SAS 21

• Two of the most common symptoms in neurologic disorders are headache and dizziness.
• For headache, ask about onset, location, duration, severity and any associated symptoms such as visual changes, weakness, or loss of sensation.
• Ask if the headache is affected by coughing, sneezing, or sudden movement of the head, which can increase intracranial pressure.
• Subarachnoid hemorrhage may present as “the worst headache of my life.”
• Severe headache in meningitis.
• Dull headache affected by the actions listed, especially in the same location, in mass lesions such as brain tumor or abscess.
• The complaint of dizziness can have many meanings.
• Dizziness or Vertigo can be caused by inner ear conditions, brainstem tumor.
• Diplopia, dysarthria, ataxia in vertebrobasilar transient ischemic attack (TIA) or stroke.
• Upon completion of this lesson, the nursing student can describe the structure and function of the nervous system, obtain an accurate history of the neurologic system, identify the cranial nerves and the motor and sensory functions, perform a screening neurologic examination, assess level of consciousness utilizing the Glasgow Coma Scale, document the finding of the nervous system examination, and discuss risk reduction and health promotion strategies to reduce strokes.
• Weakness is another common symptom and requires careful attention to detail.
• Probe for exactly what it means to the patient.
• Explore whether there is paralysis, or inability to move a part or side of the body.
• For weakness without light-headedness, try to distinguish between proximal and distal weakness.
• Bilateral proximal weakness in myopathy.
• Bilateral, predominantly distal weakness in polyneuropathy.
• Weakness made worse with repeated effort and improved with rest suggests myasthenia gravis.
• Find out if the patient has had any loss of sensation.
• Contralateral leg weakness, contralateral field cut, contralateral face, arm, increased leg weakness, sensory loss, vision field cut, aphasia, and apraxia are signs and symptoms of a stroke in the anterior circulation (middle cerebral artery).
• Tremors and other involuntary movements occur with or without additional neurologic manifestations.
• Pain may arise from neurologic causes but is usually reported with symptoms of other body systems, such as the head and neck or the musculoskeletal system.
• Loss of consciousness, or fainting, can be caused by syncope, which is the sudden but temporary loss of consciousness and postural tone that occurs with decreased blood flow to the brain, commonly described as fainting.
• Burning pain in painful sensory neuropathy is a symptom of a peripheral nervous system disorder.
• Distinct from these symptoms is an almost indescribable restlessness of the legs that typically develops at rest and is accompanied by an urge to move about.
• Cardiacsyncope from arrhythmias, more common in older patients, often with sudden onset, sudden offset is another type of syncope.
• Tonic – clonic motor activity, bladder or bowel incontinence, and postictal state suggest a generalized seizure.
• Near syncope or presyncope, symptoms of feeling faint, light-headed, or weak, but without actual loss of consciousness, are caused by vasodepressor (or vasovagal) syncope, which is more common in young people with emotional stress and warning symptoms of flushing, warmth, or nausea.
• Unlike syncope, injury such as tongue biting or bruising of limbs may occur during a seizure.
• Loss of sensation, paresthesias, and dysesthesias in central lesions in the brain and spinal cord, as well as disorders of peripheral sensory roots and nerves; paresthesias in the hands and around the mouth in hyperventilation are symptoms of central nervous system disorders.
• Seizures are a paroxysmal disorder caused by sudden excessive electrical discharge in the cerebral cortex or its underlying structures, and can be of several types.
• Transient ischemic attack (TIA) is a condition that can be mistaken for a stroke.
• Resting hand tremors and pill rolling are indicative of Myasthenia gravis.
• Absence seizures involve a sudden brief lapse of consciousness, with momentary blinking, staring or movements of the lips and hands but no falling.
• The area affected in a stroke can be in the anterior circulation (middle cerebral artery), subcortical circulation (lenticulostriate deep penetrating branches of the middle cerebral artery), posterior circulation (posterior cerebral artery), or posterior circulation (basilar artery).
• Guillain-Barre syndrome is a disease where weakness is made worse with repeated effort and improved with rest.
• Complex partial seizure is a type of seizure that starts unilaterally in the hand, foot or face and spreads to other parts of the body.
• Vasodepressor syncope, postural hypotension, micturition syncope, and cough syncope are types of fainting due to a strong emotion such as fear or pain.
• Dysphagia, dysarthria, tongue/palate deviation and ataxia are signs and symptoms of a stroke in the posterior circulation (basilar artery).
• Myasthenia gravis is a disease where weakness is made worse with repeated effort and improved with rest.
• Paresthesias, numbness, and tingling sensations are signs and symptoms of a stroke.