Cathy C. Cartwright, RN, MSN, PCNS
Pediatric Clinical Nurse Specialist
Neurosurgery
University of Missouri Health Care
Columbia, MO 65212
USA
Donna C. Wallace, RN, MS, CPNP
Pediatric Nurse Practitioner
Barrow Neurological Institute
St. Joseph‘s Hospital and Medical Center
500 West Thomas Road
Phoenix, AZ 85013
USA
ISBN 978-3-540-29703-1 Springer Berlin Heidelberg NewYork
Library of Congress Control Number: 2006936733
Th is work is subject to copyright. All rights are reserved, whether the whole or part of the
material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations,
recitation, broadcasting, reproduction on microfi lms or in any other way, and storage in data
banks. Duplication of this publication or parts thereof is permitted only under the provisions
of the German Copyright Law of September 9, 1965, in its current version, and permission for
use must always be obtained from Springer-Verlag. Violations are liable for prosecution under
the German Copyright Law.
Springer is a part of Springer Science+Business Media
springer.com
© Springer-Verlag Berlin Heidelberg 2007
Printed in Germany
Th e use of general descriptive names, registered names, trademarks, etc. in this publication
does not imply, even in the absence of a specifi c statement, that such names are exempt from the
relevant protective laws and regulations and therefore free for general use.
Product liability: Th e publishers cannot guarantee the accuracy of any information about dosage
and application contained in this book. In every individua case the user must check such
information by consulting the relevant literature.
Editor: Gabriele M. Schröder, Heidelberg, Germany
Desk Editor: Stephanie Benko, Heidelberg, Germany
Production: LE-TeX, Jelonek, Schmidt & Vöckler GbR, Leipzig, Germany
Typsetting: Satz-Druck-Service (SDS), Leimen, Germany
Cover design: Frido Steinen-Broo, eStudio Calamar, Spain
Cover Illustration: Permission with compliments from PMT corporation,
USA 2006 as well as patient’s family.
Printed on acid-free paper 24/3100/YL 5 4 3 2 1 0\
Chapter1
Neurological Assessment of the Neonate,
Infant, Child and Adolescent
Contents
Jennifer A. Disabato and Karen W. Burkett
Introduction . . . . . . . . . . . . . . . . . . . . . . . 1
Importance of Neurological Assessment . . . 1
Nursing Approach
to Neurological Assessment . . . . . . . . . . 1
Diagnostic Imaging and Testing
in Neurological Assessment . . . . . . . . . . 2
Developmental Assessment:
Growth and Developmental Tasks by Age . . . 2
Neonate . . . . . . . . . . . . . . . . . . . . . . . . 4
Infant . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Toddler . . . . . . . . . . . . . . . . . . . . . . . . . 10
Preschooler . . . . . . . . . . . . . . . . . . . . . . 11
School-Age Child . . . . . . . . . . . . . . . . . . 11
Adolescent . . . . . . . . . . . . . . . . . . . . . . 12
Developmental Assessment Tools . . . . . . . . 13
Hands-On Neurological Assessment . . . . . . . 13
Appearance and Observation . . . . . . . . . . 14
Level of Consciousness . . . . . . . . . . . . . . . 14
Cranial Nerve Assessment –
Brainstem Function . . . . . . . . . . . . . . . 16
Assessment of Vital Signs . . . . . . . . . . . . . 19
Assessment of Motor Function . . . . . . . . . . 19
Assessment of Sensory Function . . . . . . . . 20
Assessment of Reflexes . . . . . . . . . . . . . . 20
Assessment of Gait and Balance . . . . . . . . . 21
Assessment of Brain Death: Herniation
