Trigeminal Neuralgia (Cranial Nerve V)

• Disorders affecting cranial nerves impact motor, sensory, and autonomic functions.

Common Diagnostic Tests

• Cranial Nerve Exam: Assesses facial expression, eye movement, speech, and swallowing
• Electromyography (EMG): Detects motor/sensory dysfunction
• MRI: Visualizes cranial nerves and the brainstem for abnormalities

Trigeminal Neuralgia Definition

• Sudden, severe, unilateral facial pain along the trigeminal nerve (Cranial Nerve V)

Trigeminal Neuralgia Pathophysiology

• Cause: Demyelination of the trigeminal nerve due to vascular compression or multiple sclerosis (MS)
• Triggers: Touch, eating, drinking, brushing teeth, cold wind, and pressure
• Incidence is more common in women aged 50-60 years
• Higher risk in MS patients

Trigeminal Neuralgia Clinical Manifestations

• Sudden, unilateral, sharp, stabbing facial pain
• Pain lasts seconds to minutes and then stops abruptly
• Muscle twitching (Tic Douloureux) causes eye closure or facial spasms
• Pain-free intervals vary from minutes to days
• Patients avoid washing their face, chewing, or touching affected areas
• Key feature is that it's always unilateral

Trigeminal Neuralgia Medical Management

• Goal: Pain relief via medications or surgery

Trigeminal Neuralgia Pharmacologic Therapy

• First-line treatment is anticonvulsants to reduce nerve excitability
• Carbamazepine: Requires monitoring for bone marrow suppression
• Gabapentin and Baclofen: Used if carbamazepine fails
• Phenytoin: Used as an adjunct if needed

Trigeminal Neuralgia Surgical Management

• For medication failure
• Microvascular Decompression (MVD): Repositions vessels to relieve nerve pressure
• Radiofrequency Thermal Coagulation: Creates a thermal lesion to destroy the malfunctioning nerve
• Percutaneous Balloon Microcompression: Disrupts large nerve fibers for pain relief

Trigeminal Neuralgia Nursing Management

• Identify & avoid triggers
• Use soft cotton pads and room temperature water for washing face
• Use mouthwash instead of brushing teeth to avoid pain
• Eat soft foods, chew on the unaffected side, and avoid extreme temperatures

Trigeminal Neuralgia Postoperative Care

• Monitor for facial motor and sensory deficits
• Prevent corneal injury, avoid rubbing the eye if sensation is lost
• Use artificial tears to prevent eye dryness
• Avoid chewing on the affected side until numbness resolves

Bell's Palsy Definition

• Acute, unilateral inflammation of Cranial Nerve VII (Facial Nerve) that causes facial muscle weakness or paralysis

Bell's Palsy Cause & Incidence

• Believed to be viral (Herpes Simplex Virus - HSV-1)
• More common in young adults
• Higher risk in diabetics, pregnant women, and those with respiratory infections

Bell's Palsy Clinical Manifestions

• Sudden onset of unilateral facial weakness or paralysis
• Inability to close the eye on the affected side
• Drooping of the mouth, loss of nasolabial fold
• Hyperacusis with increased sensitivity to sound
• Loss of taste in the anterior 2/3 of the tongue
• Pain behind the ear or jaw before paralysis occurs
• Affects the entire half of the face, unlike a stroke which spares the forehead

Bell's Palsy Medical Management

• Reduce inflammation and restore function

Bell's Palsy Pharmacologic Therapy

• Corticosteroids (Prednisone): Reduces nerve inflammation
• Antivirals (Acyclovir, Valacyclovir): Used if HSV is suspected
• Analgesics (NSAIDs, Acetaminophen): Relieves pain

Bell's Palsy Supportive Care

• Eye Protection: Artificial tears, eye patch at night
• Facial Exercises & Massage: Prevents muscle atrophy
• Moist heat application reduces pain & improves circulation

Bell's Palsy Nursing Management

• Prevent eye damage by frequently using artificial tears and wearing an eye patch or taping the eyelid shut at night
• Wear sunglasses to protect against wind and debris
• Improve facial muscle function with facial massage and gentle stretching exercises and use a mirror to practice facial movements
• Encourage nutrition by chewing on the unaffected side and eating a soft diet if chewing/swallowing is difficult

Mnemonics for Cranial Nerve Disorders

• Trigeminal Neuralgia → "TIC": Triggered by touch, chewing, talking; Intense, unilateral pain, Carbamazepine is the drug of choice
• Bell's Palsy → "BELL": Blinking issues, Ears sensitive to sound, Loss of taste, Lopsided smile

Nursing Priorities Mnemonics

• Nursing Priorities for Facial Paralysis → "FACE": Facial exercises to restore function, Artificial tears to protect the eye, Corticosteroids for inflammation, Educate on facial care & coping strategies

Expected Outcomes

• Pain relief for trigeminal neuralgia
• Improved facial muscle function & expression for Bell’s palsy
• Eye protection without complications
• Proper nutrition & hydration
• Increased ability to communicate effectively

