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aspiration of saliva and mucus. After the attack, administer anticonvulsants, such as barbiturates or Dilantin®. The objective of drug therapy is complete suppression of symptoms. Refer the patient for evaluation.
Petit Mal Seizure—This type of seizure is characterized by myoclonic jerks (shocklike contractions of all or a part of a muscle or group of muscles), akinetic seizures (abnormal absence of muscular movement or loss of muscle tone), and sudden clouding of consciousness for a few seconds. Also, the patient will normally not fall down. The classical symptoms of a sudden vacant expression, cessation of motor activity, and loss of muscle tone are almost always present. This condition is very common in children but almost never occurs after the age of 20. Activity will resume abruptly. The patient may experience as many as 100 attacks per day.
TREATMENT—Administer phenobarbital or other anticonvulsants. Refer the patient for evaluation.
Cerebrovascular Accident
Strokes are caused by destruction of brain matter by intracerebral hemorrhage, thrombosis, embolism, or vacular insufficiency.
SYMPTOMS—They include headache, nausea, vomiting, convulsions, and coma. Consciousness may not always be altered. The patient may experience speech disturbances, confusion, loss of memory, reduction of sensation, and paralysis of extremities or of a complete side of the body. The onset may be sudden and violent, with the patient falling into an immediate coma and exhibiting stertorous breathing, Death from serious strokes may result in a few minutes to a few days.
TREATMENT—Administer IV fluids, and place the patient on immediate and strict bed rest. Evacuate the patient for hospitalization immediately.
Subarachnoid Hemorrhage
This is characterized by sudden bleeding into the subarachnoid space that maybe the result of trauma or a ruptured aneurysm.
SYMPTOMS—Before the aneurysm ruptures, it may apply pressure to nerves that will manifest as headaches, ocular palsies, diplopia, squint and facial pain, and a diminished visual field. After rupture, severe headache, nausea, vomiting, stiffness of the neck, positive Kernig’s sign, and bilateral Babinski’s reflex are usually present. The consciousness of the patient may or may not be affected, and the blood pressure is often elevated.
TREATMENT—Keep the patient at rest and maintain a fluid balance, avoid opiates and anticoagulants, and evacuate the patient immediately.
TRAUMATIC CONDITIONS OF THE CENTRAL NERVOUS SYSTEM (CNS)
Head Injuries
Head injury is the most common of the traumatic conditions of the CNS. These may be open or closed, and in each case of head injury, a neurological evaluation should be performed.
Concussion—This is the most common form of head injury and maybe diagnosed by an altered state of consciousness; abnormal vital signs; bleeding from the ears and nose; convulsions; and altered pupillary reactions. The patient normally recovers with no permanent darnage; however, recurrent concussion may cause permanent damage.
Extramural hematoma is hemorrhage into the extramural spaces. This condition is a rare occurrence. The patient will suffer a loss of consciousness at the time of the injury and eventual coma with several hours of lucidity in between. While lucid, the patient will exhibit signs of increased intracranial pressure, such as headache, irritability and mental confusion, variations in level of consciousness, and hemiplegia (paralysis on one side of the body). The condition will deteriorate and death will result if the problem if not corrected.
Subdural hematoma is caused by the rupture of a cerebral vein. There will normally be a loss of consciousness at the time of the injury followed by an asyrnptomatic period that may last for several days or weeks. Later the patient may have symptoms of increased intracranial pressure as described above. About one half of all persons