MeningitisInflammation of the membranes and the fluid space

surrounding the brain and spinal cordTypes

Septic due to bacteria (Streptococcus pneumoniae, Neisseria meningitidis)

Aseptic due viral infection, lymphoma, leukemia, or brain abscess

N. meningitidis is transmitted by secretions or aerosol contamination and infection is most likely in dense community groups such as college campuses

Manifestations include headache, fever, changes in LOC, behavioral changes, nuchal rigidity (stiff neck), projectile vomiting, positive Kernig's sign, positive Brudzinski’s sign, and photophobia, ? seizure.

Kernig’s Sign

When the patient is lying with the thigh flexed on the abdomen, the leg cannot be completely extended

Brudzinski’s Sign

When the patient's neck is flexed (after ruling out cervical trauma or injury), flexion of the knees and hips is produced; when the lower extremity of one side is passively flexed, a similar movement is seen in the opposite extremity

Assessment and Diagnostic Findings

Bacterial culture and Gram staining of CSF and blood are key diagnostic tests (Fischbach, 2002).

The presence of polysaccharide antigen in CSF further supports the diagnosis of bacterial meningitis

Medical Management Prevention by vaccination against

Haemophilus influenzae and S. pneumoniae for all children and all at-risk adults

Early administration of high doses of appropriate IV antibiotics (should cross BBB) for bacterial meningitis

Dexamethasone Treatment dehydration, shock, and seizures

Nursing ManagementFrequent/continual assessment including VS and

LOCProtect patient form injury related to seizure

activity or altered LOCMonitor daily weight, serum electrolytes, urine

volume, specific gravity, and osmolalityPrevent complications associated with immobility Infection control precautionsSupportive careMeasures to facilitate coping of patient and

family

Brain AbscessCollection of infectious material within brain tissueRisk is increased in immunocompromised patientPrevent by treating otitis media, mastoiditis, sinusitis,

dental infections, and systemic infections promptlyManifestations may include headache that is usually

worse in the morning, fever, vomiting, neurologic deficits, signs and symptoms of increased ICP

Diagnosis by MRI or CTCT-guided aspiration is used to identify the causative

organisms

Brain AbscessMedical management

Control ICPDrain abscessAdminister appropriate antibiotic therapy.

Corticosteroids may be used to treat cerebral edema

Nursing managementFrequent and ongoing neurologic assessment and

of responses to treatmentAssure patient safety and protect from injuryProvide supportive care

EncephalitisAcute, inflammatory process of the brain tissueCauses include viral infections (herpes simplex [HSV]), vector-

borne viral infections (West Nile, St. Louis), and fungal infections

Manifestations may include headache, fever, confusion, changes in LOC; rash, flaccid paralysis, Parkinson-like movements

Medical managementAcyclovir for HSV infection, amphotericin and/or other

antifungal agents for fungal infection Nursing management

Frequent and ongoing assessment Supportive care

Multiple Sclerosis (MS)A progressive immune-related demyelination

disease of the CNSClinical manifestations vary and have different

patternsFrequently, the disease is relapsing and remitting,

has exacerbations and recurrences of symptoms including fatigue, weakness, numbness, difficulty in coordination, loss of balance, pain, and visual disturbances

Medical managementDisease-modifying therapies; interferon -1a and

interferon -1b, glatiramer acetate (Copaxone), and IV methylprednisolone

Symptom management of muscle spasms, fatigue, ataxia, bowel and bladder control

Process of Demyelination

Clinical ManifestationsHas a relapsing remitting (RR) course. With each

relapse, recovery is usually complete.Quadriparesis, cognitive dysfunction, visual loss. Fatigue, depression, weakness, numbness,

difficulty in coordination, loss of balance, and pain. Visual disturbances due to lesions in the optic nerves or their connections may include blurring of vision, diplopia (double vision), patchy blindness (scotoma), and total blindness.

Spasticity (muscle hypertonicity) of the extremities

Multiple Sclerosis treatmentNo cure exists for MSTreatment directed toward to relieving the

patient's symptoms and provide continuing support.

Immunosuppressive agents

Myasthenia GravisAutoimmune disorder affecting the myoneural junctionAntibodies directed at acetylcholine at the myoneural

junction impair transmission of impulsesManifestations

Myasthenia gravis, a motor disorder Initially symptoms involve ocular muscles; diplopia and

ptosis Weakness of facial muscles, swallowing and voice

impairment (dysphonia), generalized weakness, weakness affects all the extremities and the intercostal muscles, resulting in decreasing vital capacity and respiratory failure.

Myasthenia Gravis

Normal ACh receptor siteACh receptor site in

myasthenia gravis

Medical ManagementPharmacologic therapy

Cholinesterase inhibitor: pyrostigmine bromide (Mestinon)

Immunomodulating therapyPlasmapheresisThymectomy

Guillain-Barré SyndromeAutoimmune disorder with acute attack of

peripheral nerve myelinRapid demyelination may produce respiratory

failure and autonomic nervous system dysfunction with CV instability

Most often follows a viral infection Manifestations are variable and may include

weakness, paralysis, paresthesias, pain, and diminished or absent reflexes starting with the lower extremities and progressing upward; tachycardia; bradycardia; hypertension; or hypotension

Guillain-Barré SyndromeMedical management

Requires intensive care management with continuous monitoring and respiratory support

Plasmapheresis used to reduce circulating antibodies

Recovery rates vary, but most patients recover completely

Bell’s PalsyFacial paralysis due to

unilateral inflammation of the 7th cranial nerve

Manifestations—unilateral facial muscle weakness or paralysis with facial distortion, increased lacrimation, and painful sensations in the face, may have difficulty with speech and eating

Most patients recover completely in 3–5 weeks and the disorder rarely recurs.

ManagementMedical

Corticosteroid therapy may be used to reduce inflammation and diminish severity of the disorder.

NursingProvide and reinforce information and

reassurance that stroke has not occurred. Protection of the eye from injury; cover eye

with shield at night, instruct patient to close eyelid, use of eye ointment, sunglasses.

Facial exercises and massage to maintain muscle tone.