Syndromes and Brainstem Reflexes . . . . . . . 22
Assessment of External
Monitoring Apparatus . . . . . . . . . . . . . 23
Pain Assessment in the Child
with a Neurological Diagnosis . . . . . . . . 23
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . 24
References . . . . . . . . . . . . . . . . . . . . . . 27
Chapter 2
Hydrocephalus
Nadine Nielsen, Katherine Pearce,
Elizabeth Limbacher, and Donna C. Wallace
Introduction . . . . . . . . . . . . . . . . . . . . . . . 29
History of Hydrocephalus . . . . . . . . . . . . . . 29
Incidence of Hydrocephalus . . . . . . . . . . . . 30
Prognosis . . . . . . . . . . . . . . . . . . . . . . . . . 30
Classifications of Types of Hydrocephalus . . . 30
Communicating Hydrocephalus . . . . . . . . . 31
Noncommunicating Hydrocephalus . . . . . . 31
Congenital Hydrocephalus . . . . . . . . . . . . 31
Acquired Hydrocephalus . . . . . . . . . . . . . 31
Internal Hydrocephalus . . . . . . . . . . . . . . 32
External Hydrocephalus . . . . . . . . . . . . . . 32
Ex Vacuo Hydrocephalus . . . . . . . . . . . . . 32
Normal Pressure Hydrocephalus . . . . . . . . . 32
Pathophysiology of Hydrocephalus . . . . . . . 32
Overview of CSF Production
and Flow Dynamics . . . . . . . . . . . . . . . 32
CSF Pathways . . . . . . . . . . . . . . . . . . . . . 32
Intracranial Pressure . . . . . . . . . . . . . . . . 32
Structural Changes . . . . . . . . . . . . . . . . . 34
Vascular Changes . . . . . . . . . . . . . . . . . . 34
Metabolic Changes . . . . . . . . . . . . . . . . . 34
CSF Changes . . . . . . . . . . . . . . . . . . . . . 34
Brain Tissue Changes . . . . . . . . . . . . . . . . 34
Etiologies of Hydrocephalus . . . . . . . . . . . 35
Aqueductal Stenosis . . . . . . . . . . . . . . . . 35
Myelomeningocele and Chiari II
Malformation . . . . . . . . . . . . . . . . . . . 35
Chiari I Malformation . . . . . . . . . . . . . . . . 36
Dandy-Walker Malformation . . . . . . . . . . . 36
Vein of Galen Malformation . . . . . . . . . . . . 36
Arachnoid Cysts . . . . . . . . . . . . . . . . . . . 37
Posthemorrhagic Hydrocephalus
of Prematurity . . . . . . . . . . . . . . . . . . 37
Postinfectious Hydrocephalus . . . . . . . . . . 38
CNS Tumors . . . . . . . . . . . . . . . . . . . . . . 39
Head Trauma . . . . . . . . . . . . . . . . . . . . . 39
Signs and Symptoms of Hydrocephalus . . . . . 39
Diagnosis of Hydrocephalus
by Imaging Studies . . . . . . . . . . . . . . . . . . 41
Ultrasonography . . . . . . . . . . . . . . . . . . . 41
Computed Tomography . . . . . . . . . . . . . . 42
Magnetic Resonance Imaging . . . . . . . . . . 43
Treatment of Hydrocephalus . . . . . . . . . . . . 43
Medical Therapy . . . . . . . . . . . . . . . . . . . 43
Surgical Intervention . . . . . . . . . . . . . . . . 44
Treatment of Hydrocephalus
in Specific Malformations/Diseases . . . . . 48
Complications of Shunts and Treatment . . . . 50
Shunt Malfunction . . . . . . . . . . . . . . . . . 50
Shunt Infection . . . . . . . . . . . . . . . . . . . . 52
Complications Related
to Distal Catheter Location . . . . . . . . . . 53
Lumboperitoneal Catheter Complications . . 54
Overdrainage Causing Extra-axial
Fluid Collection . . . . . . . . . . . . . . . . . . 54
Special Diagnostic and Treatment Challenge:
Slit Ventricle Syndrome . . . . . . . . . . . . . 54
Pseudotumor Cerebri
in the Pediatric Population . . . . . . . . . . . . . 56
Pathophysiology . . . . . . . . . . . . . . . . . . . 56
Nursing Care of the Hydrocephalus
