2. PREVALANCE
• Neurologic conditions tend to have high symptom burdens, variable disease
courses, and poor prognoses that affect not only patients but also their families and
caregivers.
3. • Patients with a variety of neurologic conditions such as
• Parkinson disease, dementia, amyotrophic lateral sclerosis, brain tumors, stroke,
and acute neurologic illnesses have substantial unmet needs that can be addressed
through a combination of primary and specialty palliative care.
4. PARKINSON DISEASE
• Parkinson disease is a prolonged illness that leads to progressive debility by
impairing balance, mobility, speech, and cognition. In the early stages, patients are
often responsive to dopamine replacement therapy.
• As the disease progresses, however, they experience more nonmotor symptoms that
contribute to disease burden.
• Nonmotor symptoms including orthostatic hypotension, dysphagia, cognitive
decline, psychiatric symptoms, pain, and constipation are common,
• Patients' Edmonton Symptom Assessment System Scale for Parkinson Disease
scores improved with subsequent testing, suggesting that palliative interventions
were beneficial in this population
5. DEMENTIA
• Anticipating the loss of cognitive skills and decision-making capacity, clinicians
should discuss the disease trajectory early with patients with dementia and their
caregivers or surrogate decision makers.
• Common sequelae in advanced dementia include recurrent infections,
hospitalizations, and eating and swallowing difficulties.
• 1The literature suggests that caregivers who have engaged in discussions regarding
prognosis and care preferences are more likely to focus on quality of life and
comfort for their loved ones at the end of life
6. AMYOTROPHIC LATERAL. SCLEROSIS
• most devastating illnesses because of the rapid decline in motor and respiratory
function, leading to a loss of independence and severe disability
• Patients have numerous symptoms including pain, sialorrhea, spasticity,
pseudobulbar affect, dysphagia, weight loss, and respiratory insufficiency that
require intensive treatment by the care team.
• Patients with other neuromuscular diseases such as Duchenne muscular dystrophy
and spinal muscular atrophy may also benefit from palliative considerations that are
similar to those for patients with ALS.
7. BRAIN TUMORS
• There is a growing evidence base for the benefits of palliative care in the
management of patients with cancer as it relates to symptom management and
quality of life
• High grade gliomas have symptoms, such as headaches, dysphagia, seizures,
drowsiness, difficulty communicating, and focal deficits, that would benefit from
more aggressive management
8. STROKE
• Patients with stroke have substantial palliative needs in the poststroke period,
although the severity and the course of illness are highly variable.
• Symptoms such as pain, fatigue, depression, anxiety, and dysphagia should be
identified and addressed as they can impact early and longer-term rehabilitation
effort
• stroke is the fifth leading cause of death in the United States, and early mortality
after stroke is most often attributed to the withdrawal or withholding of life-
sustaining measures.
• is also a leading cause of long-term disability.47 Estimates suggest that 15% to 30%
of patients are permanently disabled and 20% require long-term care at 3 months
poststroke
9. • Monoplegia
• What is Monoplegia?
• Monoplegia is paralysis of a single area of the body, most typically one limb. People with
monoplegia typically retain control over the rest of their body, but cannot move or feel
sensations in the affected limb
• Hemiplegia
• What is Hemiplegia?
• Hemiplegia affects an arm and a leg on the same side of the body. With hemiplegia, the
degree of paralysis varies from person to person, and may change over time. Hemiplegia
often begins with a sensation of pins and needles, progresses to muscle weakness, and
escalates to complete paralysis. However, many people with hemiplegia find that their
degree of functioning varies from day to day, and depending on their overall health, activity
level, and other factors.
10. • What Causes Hemiplegia?
• As with monoplegia, the most common cause is cerebral palsy. However, other
conditions, such as incomplete spinal cord injuries, brain injuries, and nervous
system disorders can also result in hemiplegia.
• Paraplegia
• What is Paraplegia?
• Paraplegia refers to paralysis below the waist, and usually affects both legs, the
hips, and other functions, such as sexuality and elimination. Though stereotypes of
being paralyzed below the waist hold that paraplegics cannot walk, move their legs,
or feel anything below the waist, the reality of paraplegia varies from person to
person—and sometimes, from day to day.
11. • What Causes Paraplegia?
