17 Jan 24 Flashcards
Generalized convulsive status epilepticus
> 5mins of gen convusive seizure
Or
2 generalized convulsive seizures without interval recovery of consciousness
GCSE RF
Nonadherence to AEDs
Structural brain abnormalities (tumor)
Metabolic abnormalities
Infection
Drug withdrawal
GCSE ttt
🍔 stabilize circulation, airway and breathing
🍔 BZ (repeat administration until termination of seizure activity
🍔 begin antiepileptics
🍔 EEG monitoring for refractory status epilepticus or failure to regain consciousness.
GCSE patient who is persistently unresponsive
Patients with GCSE regain consciousness after 10-20 mins
persistently unresponsive state mayb due to:
🧠 sedation due to persistent effects of BZ. Or
🧠 ongoing seizure activity without physical manifestations (non convulsive status epilepticus )
Ttt: Do EEG (to diff between them 2)
Continue BZ and AED
Propofol/ phenobarbital for refractory cases
GCSE complications
Neuronal injury and death.
Hence immediate seizure cessation is warranted.
We dont do MRi as GCSE is emergency
As seizure cessation is priority
Breath holding spell Cyanotic vs pallid
Cyanotic:
Triggered by vigorous crying leading to breath holding , cyanosis , LOC with rapid return to baseline.
Pallid BHS :
After minor trauma
No crying
Pain and fear causes slow HR and breat holding , child becomes pale , diaphoretic , limp .
Brief LOC
Sometimes sleepy and confused for a short period after.
Management of BHS
Last < 1min
Clinical dx no workup needed
Screen for iron def anemia
Iron therapy shows improvement
Monitoring shows bradycardia before LOC in BHS
Fibromyalgia Ttt
TCA
Alternates in refratory cases
Duloxetine
Milnacipran
Pregablin
Ttt of TN
Carbamezipine
Oxcarbazepine(better tolerated)
Side effects:
Hyponatremia (due to inc sensitivity to ADH)
Leukopenia
NV
Trigeminal neuralgia workup
MRA / MRI of brain with contrast
If not clear
Nerve conduction (trigeminal reflex) testing
Blepharospasm MECH
Recurrent forceful contraction of eyelid muscles
Form of focal dystonia
🤡BL and symmetric
If Ass with spasm of lower face and jaw
(Meige syndrome)
💩affected by sensory input
BRIGHT LIGHTS , may trigger muscle contraction
🦬 sensory trick ;
Touching and brushing the skin around eye may terminate the spasm.
Management of blepharospasm
🐊Wear dark glasses to block bright lights
🐊Botulism toxin inj
Workup for first time seizure
🚨Glucose CBC eectrolytes renal function liver function urine drug screen
🚨CT (acutely) MRI (elective)
🚨LP (if fever , nuchal rigidity)
🚨EEG
🚨if LOC do ECG for arrythmia
For unprovoked seizures do EEG and MRI. Otherwise dont.
Indications to start antiepileptics
Abnormal EEG or imaging
Nocturnal seizures
Focal deficits
Paroxysmal sympathetic hyperactivity
Sudden episodes of excessive sympathetic activity
Ass with severe TBI
Mech : damage to cortical areas resp for modulating and imhibiting sympathetic centers.
Paroxysmal sympathetic hyperactivity triggers and S/S
External stimuli like bathing and repositioning.
S/S:
Tachycardia
Hypertension
Tachypnea
Fever
Diaphoresis
Last for 20-30 mins.
Management of PSH
Avoid triggers
Treat fever
Medicines. Opiods GABA a2agonists
Opioids improve symptoms via gen reduction of symp tone.
Mechanism of diffuse Axonal injury
▶️Head trauma
▶️Accleration- deceleration or rotational shearing forces on axons (at gray white matter junction)
Management of DAI
Supportive
Manage incr ICP
CF of DAI
⛱ severe neurologic impairment (GCS<8)
⛱impairment greater than imaging findings
⛱ MRI:
🧠Punctate hemorrhages in white matter
🧠Blurring of gray-white matter junction
Why CT is normal in DAI?
DAI is on microscopic level hence not apparent on CT.
MRI is more sensitive and shows minute punctate hem in white matter (axons) and blurring of gray white interface (due to edema).
Pediatric TBi when to do CT without contrast in age <2
High risk features age <2
AMS/fussy
LOC
Severe mech of injury (fall>3m, high impact , MVC)
Non frontal scalp hematoma
Palpable skull fracture
TBI CT indication in age >2-18
AMS(somnolence, agitation)
LOC
Sever injury( fall>5m, high impact, MVC)
Vomiting , severe headache
Basilar skull fracture signs ( CSF rhinorrhea )
Signs of basilar skull fracture
CSF rhinorrhea
Periorbital hematoma
CSF otorrhea
Post auricular ecchymosis (battle sign)