Patient After Surgery . . . . . . . . . . . . . . . . . 57
Neurological Assessment . . . . . . . . . . . . . 58
Wound and Dressing Care . . . . . . . . . . . . . 58
Medications . . . . . . . . . . . . . . . . . . . . . . 58
Other Nursing Care . . . . . . . . . . . . . . . . . 59
Extraventricular Drainage . . . . . . . . . . . . . 60
Discharge . . . . . . . . . . . . . . . . . . . . . . . 61
Family Support . . . . . . . . . . . . . . . . . . . . 61
Living with Hydrocephalus . . . . . . . . . . . . . 62
Cognitive Abnormalities . . . . . . . . . . . . . . 63
Motor Disabilities . . . . . . . . . . . . . . . . . . 64
Ocular Abnormalities . . . . . . . . . . . . . . . . 64
Seizures . . . . . . . . . . . . . . . . . . . . . . . . 64
Precocious Puberty . . . . . . . . . . . . . . . . . 65
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . 65
References . . . . . . . . . . . . . . . . . . . . . . 65
Chapter 3
Craniosynostosis
Cathy C. Cartwright and Patricia Chibbaro
Introduction . . . . . . . . . . . . . . . . . . . . . . . 67
Nonsyndromic Craniosynostosis . . . . . . . . . 68
Pathophysiology . . . . . . . . . . . . . . . . . . . 68
Syndromic Craniosynostosis . . . . . . . . . . . . 76
Pathophysiology . . . . . . . . . . . . . . . . . . . 76
Treatment for Craniosynostosis . . . . . . . . . . 81
Surgical Intervention . . . . . . . . . . . . . . . . 81
Preoperative Preparation for Intracranial
Surgery . . . . . . . . . . . . . . . . . . . . . . . 82
Surgical Experience . . . . . . . . . . . . . . . . . 83
Surgical Technique . . . . . . . . . . . . . . . . . 84
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . 87
References . . . . . . . . . . . . . . . . . . . . . . 88
Chapter 4
Neural Tube Defects
Shona S. Lenss
Introduction . . . . . . . . . . . . . . . . . . . . . . . 91
Etiology . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Epidemiology . . . . . . . . . . . . . . . . . . . . . . 92
Pathophysiology . . . . . . . . . . . . . . . . . . . . 92
Myelomeningocele (Open Defect) . . . . . . . . 93
Comorbidities of Myelomeningocele . . . . . . 95
Prenatal Screening for Myelomeningocele . . 96
Management . . . . . . . . . . . . . . . . . . . . . 98
Nursing Considerations . . . . . . . . . . . . . . 98
Spina Bifida Occulta (Closed Defect) . . . . . . . 101
Clinical Presentation . . . . . . . . . . . . . . . . 102
Cutaneous Anomalies of OSD . . . . . . . . . . 103
Orthopedic Findings of OSD . . . . . . . . . . . 104
Urologic Dysfunction of OSD . . . . . . . . . . . 105
Management . . . . . . . . . . . . . . . . . . . . . 105
Nursing Considerations . . . . . . . . . . . . . . . 105
Diagnostic Studies
for Neural Tube Defects . . . . . . . . . . . . . . . 106
Radiographic Imaging . . . . . . . . . . . . . . . 106
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . 106
References . . . . . . . . . . . . . . . . . . . . . . 107
Chapter 5
Chiari Malformation and Syringomyelia
Susan McGee and Diane Baudendistel
Introduction . . . . . . . . . . . . . . . . . . . . . . . 109
Chiari Type I . . . . . . . . . . . . . . . . . . . . . . 109
Chiari Type II . . . . . . . . . . . . . . . . . . . . . 110
Chiari Type III . . . . . . . . . . . . . . . . . . . . . 111
Syringomyelia . . . . . . . . . . . . . . . . . . . . 111
Presentation . . . . . . . . . . . . . . . . . . . . . . . 111
Chiari Type I . . . . . . . . . . . . . . . . . . . . . . 111
Chiari Type II . . . . . . . . . . . . . . . . . . . . . 112
