YASHRAJ NURSING COLLEGE, KANPUR

G.N.M. 2ND YEAR MSN-1 NOTES

Headache

Definition:
- A headache is pain or discomfort in the head, scalp, or neck. It can range from
mild to severe and can be acute or chronic.

Types of Headaches:
1. Tension Headaches:
- Most common type.
- Characterized by a dull, aching sensation all over the head.
- Often associated with muscle tightness in the neck and shoulders.

2. Cluster Headaches:
- Severe, unilateral headaches that occur in clusters over weeks or months.
- Often described as burning or piercing pain around one eye.
- Can be accompanied by redness and tearing of the eye.

3. Sinus Headaches:
- Caused by sinus infections or inflammation.
- Pain is usually around the forehead, cheeks, and nose.

Diagnosis:
- Medical History: Includes duration, frequency, and intensity of headaches.
- Physical Examination: To check for signs of infection or neurological issues.
- Imaging (CT, MRI): If a serious underlying condition is suspected.

Treatment:
- Medications: Pain relievers, anti-inflammatories, and muscle relaxants.
- Lifestyle Modifications: Stress management, regular exercise, and adequate
hydration.
- Alternative Therapies: Acupuncture, massage, and relaxation techniques.
Migraine
Definition:
- A migraine is a neurological condition characterized by intense, throbbing
headaches, often accompanied by nausea, vomiting, and sensitivity to light and
sound.

Etiology:
- Genetic Factors: Family history of migraines.
- Triggers: Stress, hormonal changes, certain foods, environmental factors,
and sensory stimuli.

Symptoms:
- Prodrome Phase: Mood changes, food cravings, neck stiffness, and frequent
yawning.
- Aura Phase: Visual disturbances, sensory changes, or speech difficulties (not
present in all migraines).
- Attack Phase: Severe, throbbing headache usually on one side of the
head, nausea, vomiting, and sensitivity to light and sound.
- Postdrome Phase: Feeling drained, confused, or washed out after the
headache subsides.

Diagnosis:
- Medical History: Detailed history of headache patterns and associated
symptoms.
- Neurological Exam: To rule out other causes of headaches.
- Imaging: In atypical cases or to exclude other conditions.

Treatment:
- Medications:
- Acute Treatments: NSAIDs, triptans, antiemetics.
- Preventive Treatments: Beta-blockers, antidepressants, antiepileptic drugs,
CGRP inhibitors.
- Lifestyle Changes: Avoiding known triggers, regular sleep, and dietary
modifications.
- Alternative Treatments: Biofeedback, cognitive behavioral therapy (CBT), and
acupuncture.
Seizures
Definition:
- A seizure is a sudden, uncontrolled electrical disturbance in the brain that
can cause changes in behavior, movements, feelings, and levels of
consciousness.

Types of Seizures:
1. Focal Seizures:
- Originate in one area of the brain.
- Simple Focal Seizures: Affect a small part of the brain and do not impair
awareness.
- Complex Focal Seizures: Can impair consciousness or awareness and
cause repetitive movements.

2. Generalized Seizures:
- Involve both sides of the brain.
- Absence Seizures: Brief, sudden lapses in attention (often mistaken for
daydreaming).
- Tonic-Clonic Seizures: Loss of consciousness and convulsions, with muscle
stiffening (tonic phase) followed by rhythmic jerking (clonic phase).
- Myoclonic Seizures: Sudden, brief jerks or twitches of the arms and legs.
- Atonic Seizures: Sudden loss of muscle tone, leading to falls.

Diagnosis:
- Medical History: Detailed history of seizure activity, triggers, and associated
symptoms.
- Neurological Exam: To assess brain function.
- Electroencephalogram (EEG): To measure electrical activity in the brain.
- Imaging (MRI, CT): To identify any structural abnormalities in the brain.

