Common neurologic disorders

Below are several common neurologic disorders, along with their causes, pathophysiology, signs and symptoms, diagnostic test findings, treatments, and nursing interventions.

Common neurologic disorders: Headache

 

Common neurologic disorders

 

Muscle contraction, tension, and vascular changes cause 90% of head aches. Occasionally, however, a headache indicates an underlying intracranial, systemic, or psychological disorder.

Throbbing, vascular headaches — migraine headaches — affect up to 10% of Americans. Migraines usually begin in childhood or adolescence and recur throughout adulthood. Migraine headaches tend to run in families and are more common in women than in men.

What causes it

Most chronic headaches result from muscle tension caused by:

  • emotional stress or fatigue
  • menstruation
  • environmental stimuli (noise, crowds, bright lights).

Other possible causes include:

  • glaucoma
  • inflammation of the eyes or of the nasal or paranasal sinus mucosa
  • diseases of the scalp, teeth, extracranial arteries, or external or middle ear
  • vasodilators (nitrates, alcohol, histamine)
  • systemic disease
  • hypertension
  • head trauma or tumor
  • intracranial bleeding, abscess, or aneurysm.

Pathophysiology

Headache pain may emanate from the pain-sensitive structures of the skin, scalp, muscles, arteries, and veins; from cranial nerves V, VII, IX, and X; or from cervical nerves 1, 2, and 3. Intracranial mechanisms of headache include traction or displacement of arteries, venous sinuses, or venous tributaries and inflammation or direct pressure on the cranial nerves with afferent pain fibers.

The cause of migraine headaches isn’t known, but researchers associate the disorder with constriction and dilation of intracranial and extracranial arteries.

What to look for

Signs and symptoms depend on the type or cause of the headache: migraine headache, muscle contraction and traction-inflammatory vascular headache, intracranial bleeding, or tumor.

Migraine headache

  • Unilateral pulsating pain, which becomes more generalized over time, lasting up to 2 days
  • Premonitory aura of scintillating scotoma, hemianopsia, unilateral paresthesia, or a speech disorder
  • Irritability, anorexia, nausea, vomiting, photophobia

Muscle contraction and traction-inflammatory vascular headache

  • Dull, persistent ache or severe, unrelenting pain
  • Tender spots on the head or neck
  • Feeling of tightness around the head with a characteristic “hatband” distribution

Intracranial bleeding

  • Neurologic deficits, such as paresthesia and muscle weakness
  • Pain unrelieved by opioids

Tumor

  • Pain that’s most severe when the patient wakes

What tests tell you

Skull X-rays (including cervical spine and sinus), EEG, MRI, CT scan (performed before lumbar puncture to rule out increased ICP), brain scan, and lumbar puncture may help determine the cause.

How it’s treated

Depending on the type of headache, analgesics ranging from aspirin to codeine or meperidine (Demerol) may provide symptomatic relief. A tranquilizer, such as diazepam, may help during acute attacks, as could identification and elimination of causative factors and, possibly, psychotherapy for headaches caused by emotional stress. Chronic tension headaches may require muscle relaxants.

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Common neurologic disorders: Taking a coffee break

For migraine headache, ergotamine (Ergomar) alone or with caffeine provides the most effective treatment. Sumatriptan (Imitrex), which binds with serotonin receptors, is also effective in aborting migraine head aches. These drugs and others, such as metoclopramide (Reglan) or na proxen (Naprosyn), work best when taken early in the course of an attack. Antiemetics, such as promethazine (Phenergan), may be prescribed to control nausea and vomiting. Drugs that can help prevent migraine headache include propranolol (Inderal); calcium channel blockers, such as verapamil (Calan) and diltiazem (Cardizem); and antiseizure medications such as valproic acid.

What to do

Unless the headache is caused by a serious underlying disorder, hospitalization is rarely required. In these rare cases, direct your attention to treating the primary problem. The patient with migraine usually needs to be hospitalized only if nausea and vomiting are severe enough to induce dehydration and possible shock.

Common neurologic disorders: Finding a sea of tranquility

Evaluate the patient to determine the effectiveness of prescribed analgesics, tranquilizers, or muscle relaxants and document your findings. Help the patient understand the possible causes and remedies for the headaches. (See Headache teaching tips.)

 

Common neurologic disorders: Headache teaching tips

  • Help the patient understand the reason for headaches so that he can avoid exacerbating factors. Use his history and diagnosis as a guide.
  • Advise him to lie down in a dark, quiet room during an attack and to place ice packs on his forehead or a cold cloth over his eyes, or use other measures that are helpful for him.
  • Instruct the patient to take prescribed medication at the onset of migraine symptoms, prevent dehydration by drinking plenty of fluids after nausea and vomiting subside, and use other headache-relief measures.

Common neurologic disorders: Huntington’s disease

Huntington’s disease (Huntington’s chorea) is a hereditary disease that causes degeneration in the cerebral cortex and basal ganglia.

This degeneration leads to chronic progressive chorea and mental deterioration that ends in dementia.

What causes it

The cause of Huntington’s disease isn’t known. However, it’s transmitted as an autosomal dominant trait.

Pathophysiology

Huntington’s disease involves a disturbance in neurotransmitter substances, primarily gamma aminobutyric acid (GABA) and dopamine. GABA neurons in the basal ganglia, frontal cortex, and cerebellum are destroyed and replaced with glial cells. The deficiency of GABA (an inhibitory neurotransmitter) causes an excess of dopamine and abnormal neurotransmission along the affected pathways.

What to look for

  • Severe choreic movements (involuntary, rapid, usually violent, and purposeless movements), initially unilateral and more prominent in the face and arms than in the legs
  • Dementia, typically mild at first and then growing more severe until it disrupts the personality
  • Loss of musculoskeletal control

What tests tell you

  • PET scan and deoxyribonucleic acid analysis can detect Huntington’s disease.
  • CT scan and MRI reveal brain atrophy.

How it’s treated

Huntington’s disease has no known cure. Therefore, treatment focuses on supporting and protecting the patient, treating symptoms, and providing emotional support to the patient and his family. Tranquilizers and drugs, such as chlorpromazine, haloperidol, and imipramine (Tofranil), can help control choreic movement and alleviate discomfort and depression. However, they can’t stop mental deterioration. In addition, tranquilizers increase rigidity.

What to do

  • Attend to the patient’s basic needs, such as hygiene, skin care, bowel and bladder care, and nutrition. Increase support as his mental and physical deterioration becomes more pronounced.
  • Provide emotional support. The patient and his family can feel overwhelming despondency due to the degenerative and irreversible course of the disease. An extremely depressed patient may attempt suicide. Be alert for signs, and make sure the patient’s environment is free from instruments that could permit self-inflicted injury.

Common neurologic disorders: Maintaining high levels

  • Evaluate the patient’s mobility and level of function. Plan interventions that help him maintain the highest level of mobility and independence possible for as long as possible.
  • Keep the patient free from injury.
  • Help the family identify resources that can help them cope with the patient’s illness. (See Huntington’s disease teaching tips.)

Common neurologic disorders: Huntington’s disease teaching tips

  • Talk with the patient and family about the disease. Listen to their concerns and fears, and provide clear answers to questions.
  • Keep in mind the patient’s dysarthria and allow him time to express his thoughts.
  • Teach the family appropriate patient care measures, and help them assume a greater role as the patient’s condition deteriorates.
  • Explain that children have a 50% chance of inheriting the disease and that genetic counseling is a good idea before starting a family.
  • Refer the patient and family to organizations that can help them cope with the disease, such as a visiting nurse service, social services, psychiatric counseling, and long-term care facilities.
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