Chiari Type III . . . . . . . . . . . . . . . . . . . . . 113
Syringomyelia . . . . . . . . . . . . . . . . . . . . 113
Diagnostic Tests . . . . . . . . . . . . . . . . . . . . 113
Treatment Options for CIM . . . . . . . . . . . . . 114
Medical. . . . . . . . . . . . . . . . . . . . . . . . . 114
Surgical . . . . . . . . . . . . . . . . . . . . . . . . 114
Nursing Care . . . . . . . . . . . . . . . . . . . . . 114
Treatment Options for CIIM . . . . . . . . . . . . . 115
Medical. . . . . . . . . . . . . . . . . . . . . . . . . 115
Surgical . . . . . . . . . . . . . . . . . . . . . . . . 115
Nursing Care . . . . . . . . . . . . . . . . . . . . . 115
Treatment Options for Syringomyelia . . . . . . 115
Nursing Care . . . . . . . . . . . . . . . . . . . . . 116
Patient and Family Education . . . . . . . . . . . 116
Outcomes: Short and Long Term . . . . . . . . 116
Conclusions . . . . . . . . . . . . . . . . . . . . . . . 117
References . . . . . . . . . . . . . . . . . . . . . . 117
Chapter 6
Tumors of the Central Nervous System
Tania Shiminski-Maher
Introduction . . . . . . . . . . . . . . . . . . . . . . . 119
Etiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Nervous System Anatomy . . . . . . . . . . . . . . 120
Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . 121
Treatment . . . . . . . . . . . . . . . . . . . . . . . . 125
Types of Tumors . . . . . . . . . . . . . . . . . . . . 130
Infant Tumors . . . . . . . . . . . . . . . . . . . . . 138
Nursing Care: Overview . . . . . . . . . . . . . . . 139
Developmental Considerations . . . . . . . . . 139
Diagnosis . . . . . . . . . . . . . . . . . . . . . . . 139
Surgery . . . . . . . . . . . . . . . . . . . . . . . . . 140
Observation . . . . . . . . . . . . . . . . . . . . . . 141
Radiation Therapy . . . . . . . . . . . . . . . . . . 142
Chemotherapy . . . . . . . . . . . . . . . . . . . . 142
The Multidisciplinary Team . . . . . . . . . . . . 143
Late Effects of CNS Tumors
and Treatment . . . . . . . . . . . . . . . . . . . . . 143
School Re-Entry: Physical
and Neurocognitive Sequelae . . . . . . . . . . 144
Ototoxicity . . . . . . . . . . . . . . . . . . . . . . 144
Neuroendocrine Late Effects . . . . . . . . . . . 144
Psychological/Social . . . . . . . . . . . . . . . . 145
Secondary Cancers . . . . . . . . . . . . . . . . . 145
Reccurrence, Death
and Dying, and Hospice . . . . . . . . . . . . . . 145
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . 145
References . . . . . . . . . . . . . . . . . . . . . . 146
Chapter 7
Traumatic Brain Injury
Angela Enix, Jodi Mullen, Carol Green,
and Sherry Kahn
Epidemiology . . . . . . . . . . . . . . . . . . . . . . 149
Pediatric Anatomy and Physiology
in Head Trauma . . . . . . . . . . . . . . . . . . . . . 149
Skull . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
Brain . . . . . . . . . . . . . . . . . . . . . . . . . . 150
Initial Evaluation and Resuscitation . . . . . . . 150
Primary Versus Secondary
Mechanism of Injury . . . . . . . . . . . . . . 150
Neurologic Assessment and Deterioration
in Pediatric Head Trauma . . . . . . . . . . . . . . 151
General Assessment . . . . . . . . . . . . . . . . 151
Vital Functions . . . . . . . . . . . . . . . . . . . . 152
Level of Consciousness . . . . . . . . . . . . . . . 152
Glasgow Coma Scale . . . . . . . . . . . . . . . . 152
Cranial Nerve Evaluation . . . . . . . . . . . . . . . 153
Visual Acuity . . . . . . . . . . . . . . . . . . . . . 153
