Chapter 59: Adult Neurological Problems

The Glasgow Coma Scale provides an objective measurement tool for consciousness ranging from scores of three to fifteen, with scores below eight indicating comatose states. The chapter details abnormal motor responses such as decorticate and decerebrate posturing as indicators of cortical versus brainstem injury severity, and describes meningeal irritation signs including nuchal rigidity and characteristic physical maneuvers used in clinical examination. Diagnostic modalities are reviewed, emphasizing the appropriate use of computed tomography and magnetic resonance imaging for structural assessment while highlighting critical contraindications such as performing lumbar punctures in elevated intracranial pressure situations due to herniation risk. The chapter then addresses acute neurological emergencies including traumatic brain injuries with attention to epidural hematomas and their surgical urgency, increased intracranial pressure management through positioning and environmental modifications, and cerebrovascular accidents with lateralized neurological deficits correlating to affected brain hemispheres. Chronic degenerative conditions including multiple sclerosis, myasthenia gravis, Parkinson's disease, and amyotrophic lateral sclerosis are discussed with emphasis on disease pathophysiology and characteristic clinical presentations. Infectious and inflammatory disorders such as Guillain-Barré syndrome with its distinctive ascending paralysis pattern, meningitis requiring specific infection control precautions, and encephalitis are examined. The chapter concludes with seizure management principles, stressing client safety during seizure activity, appropriate interventions that avoid restraint and airway obstruction, and comprehensive documentation of seizure characteristics for clinical assessment and treatment planning.