CEREBRAL ANEURYSM

Cerebral Aneurysm – dilation & weakness of cerebral artery creating a

subarachnoid hemorrhage.

Causes:
 Congenital
 Infection
 Atherosclerosis

Angiography – diagnostic test

Before Bleeding With Bleeding

 Headache  Sudden severe headache
 Intermittent nausea  Nausea, projectile vomiting
 Nuchal rigidity  Altered LOC; deep coma
 Stiff back & legs  Meningeal irritation, nuchal
rigidity, back & leg pain, fever,
restlessness, irritability, seizures,
photophobia & blurred vision
 Diplopia, ptosis, dilated pupil,
inability to rotate the eye

Cerebral Angiography – diagnostic for bleeding aneurysm

CT Scan – diagnostic for hemorrhage

Medications:
 Analgesics
 Hydralazine
 Corticosteroids

Nursing Management:
 Repair
o Clipping
o Ligating
o Wrapping
 Bed rest at darkened room (4-6 weeks)
 No aspirin
 No coffee
HEAD INJURY
Class:
 Laceration
 Skull Injury
 Brain Injury

Concussion – jarring of brain due to forceful contact with the rigid skull
- Unconscious

Contusion – (bruising) characterized by loss of consciousness, causing diffuse

venous hemorrhage.
- Hematoma
- Decrease LOC

Laceration – brain forced against rough & sharp edges meninges & vessels are
torn
- Torned vessels

Compression – from a depressed fracture, with edema & swelling & IC hemorrhage
- Epidural
- Subdural
- Subarachnoid

Nursing Management:
 Ensure patent airway
 Keep spine straight
 Flexion & hyperextension is avoided if cervical fracture is suspected

General care:
 Established airway
 Prevent aspiration pneumonia
 Check for cardiovascular condition
 Search for spine injuries
 Prevention of infection
 Control pain

TRIGEMINAL NEURALGIA

Trigeminal neuralgia – condition is 5th cranial nerve with recurring attacks of

agonizing pain along the distribution of one or more div of nerve ophthalmic.
 1. Ophthalmic
2. Maxillary
3. Mandibular

Signs & Symptoms:

 Pressure on a trigger point during washing, shaving or cold wind

Nursing Management:
 Avoid serving food that is too hot or cold

Medications:
TEGRETOL – for pain

BELLE’S PALSY

Belle’s Palsy – 7th cranial nerve

- Facial paralysis

Cause:
 Inflammation of auditory meatus
 Infection
 Hemorrhage
 Tumor
 Meningitis
 Local traumatic injury

Signs & Symptoms:

 Unilateral facial weakness or paralysis with aching at the jaw angle
 Drooping mouth
 Distorted taste
 Inability to eat on affected side
 Pain behind the ears or face
 Inability to close eyes
 Inability to raise eyebrows

ELECTROMYOGRAPHY – diagnostic test for belle’s palsy

Medications:
PREDNISONE – to reduce facial nerve edema, imp nerve conduction & imp blood
flow

Nursing Management:
Recovery 3-5 weeks
 Apply moist heat
 Eye care, eye patch or eye drops
 Massage face in upward motion, 2 – 3x daily in 5-10 minutes
 Teach client to do facial expression

INTRACRANIAL PRESSURE (ICP)

ICP – pressure exerted within the intact skull by IC volume

Causes:
 Tumor
 Accumulation of fluids in ventricular system
 Hemorrhage
 Edematous brain tissue
 Trauma

Intracranial Volume:
Brain Tissue H20 - 20 %
CSF - 10%
Blood - 10%

3 Compensations:
1. Limit blood flow
2. Displace CSF to spinal fluid
3. Increase absorption or decrease production of CSF, thru excretion on kidneys

Complications:
 Brain death
 Cardial arrest
 Respiratory arrest

Signs & Symptoms (INFANTS)

 Bulging fontanels without normal pulsation
 Irritability
 High-pitched cry
 Increased head circumference
  Decreased LOC
 Altered feeding
 Distended veins in the scalp
Signs & Symptoms (CHILDREN)
 Nausea & vomiting
 Headaches
 Diplopia
 Seizures

Signs & Symptoms (ADULT)

 Lack of Interest
 Decreased motor activity
 Increase sleep
 Weight loss
 Lethargy that progresses to drowsiness
 Increased BP
 Decreased heart rate
 Decreased respiratory rate

LATE
 Pupil dilatation
 Posturing
 Cheyne-stokes breathing
 Papilledema
 Widening pulse pressure
 Altered pupil size

Diagnostic Test:
CT Scan
MRI

Medical Management:
Subdural Tap – needle onto anterior fontanel
Ventricular Tap – needle onto ventricles to release CSF
Hyperventilation – via mechanical ventilator to decrease CO2 levels in blood

Medications:
1. Antibiotics
2. Corticosteroids
3. Osmotic Diuretics
4. Barbiturates
5. Anti-convulsant
Nursing Management:
1. Monitor GCS
2. Monitor ICP
3. Ensure patent airway
4. Safety

SAFETY: SEIZURE PRECAUTION

 Diazepam
 Tongue depressor
 O2 tank; mask
 Side rails
 3 cc syringe