Pupillary Response . . . . . . . . . . . . . . . . . 153
Extraocular Eye Movements . . . . . . . . . . . 154
Brainstem Reflex Exam . . . . . . . . . . . . . . . 154
Motor Exam . . . . . . . . . . . . . . . . . . . . . . 155
Reflexes . . . . . . . . . . . . . . . . . . . . . . . . 156
Supratentorial Versus
Infratentorial Injury . . . . . . . . . . . . . . . 156
Radiographic Imaging
in Pediatric Head Trauma . . . . . . . . . . . . . . 158
Types of TBI . . . . . . . . . . . . . . . . . . . . . . . 158
Birth-related TBI . . . . . . . . . . . . . . . . . . . 158
Neonatal Skull Fracture . . . . . . . . . . . . . . 159
Intracranial Hemorrhage. . . . . . . . . . . . . . 161
Epidural Hemorrhage . . . . . . . . . . . . . . . 161
Subarachnoid Hemorrhage . . . . . . . . . . . . 161
Subdural Hemorrhage . . . . . . . . . . . . . . . 161
Intracerebellar Hemorrhage . . . . . . . . . . . 162
Pediatric TBI . . . . . . . . . . . . . . . . . . . . . . 163
Diffuse Axonal Injury . . . . . . . . . . . . . . . . 169
Penetrating Craniocerebral Injury . . . . . . . . 170
Inflicted TBI . . . . . . . . . . . . . . . . . . . . . . 171
Concepts of Cerebral Physiology . . . . . . . . . 174
Intracranial Dynamics . . . . . . . . . . . . . . . 174
Compensatory Mechanisms . . . . . . . . . . . 174
Intracranial Compliance . . . . . . . . . . . . . . 174
Cerebral Blood Flow . . . . . . . . . . . . . . . . 175
Cerebral Metabolism . . . . . . . . . . . . . . . . 175
Pathophysiology of Intracranial
Hypertension . . . . . . . . . . . . . . . . . . . . . . 175
Cerebral Edema . . . . . . . . . . . . . . . . . . . 176
Intracranial Hypertension . . . . . . . . . . . . . 176
Cerebral Perfusion Pressure . . . . . . . . . . . . 176
Cerebral Herniation Syndromes . . . . . . . . . 176
Collaborative Management of Intracranial
Hypertension . . . . . . . . . . . . . . . . . . . . . . 178
Initial Resuscitation . . . . . . . . . . . . . . . . . 178
Intensive Care Management . . . . . . . . . . . 178
ICP Monitoring . . . . . . . . . . . . . . . . . . . . 179
Jugular Venous Oxygenation
Saturation Monitoring . . . . . . . . . . . . . . . 180
Monitoring Partial Pressure of Oxygen . . . . . 180
CSF Drainage . . . . . . . . . . . . . . . . . . . . . 180
Analgesia, Sedation, and Neuromuscular
Blockade . . . . . . . . . . . . . . . . . . . . . . 180
Hyperosmolar Therapy . . . . . . . . . . . . . . . 181
Hyperventilation . . . . . . . . . . . . . . . . . . . 181
Temperature Regulation . . . . . . . . . . . . . . 182
Barbiturate Therapy . . . . . . . . . . . . . . . . . 182
Hydration and Nutrition . . . . . . . . . . . . . . 182
Additional Nursing Care . . . . . . . . . . . . . . 183
Endocrine Complications . . . . . . . . . . . . . . 183
Diabetes Insipidus . . . . . . . . . . . . . . . . . . 183
Syndrome of Inappropriate Secretion
of Antidiuretic Hormone . . . . . . . . . . . . . . 184
Cerebral Salt Wasting . . . . . . . . . . . . . . . . 184
Postoperative Nursing Care
and Complications . . . . . . . . . . . . . . . . . . . 184
Preoperative Baseline . . . . . . . . . . . . . . . 185
Assuming Postoperative Nursing Care . . . . . 185
Vital Functions . . . . . . . . . . . . . . . . . . . . 185
Neurologic Function . . . . . . . . . . . . . . . . 185
General Postoperative Nursing Care . . . . . . 185
Postoperative Complications . . . . . . . . . . . 186
Outcomes . . . . . . . . . . . . . . . . . . . . . . . . 187
Prevention Efforts . . . . . . . . . . . . . . . . . . . 187
