Neurological disorders

Question 1

List 5 things about epilepsy

Answer 1

a neurological condition with a tendency to have recurrent seizures.

seizures are caused by sudden bursts of of excess electrical activity in the brain causing a temporary disruption in the normal message passing between cortisol neurons.

triggers for seizures are things such as: stress, anxiety, lack of sleep, lack of food, excess alcohol, illegal drug use, missing anti-epileptic drugs (AED’s), fever

all AED’s cross the placenta with varying rates of teratogenicity - increased risk of fetal malformation with the use of AED’s and the more AED’s taken the higher the risk. however it is the role of the midwife to encourage uptake of drugs unless a medical professional has said otherwise - needs referral to consultant clinic

midwife should advise against unattended bathing, and ascertain support at home

enzyme inducing AED’s can affect vitamin k uptake therefore all women should be advised to give their baby vitamin K

Question 2

List 5 things about bells palsy

Answer 2

neurological condition - idiopathic peripheral facial paralysis which results from inflammation or compression of the7th cranial nerve within the temporal bone

manifests as drooping of the brow, and lip and inability to close the eye of the effected side even when sleeping

underlying cause for bell’s palsy is unknown however occurrence in late pregnancy or puerperium may be due to oedema, infection, hypertension, pre-eclampsia.

midwife’s role to refer to appropriate medical practitioner, reassure women of the short term nature of bell’s palsy and that it will not effect the course of pregnancy

can take regular analgesia for pain

physiotherapy referral may be of benefit.

Question 3

list 5 things about carpal tunnel syndrome

Answer 3

results from compression of the median nerve as it passes from the forearm into the hand via the carpal tunnel at the wrist.

causes pain, pins and needles, weakness, numbness of fingers and thumbs

common in pregnancy due to increase in progesterone and relaxin causing muscle and ligaments to relax and press on the median nerve, also fluid retention can cause more swelling.

excessive weight gain is a predisposing factor and therefore diet and lifestyle advise should be given.

corticosteroid injections can be given however symptoms are often relieved shortly after birth - reassurance of this

usually presents in second and third trimester.

Question 4

list 5 things about cerebrovascular disease

Answer 4

also known as cerebrovascular accidents or strokes

result of cerebral infarction - most common brain disorder in the general population caused by disrupted blood flow to brain (lack of oxygen and brain cells die)

three types of stroke:
ischeamic - decreased blood flow as a result of vascular occlusion by embolism (clot)
thrombotic - a venous event
haemorrhage - ruptured blood vessel in the brain

general DVT prevention is key: hydration, teds, mobilise

strokes usually appear in healthy women

Question 5

list 5 things about multiple sclerosis

Answer 5

unpredictable, progressive demyelinating disease that effects the CNS at different levels; a chronic, disabling, autoimmune neurological condition

the white matter within the brain or spinal cord becomes inflamed and then destroyed by the bodies own immune system. the myelin sheath becomes inflamed and then destroyed. this slows nerve impulses. symptoms are: 
vertigo
bladder incontinence
loss of vision
muscle weakness

bladder care is very important, palpation for bladder and attention to urinary output is needed, catheterisation ay be needed

immobile: BEST SHOT, monitor pressure areas for ulcer risk

relapse may occur after stressful event therefore 1:1 care and support by midwife, appropriate analgesia