• Spinal cord injuries are the most common cause of paraplegia. These injuries impede the brain's
ability to send and receive signals below the site of the injury. Some other causes include:
• Spinal cord infections
• Spinal cord lesions
• Brain tumors
• Brain infections
• Rarely, nerve damage at the hips or waist; this more typically causes some variety of monoplegia
or hemiplegia.
• Brain or spinal cord oxygen deprivation due to choking, surgical accidents, violence, and similar
causes.
• Stroke
• Congenital malformations in the brain or spinal cord
12. • Quadriplegia
• What is Quadriplegia?
• Quadriplegia, which is often referred to as tetraplegia, is paralysis below the neck.
All four limbs, as well as the torso, are typically affected. As with paraplegia, though,
the degree of disability and loss of function may vary from person to person, and
even from moment to moment. Likewise, some quadriplegics spontaneously regain
some or all functioning, while others slowly retrain their brains and bodies through
dedicated physical therapy and exercise.
13. • As with paraplegia, spinal cord injuries are the leading cause of quadriplegia. The
most common causes of spinal cord injuries include automobile accidents, acts of
violence, falls, and sporting injuries, especially injuries due to contact sports such as
football. Traumatic brain injuries can also cause this form of paralysis.
14. STROKE
1. A stroke occurs when the blood supply to part of your brain is interrupted or
reduced, preventing brain tissue from getting oxygen and nutrients. Brain cells
begin to die in minutes.
• stroke is a medical emergency, and prompt treatment is crucial. Early action can
reduce brain damage and other complications.
•
15. CAUSES OF STROKES
• There are two main causes of stroke: a blocked artery (ischemic stroke) or leaking
or bursting of a blood vessel (hemorrhagic stroke). Some people may have only a
temporary disruption of blood flow to the brain, known as a transient ischemic attack
(TIA), that doesn't cause lasting symptoms.
16. ISCHEMIC STROKE
• This is the most common type of stroke. It happens when the brain's blood vessels become
narrowed or blocked, causing severely reduced blood flow (ischemia). Blocked or narrowed
blood vessels are caused by fatty deposits that build up in blood vessels or by blood clots or
other debris that travel through your bloodstream and lodge in the blood vessels in your
brain.
17. HEMORRHAGIC STROKE
• Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures.
Brain hemorrhages can result from many conditions that affect your blood vessels.
Factors related to hemorrhagic stroke include:
• Uncontrolled high blood pressure
• Overtreatment with blood thinners (anticoagulants)
• Bulges at weak spots in your blood vessel walls (aneurysms)
• Trauma (such as a car accident)
• Protein deposits in blood vessel walls that lead to weakness in the vessel wall
(cerebral amyloid angiopathy)
• Ischemic stroke leading to hemorrhage
18. TRANSIENT ISCHEMIC ATTACK (TIA)
• transient ischemic attack (TIA) — sometimes known as a ministroke — is a
temporary period of symptoms similar to those you'd have in a stroke. A TIA doesn't
cause permanent damage. They're caused by a temporary decrease in blood
supply to part of your brain, which may last as little as five minutes.
• Like an ischemic stroke, a TIA occurs when a clot or debris reduces or blocks blood
flow to part of your nervous system.
• Seek emergency care even if you think you've had a TIA because your symptoms
got better. It's not possible to tell if you're having a stroke or TIA based only on your
symptoms. If you've had a TIA, it means you may have a partially blocked or
narrowed artery leading to your brain. Having a TIA increases your risk of having a
full-blown stroke later.
19. RISK FACTORS
• Many factors can increase your stroke risk. Potentially treatable stroke risk factors include:
• Lifestyle risk factors
• Being overweight or obese
• Physical inactivity
• Heavy or binge drinking
• Use of illegal drugs such as cocaine and methamphetamine
• Medical risk factors
• High blood pressure
• Cigarette smoking or secondhand smoke exposure
• High cholesterol
• Diabetes
• Obstructive sleep apnea
• Cardiovascular disease, including heart failure, heart defects, heart infection or abnormal heart rhythm, such as atrial fibrillation
• Personal or family history of stroke, heart attack or transient ischemic attack
•
20. • Other factors associated with a higher risk of stroke include:
• Age — People age 55 or older have a higher risk of stroke than do younger people.
• Race — African Americans have a higher risk of stroke than do people of other
races.