References . . . . . . . . . . . . . . . . . . . . . . 188
Chapter 8
Spine
Laurie Baker, Suzan R. Miller-Hoover,
Donna C. Wallace and Sherry Kahn
The Pediatric Spinal Column . . . . . . . . . . . . 191
Traumatic Spinal Cord Injuries . . . . . . . . . . . 192
Etiology . . . . . . . . . . . . . . . . . . . . . . . . 192
Injury Classifications . . . . . . . . . . . . . . . . 192
Assessment . . . . . . . . . . . . . . . . . . . . . . 199
Treatment . . . . . . . . . . . . . . . . . . . . . . . 199
Nursing Care . . . . . . . . . . . . . . . . . . . . . . . 200
Developmental Considerations . . . . . . . . . 200
Secondary Medical Conditions . . . . . . . . . . 200
Summary . . . . . . . . . . . . . . . . . . . . . . . . . 202
Congenital Spinal Cord Disorders . . . . . . . . . 202
Spinal Manifestations of Achondroplasia . . . 202
Klippel-Feil Syndrome . . . . . . . . . . . . . . . 205
Outcomes . . . . . . . . . . . . . . . . . . . . . . . . 206
Mucopolysaccharide Disorders . . . . . . . . . 206
Summary . . . . . . . . . . . . . . . . . . . . . . . . . 208
References . . . . . . . . . . . . . . . . . . . . . . 208
Chapter 9
Cerebrovascular Disease
Patti Batchelder, Tina Popov, Arbelle Manicat-Emo,
Patricia Rowe, Maria Zak, and Amy Kolwaite
Introduction . . . . . . . . . . . . . . . . . . . . . . . 211
Cerebral Blood Supply . . . . . . . . . . . . . . . . 211
Arterial Supply . . . . . . . . . . . . . . . . . . . . 212
Venous Supply . . . . . . . . . . . . . . . . . . . . 213
Vein of Galen Aneurysmal Malformations . . . 214
Pathophysiology . . . . . . . . . . . . . . . . . . . 214
Presenting Symptoms . . . . . . . . . . . . . . . 214
Diagnostic Tests . . . . . . . . . . . . . . . . . . . 215
Treatment Options . . . . . . . . . . . . . . . . . 216
Nursing Care . . . . . . . . . . . . . . . . . . . . . 216
Family Education . . . . . . . . . . . . . . . . . . 217
Outcomes . . . . . . . . . . . . . . . . . . . . . . . 217
Cerebral Arteriovenous
Malformation in Children . . . . . . . . . . . . . . 217
Etiology . . . . . . . . . . . . . . . . . . . . . . . . 217
Pathophysiology . . . . . . . . . . . . . . . . . . . 218
Presenting Symptoms . . . . . . . . . . . . . . . 218
Diagnostic Imaging . . . . . . . . . . . . . . . . . 218
Treatment . . . . . . . . . . . . . . . . . . . . . . . 219
Outcomes . . . . . . . . . . . . . . . . . . . . . . . 221
Cerebral Arteriovenous
Fistulas (AVFs) in Children . . . . . . . . . . . . . . 221
Etiology . . . . . . . . . . . . . . . . . . . . . . . . 221
Pathophysiology . . . . . . . . . . . . . . . . . . . 221
Presenting Symptoms . . . . . . . . . . . . . . . 222
Diagnostic Imaging . . . . . . . . . . . . . . . . . 222
Treatment . . . . . . . . . . . . . . . . . . . . . . . 223
Outcomes . . . . . . . . . . . . . . . . . . . . . . . 223
Intracranial Aneurysms . . . . . . . . . . . . . . . . 223
Incidence . . . . . . . . . . . . . . . . . . . . . . . 223
Aneurysm Subtypes . . . . . . . . . . . . . . . . 223
Etiology . . . . . . . . . . . . . . . . . . . . . . . . 224
Pathophysiology . . . . . . . . . . . . . . . . . . . 224
Presenting Symptoms . . . . . . . . . . . . . . . 225
Diagnostic Tests . . . . . . . . . . . . . . . . . . . 225
Treatment Options . . . . . . . . . . . . . . . . . 225
Assessment of Intracranial Aneurysms . . . . . 226
Outcomes . . . . . . . . . . . . . . . . . . . . . . . 226
Venous Angiomas
(Developmental Venous Anomaly) . . . . . . . . 227
