versus delirium
DEMENTIA
chronic brain syndrome
irreversible
progressive
no loss of consciousness
Dementia versus delirium
DELIRIUM
acute brain syndrome
can revert back to normal
(+) level of consciousness changes
Neoplastic diseases
A brain tumor is a localized intracranial lesion that occupies space
within the skull
Primary brain tumors originate from cells and structures within the
brain.
Neoplastic diseases
The cause of brain tumors is unknown
The only risk factor accepted is radiation exposure to ionization rays
Neoplastic disease
CLINICAL MANIFESTATIONS
1. increased ICP
Vomiting
Headache. Especially early in the morning
Vomiting
Visual disturbances
Neoplastic disease
2. Localized symptoms
Hemiparesis
Seizures
Mental status changes
Neoplastic disease
DIAGNOSTIC TESTS
1. CT scan
2. MRI
3. PET
4. EEG
Neoplastic disease
MEDICAL MANAGEMENT
Surgery
Chemotherapy
Radiotherapy
Neoplastic disease
NURSING INTERVENTIONS
1. promote self-care independence
2. improve nutrition
3. relieve anxiety
4. enhance family processes
5. provide pre-operative and post-operative care
6. manage pain
Sample Board Question
Which of the following statements is TRUE of Alzheimer’s disease?
A. There is no evidence of hallucinations and delusions
B. It is more common among males
C. It is a curable disease
D. A risk factor is a family history of Alzheimer's disease

Sample Board question

The difficulty in using simple words is one of the symptoms of
Alzheimer’s disease. This is known as which of the following?
A. Apraxia
B. Perseveration
C. Confabulation
D. Aphasia