Treatments for Brain conditions
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Dysarthria:
Treatment
(In a Page: Signs and Symptoms)
-
Speech therapy is often necessary to relearn oral movements and communication skills, prevent aspiration, and motivate the patient
-
Treat underlying etiologies as necessary
–ALS does not improve
–Dysarthria may improve with treatment of diabetes
and/or hypothyroidism
–Myasthenia gravis improves with pyridostigmine and
immunosuppression
–Pralidoxime and atropine for nerve gas poisoning
–Antitoxin and close ICU observation for botulism
–Steroids for polymyositis and dermatomyositis - Surgical intervention may be necessary for structural causes
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Headache:
Treatment
(In a Page: Signs and Symptoms)
-
Tension-type headache: Regular exercise, stress management, tricyclic antidepressants, analgesics
-
Migraine headache: Avoid triggers; serotonin agonists (e.g., sumatriptan), NSAIDs, ergotomines
-
Temporal arteritis: High-dose corticosteroids
-
Meningitis: Search for and treat the primary source (e.g., pneumonia, sinusitis, neoplasm)
–Urgent antimicrobial administration for infections
–Treat inflammatory causes with steroids
-
Subarachnoid hemorrhage requires attention to airway, breathing, and circulation, and management of increased intracranial pressure (maintain normal blood pressure; hypertension may cause the aneurysm to rebleed, hypotension may cause cerebral ischemia); administer nimodipine to prevent cerebral vasospasm, seizure prophylaxis with IV phenytoin, surgery
-
Cluster headache: Oxygen inhalation for 5–10 minutes; serotonin agonists, ergotamines, and/or methysergide
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Headache:
Treatment
(In A Page: Pediatric Signs and Symptoms)
-
Explanation and reassurance alone may provide relief
-
Avoid triggers
–Trauma, sunlight, insomnia, stress, diet, dehydration
-
Symptomatic treatment:
–Acetominophen, NSAIDs, Midrin, Fioricet, Fiorinal
–Selective serotonin-1 receptor agonists
–Dihydroergotamine (DHE); Migranal nasal spray
–Antiemetics
-
Prophylaxis
–NSAIDs, β-blockers, tricyclic antidepressants,
cyproheptadine, calcium channel blockers,
antiepileptic drugs, biofeedback
-
Cluster headaches
–Treated with inhalation of oxygen; sumatriptan
-
Pseudotumor
–Weight reduction, Diamox
–Optic nerve sheath decompression or shunting
>>
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Headache:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Depending on the type of headache, analgesics — ranging from aspirin to codeine or meperidine — may provide symptomatic relief. Other measures include identification and elimination of causative factors and, possibly, psychotherapy for headaches caused by emotional stress. Chronic tension headaches may also require muscle relaxants.
For migraine headaches, ergotamine alone or with caffeine may be an effective treatment. The Food and Drug Administration allows labeling of various analgesic preparations that include caffeine to state that they’re for the treatment of migraine headaches. Remember that these medications can’t be taken by pregnant women because they stimulate uterine contractions. These drugs and others, such as metoclopramide or naproxen, work best when taken early in the course of an attack. If nausea and vomiting make oral administration impossible, drugs may be given as rectal suppositories.
Drugs in the class of sumatriptan are considered by many clinicians to be the drug of choice for acute migraine attacks or cluster headaches. Drugs that can help prevent migraine headaches include antidepressants (such as nortriptyline or fluoxetine), beta blockers (propranolol), and calcium-channel blockers (verapamil). Corticosteroids provide short-term relief for some patients with cluster headaches.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Malignant brain tumors:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment includes removing a resectable tumor; reducing a nonresectable tumor; relieving cerebral edema, increased ICP, and other symptoms; and preventing further neurologic damage.
The mode of therapy depends on the tumor's histologic type, radiosensitivity, and location and may include surgery, radiation, chemotherapy, or decompression of increased ICP with diuretics, cortico-steroids, or possibly ventriculoatrial or ventriculoperitoneal shunting of CSF.
A glioma usually requires resection by craniotomy, followed by radiation therapy and chemotherapy. The combination of nitrosoureas (carmustine [BCNU], lomustine [CCNU], or procarbazine) and postoperative radiation is more effective than radiation alone.
Surgical resection of low-grade cystic cerebellar astrocytomas brings long-term survival. Treatment of other astrocytomas includes repeated surgery, radiation therapy, and shunting of fluid from obstructed CSF pathways. Some astrocytomas are highly radiosensitive, but others are radioresistant.
Treatment of oligodendrogliomas and ependymomas includes resection and radiation therapy; for medulloblastomas, resection and possibly intrathecal infusion of methotrexate or another antineoplastic drug. Meningiomas require resection, including dura mater and bone (operative mortality may reach 10% because of large tumor size).
For schwannomas, microsurgical technique allows complete resection of the tumor and preservation of facial nerves. Although schwannomas are moderately radioresistant, postoperative radiation therapy is necessary.
Chemotherapy for malignant brain tumors includes the nitrosoureas that help break down the blood-brain barrier and allow other chemotherapeutic drugs to go through as well. Intrathecal and intra-arterial administration of drugs maximizes drug actions.