Etiology . . . . . . . . . . . . . . . . . . . . . . . . 227
Pathophysiology . . . . . . . . . . . . . . . . . . . 227
Presenting Symptoms . . . . . . . . . . . . . . . 227
Diagnostic Tests . . . . . . . . . . . . . . . . . . . 227
Treatment Options . . . . . . . . . . . . . . . . . 227
Capillary Angiomas and Telangiectasia . . . . . 228
Capillary Angiomas . . . . . . . . . . . . . . . . . 228
Telangiectasias . . . . . . . . . . . . . . . . . . . . 228
Cavernous Malformations . . . . . . . . . . . . . . 228
Etiology . . . . . . . . . . . . . . . . . . . . . . . . 228
Pathophysiology . . . . . . . . . . . . . . . . . . . 228
Presenting Symptoms . . . . . . . . . . . . . . . 229
Diagnostic Imaging . . . . . . . . . . . . . . . . . 229
Treatment . . . . . . . . . . . . . . . . . . . . . . . 229
Outcomes . . . . . . . . . . . . . . . . . . . . . . . 230
Moyamoya Syndrome . . . . . . . . . . . . . . . . 231
Etiology . . . . . . . . . . . . . . . . . . . . . . . . 231
Pathophysiology . . . . . . . . . . . . . . . . . . . 231
Presenting Symptoms . . . . . . . . . . . . . . . 231
Diagnostic Test . . . . . . . . . . . . . . . . . . . . 231
Treatment Options . . . . . . . . . . . . . . . . . 231
Outcomes . . . . . . . . . . . . . . . . . . . . . . . 232
Nursing Care . . . . . . . . . . . . . . . . . . . . . 232
Patient and Family Education . . . . . . . . . . . 232
Nursing Care for Vascular Brain Lesions . . . . . 233
Monitoring of Neurological Status . . . . . . . 233
Cerebral Perfusion – Monitoring
and Maintenance . . . . . . . . . . . . . . . . 233
Monitoring for Seizures . . . . . . . . . . . . . . 233
Management of Environmental Stress . . . . . 233
Management of Pain and Anxiety . . . . . . . . 233
Management of Nausea and Vomiting . . . . . 234
Monitoring for Signs of Infection . . . . . . . . 234
General Postoperative Care . . . . . . . . . . . . 234
Patient and Family Education . . . . . . . . . . . 234
Spinal Arteriovenous Malformations . . . . . . . 235
Etiology . . . . . . . . . . . . . . . . . . . . . . . . 235
Pathophysiology . . . . . . . . . . . . . . . . . . . 235
Presenting Signs and Symptoms . . . . . . . . 236
Cavernous Malformations and Arteriovenous
Fistulas of the Spine . . . . . . . . . . . . . . . . . . 237
Diagnostic Tests . . . . . . . . . . . . . . . . . . . 237
Treatment Options . . . . . . . . . . . . . . . . . 237
Nursing Care . . . . . . . . . . . . . . . . . . . . . 238
Outcomes . . . . . . . . . . . . . . . . . . . . . . . 239
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . 239
Neurovascular Websites for Parents . . . . . . . 239
References . . . . . . . . . . . . . . . . . . . . . . 240
Chapter 10
Surgical Management of Epilepsy
Mary Smellie-Decker, Jennifer Berlin, Trisha Leonard,
Cheri Salazar, and Kristin Wall Strother
Introduction . . . . . . . . . . . . . . . . . . . . . . . 243
Preoperative Preparation . . . . . . . . . . . . . . 244
Invasive Monitoring . . . . . . . . . . . . . . . . . 245
Seizure Surgery . . . . . . . . . . . . . . . . . . . . . 247
Temporal Lobectomy . . . . . . . . . . . . . . . . 248
Frontal Lobectomy . . . . . . . . . . . . . . . . . 248
Lesionectomy . . . . . . . . . . . . . . . . . . . . 248
Hemispherectomy . . . . . . . . . . . . . . . . . 248
Subpial Resection and Corpus Callostomy . . 249
Complications . . . . . . . . . . . . . . . . . . . . 249
Nursing Care . . . . . . . . . . . . . . . . . . . . . 249
