Introduction
Neurological procedures can lead to significant postoperative deficits. It is important for physicians to assess nervous system function intraoperatively so that any deficits can be corrected before they become permanent. The oldest method of assessing spinal cord function is with the Stagnara wake up test where patients are awoken in the middle of surgery in order to assess motor function(1). Once the neurological status of the patient is evaluated, the patient would be reanesthetized and the surgery would resume. The wake up test is limited in that it only provides a brief assessment of motor function. It fails to detect ischemia and sensory function(2). Now, intraoperative neurophysiological monitoring with motor evoked potentials (MEPs), somatosensory evoked potentials (SEPs), electromyography (EMG), electrocorticography (ECoG), and cortical mapping has become the new standard of care. It allows physicians to examine the nervous system function without waking the patient. It has become an essential intraoperative tool to improve safety in surgical procedures and helping minimize postoperative deficits. It has allowed surgeons to accept high-risk patients who might have been otherwise denied for a surgical procedure. There are many intraoperative monitoring modalities used to assess different part of brain, spinal cord, and the peripheral nervous system. The strength of each modality is able to offset the limitations of other monitoring modalities, and when combined together, they provide a comprehensive picture on the complex spinal cord function.
Motor Evoked Potentials (MEPs)
Motor evoked potentials (MEPs) have widespread use to diagnose and assess the functional integrity of the descending motor path...
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... for assessing postoperative sensory function.
It is important to note some of the strengths and limitations of SEPs. The strengths of SEPs are that it allows for continuous monitoring, has excellent specificity, and can be used with neuromuscular blocking agents(11). A limitation of SEPs is that it requires temporal summation of neural signals that enter the spinal cord. Recorded data are based on calculated averages, so it may take several minutes after an acute insult for it to show up on the data. Studies have shown that that the average delay time of SEPs is 16 minutes after MEPs and that SEPs can be as delayed for as long as 33 minutes(19). Other limitations of SEPs are that it does not directly monitor the corticospinal tract, has low sensitivity for motor deficits, and its recording can remain unchanged in patients with anterior spinal artery injury(11).
Rocha, J. A., Reis, C., Simoes, F., Fonseca, J., & Mendes Ribeiro, J. (2005). Diagnostic investigation and multidisciplinary management in motor neuron disease. Journal of Neurology, 252(12), 1435–1447.
A spinal cord injury refers to any traumatic injury to the nervous tissue that runs throughout the spine. Spinal cord injuries can be in one of two basic types, incomplete, or complete (A brief overview). In a complete spinal cord injury there is a total loss of function in everything below the area of the injury. In an incomplete spinal cord injury the patient retains some function. In some cases, with a minor injury the patient may even suffer no loss of function at all. Other effects of spinal cord injuries include lack of ability to regulate automatic bodily functions, such as body temperature and blood pressure, muscular and bone degradation, and kidney stones (A brief overview).
Based upon previous knowledge of spinal cord function, what results from the testing were consistent with a spinal cord injury?
..., Ducker, T.B., ….. Young, W. (1997). International Standards for Neurological and Functional Classification of Spinal Cord Injury: International Medical Society of Paraplegia, 35, 266 – 274.
In patients with epidural hematomas it is especially important that nurses be diligent when assessing their patients. The brain is a closed compartment and bleeding inside can go unnoticed easily. Many nurses could misconstrue sleeping with a decrease in level of consciousness. A more obvious and very avoidable reason in failure to rescue is nurses not following doctor’s orders properly. Frequent neurological assessments are essential and should be completed as ordered. Another reason epidural hematomas often get over looked is due to the signs that go along with the condition. The lucid interval that patients experience in epidural hematomas could be mistaken for the patient being stable and not needing intense monitoring. With continuous monitoring and being aware of the complications that follow epidural hematomas we can greatly reduce the risk of disability or death in these
The nervous system is the most complex part of the body, as they govern our thoughts, feelings, and bodily functions. It is an important factor in science because it can lead to new discoveries for cures or diseases. The studies of the nervous system helped lower death rates from heart disease, stroke, accidents, etc. The nervous system is a network of neurons (nerve cells that sends information to the brain to be analyzed.