Overview of Brain & Spinal Cord Tumors

• Brain and spinal tumors occupy space in the central nervous system (CNS); leading to inflammation, compression, and tissue infiltration

Effects of Tumors

• Increased Intracranial Pressure (ICP) & cerebral edema
• Focal Neurologic Deficits such as headaches, motor/sensory loss
• Seizures & Hydrocephalus, which is caused by cerebrospinal fluid (CSF) obstruction
• Altered Pituitary Function (hormonal imbalances)

Classification of Brain Tumors

• Primary brain tumors originate within the brain
• Secondary brain tumors (metastatic) originate outside the CNS

Primary Brain Tumors

• Gliomas like astrocytomas and glioblastomas infiltrate brain tissue and are often malignant
• Meningiomas are slow-growing and usually benign
• Pituitary Adenomas affect hormone production
• Acoustic Neuromas affect hearing & balance on Cranial Nerve VIII

Secondary (Metastatic) Brain Tumors Origination

• Lungs
• Breast
• GI tract
• Pancreas
• Kidney
• Skin/melanoma
• More common than primary brain tumors

Primary Brain Tumors & Key Features

• Gliomas infiltrate brain tissue and are difficult to remove; causing headache, seizures, and motor/sensory loss
• Meningiomas are slow-growing and often are benign; causing ICP symptoms and visual disturbances
• Acoustic Neuromas are tumors of Cranial Nerve VIII affecting hearing and balance; causing hearing loss, tinnitus, vertigo, and facial numbness
• Pituitary Adenomas can secrete hormones such as prolactin, GH, and ACTH; causing visual disturbances, headache, and endocrine dysfunction

Brain Tumor Clinical Manifestations

• General symptoms of increased ICP include headaches, projectile vomiting and seizures
• Cognitive changes and personality disturbances can occur
• Localized symptoms vary based on tumor location

Clinical Manifestations based on Location

• Frontal Lobe: Personality changes and hemiparesis
• Parietal Lobe: Sensory loss and seizures
• Temporal Lobe: Phychosis and hallucinations
• Occipital Lobe: Visual field loss and hallucinations
• Cerebellum: Ataxia, dizziness, and coordination issues

Diagnostic Tests for Tumors

• MRI is the most sensitive for detecting tumors
• CT Scan with Contrast determines tumor size/location
• EEG detects seizure activity
• Biopsy is definitive for diagnosis & tumor grading

Medical & Surgical Management

• Craniotomy removes the Tumor removal via skull incision
• Transsphenoidal Surgery treats pituitary adenomas
• Stereotactic Biopsy treats deep-seated tumors
• Gamma Knife Surgery delivers precise radiation treatment without incision
• Brachytherapy involves implantation of radioactive material inside the tumor

Chemotherapy

• Temozolomide is effective for glioblastomas and crosses the blood-brain barrier
• Often combined with radiation for better outcomes

Pharmacologic Therapy

• Corticosteroids like dexamethasone reduces edema & ICP
• Osmotic Diuretics like mannitol and hypertonic saline decreases brain swelling
• Anticonvulsants such as levetiracetam and phenytoin prevents seizures

Nursing Management for Brain Tumors

• Perform frequent neuro assessments to monitor level of consciousness, pupils, and motor response
• Monitor blood pressure & oxygenation to prevent secondary injury and keep the head-of-bed at 30 degrees to reduce ICP
• Assess headache patterns & intensity
• Administer pain medications & antiemetics as needed
• Ensure seizure precautions (bed rails up, airway available, suction ready) and administer prescribed anticonvulsants

Prevent Complications

• Monitor for aspiration, falls and provide psychosocial support

Mnemonics

• "TUMORS" (Key Features of Brain Tumors): Throbbing headache, Unsteady gait, Memory loss & cognitive decline, Ongoing seizures, Regurgitation, Sensory or motor deficits

Nursing Priorities

• "BRAIN": Blood pressure & oxygen monitoring, Raise head-of-bed, Assess neuro status, Implement seizure precaution, Nutrition support

Expected Patient Outcomes

• Controlled ICP & edema to control minimal symptoms of increased pressure
• Effective pain relief with medication
• Seizure prevention
• Improved cognitive & motor function
• Emotional well-being

Management of Cerebral Metastases

• Cancerous lesions that spread to the brain from primary tumors in other parts of the body
• Common primary sources of brain metastases are lung cancer, breast cancer, melanoma, kidney cancer, and gastrointestinal (GI) cancers
• Poor survival rate <10% 2-year survival and treatment is palliative focused on symptom relief & quality of life

Clinical Manifestations of Cerebral Metastases

• General symptoms from Increased Intracranial Pressure
• Headaches, seizures, nausea and vomiting, and altered mental status

Diagnostic & Deficits

• MRI with contrast to identify tumor size, number, and location
• CT Scan if MRI is unavailable
• Lumbar Puncture for Leptomeningeal Metastases so CSF is analyzed to find cancer cells
• Electroencephalogram test (EEG) will detect seizure activity