Vagal Nerve Stimulator . . . . . . . . . . . . . . . . 250
History . . . . . . . . . . . . . . . . . . . . . . . . . 250
Surgical Procedure . . . . . . . . . . . . . . . . . 250
Complications . . . . . . . . . . . . . . . . . . . . 251
Function . . . . . . . . . . . . . . . . . . . . . . . . 251
Nursing Care . . . . . . . . . . . . . . . . . . . . . 251
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . 251
References . . . . . . . . . . . . . . . . . . . . . . 252
Chapter 11
Surgical Management of Spasticity
Herta Yu and Mary Szatkowski
Pathophysiology of Spasticity . . . . . . . . . . . 253
Baclofen. . . . . . . . . . . . . . . . . . . . . . . . . . 254
Oral Baclofen . . . . . . . . . . . . . . . . . . . . . 255
Intrathecal Baclofen . . . . . . . . . . . . . . . . . 255
Intrathecal Baclofen Therapy . . . . . . . . . . . 256
Rhizotomy . . . . . . . . . . . . . . . . . . . . . . . . 260
History . . . . . . . . . . . . . . . . . . . . . . . . . 260
Patient Selection . . . . . . . . . . . . . . . . . . . 260
Procedure . . . . . . . . . . . . . . . . . . . . . . . 260
Postoperative Nursing Care . . . . . . . . . . . . 261
References . . . . . . . . . . . . . . . . . . . . . . 261
Chapter 12
Infections of the Central Nervous System
George Marcus Galvan
Brain Abscess, Epidural Abscess,
Subdural Empyema . . . . . . . . . . . . . . . . . . 263
Etiology . . . . . . . . . . . . . . . . . . . . . . . . 263
Pathophysiology . . . . . . . . . . . . . . . . . . . 264
Presenting Symptoms . . . . . . . . . . . . . . . 264
Diagnostic Tests . . . . . . . . . . . . . . . . . . . 265
Treatment Options . . . . . . . . . . . . . . . . . 265
Nursing Care . . . . . . . . . . . . . . . . . . . . . 266
Patient and Family Education . . . . . . . . . . . 266
Outcome . . . . . . . . . . . . . . . . . . . . . . . . 266
Neurocysticercosis . . . . . . . . . . . . . . . . . . . 267
Etiology . . . . . . . . . . . . . . . . . . . . . . . . 267
Pathophysiology . . . . . . . . . . . . . . . . . . . 267
Presenting Symptoms . . . . . . . . . . . . . . . 267
Diagnostic Tests . . . . . . . . . . . . . . . . . . . 267
Treatment Options . . . . . . . . . . . . . . . . . 268
Nursing Care . . . . . . . . . . . . . . . . . . . . . 268
Patient and Family Education . . . . . . . . . . . 268
Outcome . . . . . . . . . . . . . . . . . . . . . . . . 269
Shunt Infections . . . . . . . . . . . . . . . . . . . . 269
Etiology . . . . . . . . . . . . . . . . . . . . . . . . 269
Pathophysiology . . . . . . . . . . . . . . . . . . . 269
Presenting Symptoms . . . . . . . . . . . . . . . 269
Diagnostic Tests . . . . . . . . . . . . . . . . . . . 270
Treatment Options . . . . . . . . . . . . . . . . . 270
Nursing Care . . . . . . . . . . . . . . . . . . . . . 270
Patient and Family Education . . . . . . . . . . . 271
Outcome . . . . . . . . . . . . . . . . . . . . . . . . 271
Postoperative Infections . . . . . . . . . . . . . . . 271
Etiology . . . . . . . . . . . . . . . . . . . . . . . . 271
Pathophysiology . . . . . . . . . . . . . . . . . . . 271
Diagnostic Tests . . . . . . . . . . . . . . . . . . . 272
Treatment Options . . . . . . . . . . . . . . . . . 272
Nursing Care . . . . . . . . . . . . . . . . . . . . . 272
Patient and Family Education . . . . . . . . . . . 272
Outcome . . . . . . . . . . . . . . . . . . . . . . . . 272
References . . . . . . . . . . . . . . . . . . . . . . 273
Subject Index . . . . . . . . . . . . . . . . . . . . . . 275
No comments:
Post a Comment