The CNS, also known as the central nervous system, is the principle amalgamation system of the human body and is composed of the brain and spinal cord. In contrast, the PNS, also known as the peripheral nervous system, is composed of all neural tissue except the brain and spinal cord. These two systems work together, for example, sensory information makes its entrance into the CNS, which examines it and then transmits a motor reply via the PNS to muscular or glandular tissue. Furthermore, information arrives the CNS from the afferent division of the
Dind, A., Short, A., Ekholm, J., & Holdgate, A. (2011). The inaccuracy of automatic devices taking postural measurements in the emergency department. International Journal of Nursing Practice, 17, 525-533. doi: 10.1111/j.1440-172X.2011.01958.x
The primary function of a Neurological NPs is to facilitate the surgery collaborating with the number of surgeons for the pre and post-operations. Their principal purpose includes assessment and management of the patient by applying clinical knowledge but is not limited to refer patients to specialists, ordering diagnostic investigations and prescribing medications. A neurosurgery NP's roles are to diagnose test (CT scans and MRI's), treat plus manage patients with neurological and neurosurgical conditions. They are taught to practice holistically and to work in partnership with the patient while cooperating to facilitate the wellbeing of health instead of treating symptoms. An NP must assess patients to perform a physical exam, review scans and other clinical diagnostic information. After handling the test data, an NP is obliged to make a diagnosis with a selected appropriate treatment, set medical purpose, implement the treatment and evaluate the effect of the
Most of the noninvasive imaging methods estimate brain activity by changes in blood flow, oxygen consumption, glucose utilization, etc. Discuss the potential problems with using this type of indirect measure.
Neuromyths consist of a brain-based, or neurological, concept that has been taken out of disproportion and fed to the masses as food for thought. Many neuromyths find their inception in small research labs or in a published article that is not well founded. While most neuromyths are harmless, some of them can be blown so out of proportion that marketing industries prey on the vulnerability of individuals because today’s society flourishes on being the best an individual can possibly be. Dr. Usha Goswami explains a common neuromyth susceptible to such scrutiny that finds its foundation in “enriched environments” (Goswami, 2004). This neuromyth states that by having an ‘enriched environment’ such as increased educational programs or language immersion it helps to enhance the brain’s capacity
National Institute of Neurological Disorders and Stroke (2011). National Institutes of Health. Retrieved [18th April 2011] from http://www.ninds.nih.gov/disorders/picks/picks.htm.
Within the human anatomy, an intricate and complex network of specialised nerve fibres and neurons works in collaboration with the central nervous system and peripheral system, designed to carry out the various actions humans perform every day. The nervous system is also known as the master control unit of the human body, as it operates other major functions such as the circulatory and respiratory systems (Jakab, 2006). It is composed of the central nervous system (CNS) and the peripheral nervous system (PNS). The neurons established within the various sections of the nervous system, is structured with three main parts: a dendrite which is a cluster of branches that operates by receiving information from the receptor and neurons and transferring nerve impulses to the cell body; furthermore, a cell body is composed of a nucleus, that works to provide energy and nutrients for the neuron; lastly is an axon, electrically conducted by the myelin sheath, the axon is a pathway nerve impulses pass through from the cell body. In addition, this is the process in which nerve impulses travel by to be able to access the rest of the system (Core Science, 2010). The correct function of the nervous system is vital to the daily survival of an individual, as it obtains a significant role in the control and co-ordination of the human body. Furthermore, if a situation occurs where the nervous system dysfunctions or develops a disease (such as multiple sclerosis), it would in that case threaten the current status of one’s health and cause havoc in the system.
Paramedics are frequently presented with neurological emergencies in the pre-hospital environment. Neurological emergencies include conditions such as, strokes, head or spinal injuries. To ensure the effective management of neurological emergencies an appropriate and timely neurological assessment is essential. Several factors are associated with the effectiveness and appropriateness of neurological assessments within the pre-hospital setting. Some examples include, variable clinical presentations, difficulty undertaking investigations, and the requirement for rapid management and transportation decisions (Lima & Maranhão-Filho, 2012; Middleton et al., 2012; Minardi & Crocco, 2009; Stocchetti et al., 2004; Yanagawa & Miyawaki, 2012). Through a review of current literature, the applicability and transferability of a neurological assessment within the pre-hospital clinical environment is critiqued. Blumenfeld (2010) describes the neurological assessment as an important analytical tool that evaluates the functionality of an individual’s nervous system. Blumenfeld (2010) dissected and evaluated the neurological assessment into six functional components, mental status, cranial nerves, motor exam, reflexes, co-ordination and gait, and a sensory examination.
Nervous Conditions by Tsitsi Dangarembga is the story of young Tambu. The book starts off with her living with her parents, Ma’Shingyai and Jeremiah, and her brother, Nhambo in post-colonial Zimbabwe. After facing the news that her brother died, she and her immediate family decided move Tambu to live with her aunt and uncle, Babamukuru and Maiguru, to go to the missionary school where her uncle is head of and to get a better life for herself from the homestead. While living with her aunt, uncle, and their daughter, Nyahsa, Tambu realizes the nervous conditions that are around her as she sees the issues between race and gender in modern day Zimbabwe through her family. Even though, she has lived the luxury life of her uncle’s house, she sees that all things