CNS Anatomy & Seizure Assessment Review

Review CNS Anatomy & Physiology

• Neurologic assessment covers mental status, general appearance, cognition, affect, strength, coordination, muscle ability, range of motion (ROM), sensation, and cranial nerves.
• Sensory system assessment involves touch, pain, temperature and vibration/position sense.
• Pupil assessment and documentation should be reviewed.
• Stroke review and seizure review are important topics.

Review Seizures

• Seizure causes include systemic and metabolic factors (acidosis, electrolyte imbalance, hypoglycemia, hypoxia), drug and alcohol withdrawal, and dehydration.
• Epilepsy includes identifying the cause and treatment, spontaneous recurrences and underlying issues, and understanding triggers.

Clinical Seizures

• Generalized seizures involve both sides of the brain, may occur without warning.
• Tonic-clonic seizures (grand mal) involve stiffening and jerking movements.
• Absence seizures (petit mal) are characterized by smaller motions or zoning out.
• Partial seizures involve a focal point and are described as focal irritant seizures.

Intracranial Pressure (ICP)

• ICP is the hydrostatic pressure exerted by brain tissue, blood, and cerebrospinal fluid (CSF) within the skull.
• Increased ICP (IICP) is an acute condition, typically characterized by a change in mental status or loss of consciousness.
• Important signs/symptoms may include headache, vomiting, and neurologic dysfunction, (e.g., altered levels of consciousness).
• Factors affecting ICP include arterial and venous pressure, intra-abdominal and intrathoracic pressure, posture, and temperature.

Head Trauma

• Head trauma includes scalp lacerations, resulting in profuse bleeding due to poor vasoconstriction of blood vessels in scalp.
• Skull fractures include basilar skull fractures (associated with tearing of dura, CSF leakage from nose or ears, and possible periorbital ecchymosis (i.e., battle sign)) and linear/depressed/simple/comminuted fractures.
• It is important to monitor for cranial infections (if exposed/hematomas), as brain damage can be localized and swelling might occur.
• Concussions present as cognitive and physical symptoms for an unknown period following trauma. Major head trauma may include contusions.

Head Trauma Assessments

• Expected findings after head trauma include amnesia (loss of memory) before or after the injury, loss of consciousness, CSF leakage, and neurologic/cranial nerve changes.
• Interventions focus on airway and oxygen management and addressing potential complications such as increased ICP.

Brain Tumors

• Gliomas, Astrocytomas, and Glioblastoma multiforme are among the most common types of brain tumors.
• Symptoms include headaches, seizures, neurologic changes, and/or changes in memory/mood.

Multiple Sclerosis (MS)

• MS is an autoimmune disease affecting the CNS, causing demyelination and nerve impulse impairment and resulting in neurological symptoms.

Amyotrophic Lateral Sclerosis (ALS)

• ALS is a progressive neurologic disorder characterized by the gradual degeneration of motor neurons in the brain and spinal cord.
• It leads to significant muscle weakness, difficulty with movement, speech, swallowing, and breathing.
• Risks include aspiration, falls, respiratory insufficiency, and pain due to muscle weakness.

Bacterial Meningitis

• Bacterial Meningitis is a serious infection of the lining of the brain and spinal cord.
• Signs and symptoms include headache, fever, stiff neck, and altered mental status.
• Diagnosis is typically made through a lumbar puncture (spinal tap) where cerebrospinal fluid (CSF) is collected for laboratory analysis to identify the causative bacteria.
• Treatment is critical, and typically will involve intravenous antibiotics to address the causative bacteria as well as supportive care, such as fever reduction, and fluid balance.

Other Important Topics

• Craniotomy: surgical procedure to remove brain tissue, reduce intracranial pressure/tumors.
• VP Shunt: a shunt surgically placed to help manage the buildup of cerebrospinal fluid.
• Burr Holes are small openings into the skull to assess/diagnose certain conditions of the brain tissue.
• GBS: acute, inflammatory disorder of the peripheral nerves.