Treatment:
- Medications: Antiepileptic drugs (AEDs) tailored to the type of seizure.
- Lifestyle Modifications: Avoiding known triggers, maintaining a healthy
lifestyle, and ensuring medication adherence.
- Surgical Interventions: For drug-resistant epilepsy, options include
lobectomy, lesionectomy, or corpus callosotomy.
- Vagus Nerve Stimulation (VNS): Implanted device that sends electrical
impulses to the brain to reduce seizure frequency.
 Epilepsy
Definition:
- Epilepsy is a chronic neurological disorder characterized by recurrent,
unprovoked seizures.

Etiology:
- Genetic Factors: Inherited genetic mutations.
- Structural Abnormalities: Brain injuries, tumors, infections, or congenital
malformations.
- Metabolic Disorders: Conditions that affect the brain's metabolism.

Symptoms:
- Seizure Activity: Varied depending on the type of seizure.
- Postictal State: Period after a seizure, often involving confusion, fatigue, and
disorientation.

Diagnosis:
- Medical History: Detailed seizure history and family history of epilepsy.
- Neurological Exam: To assess brain function and rule out other conditions.
- EEG: To detect abnormal electrical activity in the brain.
- Neuroimaging: MRI or CT scans to identify structural causes.

Treatment:
- Medications: AEDs to control or reduce seizure frequency.
- Surgical Options: For drug-resistant epilepsy, including resective surgery or
implantation of devices like VNS or responsive neurostimulation (RNS).
- Dietary Therapy: Ketogenic diet for some patients, particularly children with
certain types of epilepsy.
- Lifestyle Modifications: Regular sleep, stress management, and adherence to
treatment plans.

Cerebrovascular Disorder – CVA (Cerebrovascular Accident)

Definition:
CVA, commonly known as a stroke, is a sudden interruption in the blood
supply to the brain, resulting in neurological deficits.

Types:
1. Ischemic Stroke
- Thrombotic Stroke: Caused by a blood clot (thrombus) forming in an artery
supplying blood to the brain.
- Embolic Stroke: Caused by a blood clot or other debris (embolus) forming
away from the brain, usually in the heart, and traveling through the
bloodstream to lodge in narrower brain arteries.

2. Hemorrhagic Stroke
- Intracerebral Hemorrhage: Bleeding occurs within the brain tissue itself.
- Subarachnoid Hemorrhage: Bleeding occurs in the space between the brain
and the tissues covering it.

Risk Factors:
- Hypertension
- Diabetes mellitus
- Hyperlipidemia
- Smoking
- Obesity
- Sedentary lifestyle
- Atrial fibrillation
- Family history of stroke

Clinical Manifestations:
- Sudden numbness or weakness in the face, arm, or leg (especially on one side
of the body)
- Sudden confusion, trouble speaking, or understanding
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking, dizziness, loss of balance, or lack of coordination

Diagnosis:
- CT Scan: To differentiate between ischemic and hemorrhagic stroke
- MRI: Provides detailed images of brain tissue
- Carotid Ultrasound: To check for carotid artery stenosis
- Blood Tests: To assess for clotting disorders, cholesterol levels, and other
relevant factors

Treatment:
- Ischemic Stroke: Administration of thrombolytics (e.g., tPA) to dissolve clots
if given within a specific time window. Anticoagulants and antiplatelet agents
are also used.
- Hemorrhagic Stroke: Control of bleeding, reduction of intracranial pressure,
and surgical interventions if necessary.

Nursing Care:
- Monitor neurological status frequently
- Administer medications as prescribed
- Implement fall precautions
- Provide support for physical therapy and rehabilitation
Neurological Trauma

1. Head Trauma:

Types:
- Concussion: A mild traumatic brain injury caused by a blow to the head or
body.
- Contusion: A bruise on the brain tissue resulting from a blow to the head.
- Diffuse Axonal Injury: Widespread damage to brain cells due to shaking or
rotational forces.

