Neurological Disorders: Stroke, Seizures, and Increased Intracranial Pressure

Neurological Disorders: Stroke, Seizures, and Increased Intracranial Pressure

Neurological emergencies can progress rapidly, and early recognition by the LPN is critical to patient survival and recovery. This lesson covers three priority conditions: stroke, seizures, and increased intracranial pressure (ICP).

Stroke Recognition and Priority Care

A stroke occurs when blood supply to part of the brain is interrupted, causing brain cells to die. There are two major types:

• Ischemic stroke – caused by a clot blocking a cerebral artery. This is the most common type. Treatment may include clot-dissolving medications (thrombolytics) if the patient meets strict eligibility criteria and arrives within the treatment window.
• Hemorrhagic stroke – caused by a ruptured blood vessel bleeding into or around the brain. Thrombolytics are contraindicated here.

Use the BE-FAST mnemonic to recognize stroke rapidly:

| Letter | Meaning |

|---|---|

| B | Balance – sudden loss of balance or coordination |

| E | Eyes – sudden vision change or double vision |

| F | Face drooping – one side of the face droops; smile is uneven |

| A | Arm weakness – one arm drifts down when both are raised |

| S | Speech difficulty – slurred, strange, or absent speech |

| T | Time – note the exact time symptoms began; call for help immediately |

Time is brain. The LPN's priority actions include calling for emergency assistance immediately, noting the exact time of symptom onset, keeping the patient calm and positioned safely (head of bed elevated 30 degrees unless ordered otherwise), monitoring airway and level of consciousness (LOC), and preparing for rapid provider assessment. Do not give the patient anything by mouth, as swallowing may be impaired.

Seizures: Types, Management, and Postictal Care

A seizure is an episode of abnormal, uncontrolled electrical activity in the brain. Seizures may be:

• Focal (partial) – affect one area of the brain; the patient may remain conscious or have altered awareness.
• Generalized tonic-clonic – involve the whole brain; characterized by muscle rigidity (tonic phase) followed by rhythmic jerking (clonic phase), loss of consciousness, and possible incontinence.
• Absence seizures – brief episodes of staring or unresponsiveness, more common in children but seen in adults.

Seizure Precautions (safety measures placed before a seizure occurs):

• Padded side rails in the up position
• Suction equipment at the bedside and functional
• Oxygen delivery supplies available
• Bed in lowest position, call light within reach
• IV access in place for at-risk patients

During a seizure:

1. Stay with the patient and call for help.

2. Note and record the exact start time.

3. Position the patient on their side (lateral/recovery position) to protect the airway and prevent aspiration.

4. Clear the immediate area of hard objects.

5. Do NOT restrain the patient forcefully or put anything in the mouth.

6. Maintain a patent airway; apply oxygen as indicated.

7. Time the duration of the seizure.

A seizure lasting more than 5 minutes, or repeated seizures without regaining consciousness, is status epilepticus — a medical emergency requiring immediate provider notification and intervention.

Postictal phase follows the seizure: the patient is drowsy, confused, and may have a headache or temporary weakness (Todd's paralysis). Monitor LOC, vital signs, and orientation closely. Document the seizure fully including duration, movements observed, and postictal findings.

Increased Intracranial Pressure

The skull is a rigid structure; any increase in its contents — blood, brain tissue, or cerebrospinal fluid — raises ICP. Causes include head trauma, stroke, tumors, and infections such as meningitis.

Early signs of increased ICP:

• Altered level of consciousness (restlessness, confusion)
• Headache, often severe
• Nausea and vomiting
• Pupil changes (sluggish or unequal pupils)

Late signs — Cushing's Triad (a neurological emergency):

1. Hypertension with widening pulse pressure

2. Bradycardia (slow, bounding heart rate)

3. Irregular respirations

Cushing's triad indicates the brain is herniating — this is a life-threatening emergency. Notify the provider immediately.

Glasgow Coma Scale (GCS): The GCS objectively measures LOC across three areas:

| Component | Best Response | Points |

|---|---|---|

| Eye Opening | Spontaneous | 4 |

| Verbal Response | Oriented | 5 |

| Motor Response | Obeys commands | 6 |

| Total | Normal | 15 |

A GCS of 8 or below indicates severe neurological impairment and potential need for airway protection. Any downward trend in GCS score must be reported to the provider promptly.

Nursing priorities for increased ICP:

• Elevate the head of bed 30 degrees, keep head midline
• Minimize stimulation (limit suctioning, clustering care)
• Monitor neuro checks frequently and report changes
• Avoid hypoxia and hypercapnia
• Accurately document and trend GCS scores

Safety Summary

Across all three conditions, LPN priorities follow the same framework: recognize early, protect the airway, ensure patient safety, notify the provider without delay, document thoroughly, and reassess continuously. Never delay reporting a declining neurological status — early intervention saves lives and function.