• Sex — Men have a higher risk of stroke than women. Women are usually older
when they have strokes, and they're more likely to die of strokes than are men.
• Hormones — Use of birth control pills or hormone therapies that include estrogen
increases risk.
21. COMPLICATIONS
• stroke can sometimes cause temporary or permanent disabilities, depending on how long
the brain lacks blood flow and which part was affected. Complications may include:
• Paralysis or loss of muscle movement. You may become paralyzed on one side of your
body, or lose control of certain muscles, such as those on one side of your face or one arm.
• Difficulty talking or swallowing. A stroke might affect control of the muscles in your mouth
and throat, making it difficult for you to talk clearly, swallow or eat. You also may have
difficulty with language, including speaking or understanding speech, reading, or writing.
• Memory loss or thinking difficulties. Many people who have had strokes experience some
memory loss. Others may have difficulty thinking, reasoning, making judgments and
understanding concepts.
• Emotional problems. People who have had strokes may have more difficulty controlling
their emotions, or they may develop depression.
• Pain. Pain, numbness or other unusual sensations may occur in the parts of the body
affected by stroke. For example, if a stroke causes you to lose feeling in your left arm, you
may develop an uncomfortable tingling sensation in that arm.
• Changes in behavior and self-care ability.People who have had strokes may become
more withdrawn. They may need help with grooming and daily chores.
22. PREVENTION
• Knowing your stroke risk factors, following your doctor's recommendations and
adopting a healthy lifestyle are the best steps you can take to prevent a stroke. If
you've had a stroke or a transient ischemic attack (TIA), these measures might help
prevent another stroke. The follow-up care you receive in the hospital and afterward
also may play a role.
• Many stroke prevention strategies are the same as strategies to prevent heart
disease. In general, healthy lifestyle recommendations include:
• Controlling high blood pressure (hypertension). This is one of the most
important things you can do to reduce your stroke risk. If you've had a stroke,
lowering your blood pressure can help prevent a subsequent TIA or stroke. Healthy
lifestyle changes and medications are often used to treat high blood pressure.
•
23. • Lowering the amount of cholesterol and saturated fat in your diet. Eating less
cholesterol and fat, especially saturated fat and trans fats, may reduce the buildup in your
arteries. If you can't control your cholesterol through dietary changes alone, your doctor
may prescribe a cholesterol-lowering medication.
• Quitting tobacco use. Smoking raises the risk of stroke for smokers and nonsmokers
exposed to secondhand smoke. Quitting tobacco use reduces your risk of stroke.
• Managing diabetes. Diet, exercise and losing weight can help you keep your blood
sugar in a healthy range. If lifestyle factors don't seem to be enough to control your
diabetes, your doctor may prescribe diabetes medication.
• Maintaining a healthy weight. Being overweight contributes to other stroke risk factors,
such as high blood pressure, cardiovascular disease and diabetes.
24. PREVENTIVE MEDICATIONS
• Anti-platelet drug—ASPIRIN
• Aggrenox, a combination of low-dose aspirin and the anti-platelet drug dipyridamole
to reduce the risk of blood clotting
• After a TIA or minor stroke, doctor may give aspirin and an anti-platelet drug such
as clopidogrel (Plavix) for a period of time to reduce the risk of another stroke. If
patient can't take aspirin, doctor may prescribe clopidogrel alone.
• Anticoagulants. These drugs reduce blood clotting. Heparin is fast acting and may
be used short-term in the hospital.
• Slower-acting warfarin (Coumadin, Jantoven) may be used over a longer term.
Warfarin is a powerful blood-thinning drug
25. NEWER DRUGS
• Several newer blood-thinning medications (anticoagulants) are available for
preventing strokes in people who have a high risk. These medications include
dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis) and edoxaban
(Savaysa). They're shorter acting than warfarin and usually don't require regular
blood tests or monitoring by your doctor. These drugs are also associated with a
lower risk of bleeding complications.
26. PSYCHOSOCIAL & SPIRITUAL
SUPPORT
• Patients’ spiritual needs to be identified as: need to talk about spiritual concerns, showing
sensitivity to patients’ emotions, responding to religious needs; and relatives’ spiritual needs
included: supporting them with end of life decisions, supporting them when feeling being
lost and unbalanced, encouraging exploration of meaning of life, and providing space, time
and privacy to talk.
• Spiritual support need to be provided for the better out come to the patient