Management

• Treatment for cerebral metastases can include:
• Whole Brain Radiation
• Stereotactic Radiosurgery
• Surgery (Craniotomy
• Systemic Chemotherapy

First-line Pain Management

• Non-opioids
• Followed by moderate with weak opioids

Assessment during this nursing process

• Patients with Cerebral Metastases assessment includes
• Cognitive status
• Motor Function
• Sensory deficits

Monitoring

• Vital Signs & ICP
• Cushing's Triad
• Pain Assessment
• Seizure Activity
• Nutritional Status
• . Family Coping & Support System

Nursing Diagnoses may include

• Impaired self-care r/t neurologic deficits
• Risk for aspiration r/t impaired swallowing
• Imbalanced nutrition r/t cachexia, anorexia

Goals

• Maximize patient independence for as long as possible,
• Improve nutrition & prevent weight loss
• Enhance family coping & support
• Reduce anxiety & depression

Nursing Interventions include

• Promoting Self-Care & Mobility
• Improving Nutrition
• Pain & Symptom Management

Preventative Measures

• Prevent Seizures .Relieving Anxiety & Depression
• Enhancing Family Coping

Educating Patients & Caregivers

• Symptom management & medication adherence
• Palliative & Hospice Care

Evaluation includes

• Patient maintains independence as long as possible
• Pain is effectively managed
• anxiety is reduced through psychosocial support
• family members feel supported & involved in care

Summary

• Nurses play a key role in pain management, seizure control, mobility, nutrition, & psychosocial care
• Cerebral metastases have a poor prognosis, requiring palliative care and early involvement of hospice & supportive care is essential to treatment

Muscular Dystrophies Definition

• A group of over 30 genetic disorders characterized by progressive muscle weakness and wasting

Muscular Dystrophies Types

• , Duchenne Muscular Dystrophy (DMD) and the most common, Becker, Myotonic

Muscular Dystrophies Pathophysiology

• Caused by genetic mutations leading to muscle fiber degeneration and replacement by connective tissue

Muscular Dystrophies Key Pathologic Features

• Variation in muscle fiber size atrophy and hypertrophy
• Phagocytosis and regeneration
• Replacement of muscle tissue by connective tissue & fat

Muscular Dystrophies Clinical Manifestations

• Muscle Weakness & Stiffness
• Decreased Respiratory Capacity
• Cardiomyopathy

Muscular Dystrophies Treatments

• No cure, treatment focuses on symptom & complication prevention, Exercise is important to maintain muscle
• Supportive therapy & respiratory and cardiac care, along with Gene Therapy (Elevidys)

Muscular Dystrophies Nursing Managment

• Educate and give emotional support to the patient and coordinate other care to assist in treatment

Degenerative Disc Disease (DDD)

• 2nd most common neurologic disorder in US, mostly from the aging process.

Degenerative Disc Disease Facts

• Associated With: Depression, Anxiety, Obesity, Smoking, & Alcohol abuse.
• DDD is caused by gradual degeneration of intervertebral discs, leading to nerve compression & chronic pain.

Degenerative Disc Disease Key Structural Changes

• Outer layer, nucleus pulpous, intervertebral disc.

Degenerative Disc Disease Effects of Degeneration

• Results in Disc Herniation causing spinal nerve compression

Degenerative Disc Disease Risk Factors

• Smoking, obesity, age

Degenerative Disc Disease Clinical Manifestations

• Depend on severity & location: Radiating Pain is common, along with Numbness Tingling.
• The assessment will determine which treatment and management solutions are necessary

Medical Management Conservative

• NSAIDs and Muscle Relaxants used to reduce inflammations as needed

Medical Management Interventions

• Core Strengthening Exercises to support the spine and physical therapy for adjustment

Surgical Management

• Surgical intervention may be needed with a Microdiscectomy

Post Surgical Procedure

• Herniated disc is removed to decompress the spinal cord

Preop Nursing Management

• Educate about surgical risks & assess neurologic function

Postop Nursing Management

• Monitor for complications and encourage Early Mobilization

Rehabilitation

• Physical therapy to strengthen muscles and avoid excessive strain

Herniation of Cervical & Lumbar Intervertebral Discs

• Cervical disc herniation can cause spinal cord damage

Pathophysiology

• Is most common when aging is occurring and causing disk tear

Intervertebral Disc

• Can be mistaken for heart issues

###Medical Management

• Treatment includes:
• Reducing inflammation • relieving pressure on nerve roots & spinal cord

Conservative Treatment

• Includes Physical therapy, cervical collar and rest

Cervical Discectomy Approaches

• To remove material in the procedure
• Neck range must be monitored

Herniation of a Lumbar

• Disc is the compression of spinal nerves

###Medical Management

• NSAID's for muscle strains or spams to help ease pain

This lesson explores trigeminal neuralgia, a disorder affecting the trigeminal nerve (Cranial Nerve V). It covers diagnostic tests like cranial nerve exams and MRI, as well as the pathophysiology, triggers, and clinical manifestations of trigeminal neuralgia. Common diagnostic tests include facial expression, eye movement, speech, and swallowing.