Palliative measures for gliomas, astrocytomas, oligodendrogliomas, and ependymomas include dexamethasone for cerebral edema; osmotic diuretics, such as urea and mannitol, to reduce brain swelling; analgesics to control pain; and antacids and histamine receptor antagonists for stress ulcers. These tumors and schwannomas may also require anticonvulsants such as phenytoin to reduce seizures.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Brain abscess:
Treatment (Tx)
(Professional Guide to Diseases (Eighth Edition))
Antibiotics, drainage of abscess, supportive care (analgesics, bed rest)
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Dysarthria:
Emergency interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient displays dysarthria, ask him about associated difficulty swallowing. Then determine respiratory rate and depth. Measure vital capacity with a Wright respirometer if available. Assess blood pressure and heart rate. Tachycardia, slightly increased blood pressure, and shortness of breath are usually early signs of respiratory muscle weakness.
Ensure a patent airway. Place the patient in Fowler’s position and suction him if necessary. Administer oxygen and keep emergency resuscitation equipment nearby. Anticipate intubation and mechanical ventilation in progressive respiratory muscle weakness. Withhold oral fluids in the patient with associated dysphagia.
If dysarthria isn’t accompanied by respiratory muscle weakness and dysphagia, continue to assess for other neurologic deficits. Compare muscle strength and tone in the limbs, and evaluate tactile sensation. Ask the patient about numbness or tingling. Test deep tendon reflexes (DTRs), and note gait ataxia. Assess cerebellar function by observing rapid alternating movement, which should be smooth and coordinated. Next, test visual fields and ask about double vision. Check for signs of facial weakness such as ptosis. Finally, determine level of consciousness (LOC) and mental status.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Headache:
Treatment
(Handbook of Diseases)
Depending on the type of headache, treatment interventions range from relaxation techniques, massage, and biofeedback to pharmacologic agents. Tricyclic antidepressants, beta-adrenergic blockers, and anticonvulsants may be prescribed for headache prevention; nonsteroidal anti-inflammatory drugs (NSAIDs), combination NSAIDs with caffeine, ergotamines, and dopamine antagonists may be used for abortive measures. Narcotic agents are generally avoided or may be limited to twice weekly.
Abortive therapy using the synthetic form of serotonin (sumatriptan) is available in an oral form and as a nasal spray and can easily be carried for immediate use.
Other measures include identification and elimination of causative factors, stressors, or stimuli that might trigger an attack such as in the migraine-type headache. Diet history and examination of lifestyle patterns may help identify causative agents.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Brain tumors, malignant:
Treatment
(Handbook of Diseases)
Remedial approaches include removing a resectable tumor; reducing a nonresectable tumor; relieving cerebral edema, increased ICP, and other signs and symptoms; and preventing further neurologic damage.
The mode of therapy depends on the tumor’s histologic type, radiosensitivity, and location and may include surgery, radiation, chemotherapy, or decompression of increased ICP with a diuretic, corticosteroid or, possibly, ventriculoatrial or ventriculoperitoneal shunting of CSF.
❑ Gliomas. Treatment usually requires resection by craniotomy, followed by radiation therapy and chemotherapy. The combination of nitrosoureas (carmustine [BCNU], lomustine [CCNU], or procarbazine) and postoperative radiation is more effective than radiation alone.
❑ Astrocytomas. Surgical resection of low-grade cystic cerebellar astrocytomas brings long-term survival. Treatment of other astrocytomas includes repeated surgery, radiation therapy, and shunting of fluid from obstructed CSF pathways. Some astrocytomas are highly radiosensitive, but others are radioresistant.
❑ Oligodendrogliomas and ependymomas. Treatment includes resection and radiation therapy.
❑ Medulloblastomas. Treatment involves resection and, possibly, intrathecal infusion of methotrexate or another antineoplastic.
❑ Meningiomas. Treatment requires resection, including dura mater and bone (operative mortality may reach 10% because of large tumor size).
❑ Schwannomas. Microsurgical technique allows complete resection of the tumor and preservation of facial nerves. Although schwannomas are moderately radioresistant, postoperative radiation therapy is necessary.
Chemotherapy for malignant brain tumors includes a nitrosourea to help break down the blood-brain barrier and permit other chemotherapeutic drugs to go through as well. Intrathecal and intra-arterial administration of drugs maximizes drug action.
Palliative measures for gliomas, astrocytomas, oligodendrogliomas, and ependymomas include dexamethasone for cerebral edema and an antacid and a histamine-receptor antagonist for stress ulcers. These tumors and schwannomas may also require an anticonvulsant.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Brain abscess:
Treatment
(Handbook of Diseases)
Therapy consists of an antibiotic to combat the underlying infection and surgical aspiration or drainage of the abscess. However, surgery is delayed until the abscess becomes encapsulated (a CT scan helps determine this) and is contraindicated in patients with congenital heart disease or another debilitating cardiac condition. Administration of a penicillinase-resistant antibiotic, such as nafcillin or methicillin, for at least 2 weeks before surgery can reduce the risk of spreading infection.