Clinical Manifestations:
- Loss of consciousness
- Confusion
- Headache
- Nausea/vomiting
- Dizziness

Diagnosis:
- CT Scan/MRI: To identify structural injuries and bleeding

Treatment:
- Rest and observation
- Medications for headache and nausea
- Surgery if needed for severe injuries

Nursing Care:
- Monitor for signs of increased intracranial pressure
- Regular neurological assessments
- Educate patients and families about signs of worsening symptoms

2. Brain Trauma:

Types:
- Closed Head Injury: The skull remains intact but the brain is injured.
- Open Head Injury: The skull is fractured or penetrated.

Diagnosis and Treatment: Similar to head trauma but may require more
specialized management depending on the extent and location of the injury.

3. Spinal Cord Trauma:

Types:
- Complete Spinal Cord Injury: Loss of all sensory and motor functions below
the level of injury.
- Incomplete Spinal Cord Injury: Partial loss of sensory and/or motor function.

Clinical Manifestations:
- Paralysis or loss of sensation below the level of injury
- Pain or abnormal sensations
- Loss of bladder and bowel control

Diagnosis:
- CT Scan/MRI: To visualize spinal cord injuries and associated fractures or
dislocations

Treatment:
- Immobilization and stabilization of the spine
- Surgical interventions to relieve pressure on the spinal cord
- Rehabilitation for functional recovery

Nursing Care:
- Monitor for signs of complications such as pressure sores and infections
- Assist with mobility and activities of daily living
- Provide psychological support

4. Subdural and Extradural Hematoma

Subdural Hematoma:
- Definition: Accumulation of blood between the dura mater and the brain
- Causes: Often due to tearing of veins from traumatic injury
- Symptoms: Headache, confusion, drowsiness, and changes in consciousness

Extradural Hematoma:
- Definition: Accumulation of blood between the skull and the dura mater
- Causes: Typically results from arterial bleeding due to skull fractures
- Symptoms: Rapid onset of symptoms including loss of consciousness,
headache, and focal neurological deficits

Diagnosis:
- CT Scan/MRI: To detect and assess the extent of bleeding

Treatment:
- Surgical evacuation of hematoma if necessary
- Management of intracranial pressure

Nursing Care:
- Close monitoring of neurological status
- Postoperative care if surgery was performed

Neurologic Infection

1. Meningitis:

Definition:
- Inflammation of the protective membranes covering the brain and spinal cord

Types:
- Bacterial Meningitis: Severe and often life-threatening
- Viral Meningitis: Typically less severe and often resolves on its own
- Fungal and Parasitic Meningitis: Less common but can be severe

Clinical Manifestations:
- Headache
- Neck stiffness
- Fever
- Nausea/vomiting
- Sensitivity to light (photophobia)

Diagnosis:
- Lumbar Puncture: To analyze cerebrospinal fluid (CSF)
- Blood Cultures: To identify the causative organism

Treatment:
- Bacterial Meningitis: Prompt administration of intravenous antibiotics
- Viral Meningitis: Supportive care and antiviral medications if necessary

Nursing Care:
- Monitor vital signs and neurological status
- Administer medications as prescribed
- Implement infection control measures

2. Encephalitis:

Definition:
- Inflammation of the brain tissue itself, often caused by viral infections

Clinical Manifestations:
- Fever
- Headache
- Seizures
- Confusion or altered mental status

Diagnosis:
- MRI/CT Scan: To visualize brain inflammation
- Lumbar Puncture: To analyze CSF

Treatment:
- Antiviral medications if caused by viruses
- Supportive care for symptoms

Nursing Care:
- Monitor neurological status and vital signs
- Provide supportive care and manage symptoms

3. Brain Abscess:

Definition:
- Localized collection of pus within the brain tissue due to infection

Clinical Manifestations:
- Headache
- Fever
- Neurological deficits
- Seizures

Diagnosis:
- CT Scan/MRI: To identify abscess and assess its size and location
- Blood Cultures: To identify the causative organism

Treatment:
- Surgical drainage of the abscess
- Antibiotic therapy

Nursing Care:
- Monitor for signs of infection and complications
- Provide postoperative care and support