Other treatments during the acute phase are palliative and supportive; they include mechanical ventilation and administration of I.V. fluids with a diuretic (urea, mannitol) and a glucocorticoid (dexamethasone) to combat increased ICP and cerebral edema. An anticonvulsant, such as phenytoin or phenobarbital, can help prevent seizures.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Battle's sign:
Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Assess the patient’s neurologic function frequently. Keep him in a supine position to decrease pressure on dural tears and to minimize CSF leakage. Avoid nasogastric intubation and nasopharyngeal suction, which may cause cerebral infection. Also, caution the patient against blowing his nose, which may worsen a dural tear.
The patient may need skull X-rays and a CT scan to help confirm a basilar skull fracture and to evaluate the severity of the head injury. Typically, a basilar skull fracture and associated dural tears heal spontaneously within several days to weeks. However, if the patient has a large dural tear, a craniotomy may be necessary to repair the tear with a graft patch. If the injury was due to abuse, notify the appropriate authority in the facility.
Patient teaching
Explain all procedures and tests. Inform the patient with a basilar skull fracture that he’ll require bed rest for several days to weeks. Explain the need to avoid placing pressure on the brain tissue, and advise him on proper positioning. Also tell him to refrain from blowing his nose.
If the injury was due to an accidental fall, advise the patient’s family to assess the household for safety hazards and remove precipitating factors such as throw rugs.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Dysarthria:
Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Encourage the patient with dysarthria to speak slowly so that he can be understood. Give him time to express himself, and encourage him to use gestures. Dysarthria usually requires consultation with a speech pathologist.
Patient teaching
Instruct the patient and his family about communication techniques. Encourage the patient to express his feelings. Provide guidelines on foods or liquids that should be avoided due to risk for aspiration. Refer the patient to a speech therapist.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Battle's sign:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Explain activity restrictions and the need for bed rest to the patient. Provide emotional support to the patient and his family. Caution the patient against blowing his nose, which may worsen a dural tear.
Before discharge, instruct the patient’s family or caregiver to watch closely for changes in mental status, LOC, or respirations. Tell them to give the patient acetaminophen if he experiences headaches.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Dysarthria:
Emergency Actions
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
If the patient displays dysarthria, ask him about associated difficulty swallowing. Then determine his respiratory rate and depth, and measure vital capacity. Assess blood pressure and heart rate. Usually, tachycardia, slightly increased blood pressure, and shortness of breath are early signs of respiratory muscle weakness.
Ensure a patent airway. Place the patient in Fowler’s position and suction him if necessary. Administer oxygen, and keep emergency resuscitation equipment nearby. Anticipate intubation and mechanical ventilation in progressive respiratory muscle weakness. Withhold oral fluids in the patient with associated dysphagia.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Headache:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Teach the patient and his family or caregiver how to recognize signs of reduced LOC and seizures. Discuss ways to maintain a safe, quiet environment and reduce environmental stress, if indicated. Discuss the use of analgesics to ease the headache.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Battle's sign:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Expect a patient with a basilar skull fracture to be on bed rest for several days to weeks. (See Managing the patient with a basilar skull fracture.)
▪ Monitor his neurologic status closely.
▪ Anticipate that the patient may need skull X-rays and a computed tomography scan to help confirm basilar skull fracture and to evaluate the severity of head injury.
▪ Although a basilar skull fracture and associated dural tears typically heal spontaneously within several days to weeks, if the patient has a large dural tear, a craniotomy may be necessary to repair the tear with a graft patch.
Patient teaching
▪ Explain activities the patient should avoid, and emphasize the importance of bed rest.
▪ Explain to the patient and family the signs and symptoms to look for and report, such as changes in mental status, LOC, or breathing.
▪ Tell the patient to take acetaminophen for headaches.
▪ Explain what diagnostic tests the patient may need.
▪ Discuss surgery with the patient, if indicated, and answer his questions and concerns.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Dysarthria:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Consult with a speech pathologist, as needed.
▪ Administer medications and treatments as needed.
▪ Assess the patient's swallow and gag reflexes before feeding him.
▪ Give the patient time to express himself.
▪ Encourage the patient to express his feelings.
Patient teaching
▪ Encourage the patient with dysarthria to speak slowly so that he can be understood.
▪ Encourage him to use gestures to aid communication.
▪ Discuss different ways to communicate.
▪ Explain to the patient his diagnosis and the treatment plan.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Headache:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Monitor the patient's vital signs and LOC.
▪ Watch for a change in the headache's severity or location.
▪ To help ease the headache, administer an analgesic, darken the patient's room, and minimize other stimuli.
▪ Prepare the patient for diagnostic tests, such as skull X-rays, a computed to-mography scan, lumbar puncture, or cerebral arteriography.
Patient teaching
▪ Explain all procedures and treatments to the patient.
▪ Discuss the signs of reduced LOC and seizures that the patient or his caregivers should report.
▪ Explain ways to maintain a safe, quiet environment and reduce environmental stress.
▪ Discuss the proper use of analgesics.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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