1a Flashcards by Guy Greco

ictal headache localizes to

ipsilateral temporal/occipital

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Ictal fear/cry localizes to?

amygdala, cingulate

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gustatory aura (metal/rubber taste) localizes to?

insular region, rolandic operculum, parietal region

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olfactory aura localizes to?

anterior mesial temporal/uncinate

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deja vu localizes to?

mesiotemporal (no side)

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orgasmic aura

non dominant mesiotemporal or parasagittal regions

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ictal autoscopy (out of body sensation)?

non dominant parietal lobe

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forced and sustained head and eye version?

94% PPV for contralateral temporal or frontal (frontal eye fields) rising to 100% if accompanied by neck extension and followed by generalization

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head and eye deviation AFTER generalization?

ipsilateral focus (FEF)

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fencing position

contralateral frontal lobe of the raised arm

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sign of 4?

contralateral temporal lobe of the extended arm

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Y sign

supplementary sensori-motor area

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hyperkinetic seizre

frontal lobe

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ictal smile

nondominant parietal

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ictal pouting/frown

“chapeaux de gendarme”, frontal lobe (mesial frontal, anterior cingulate)

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manipulative unilateral limb automatism

ispilateral

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nonmanipulative unilateral limb automatism

contralateral

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oral automatisms (smacking,sucking, swallowing)

temporal lobe/inferomesial/hippocampal

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ictal cough

dominant hemisphere

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post-ictal cough

nondominant temporal

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unilateral eye blink

ipsilateral hemisphere

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bilateral eye blink

occipital

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gelastic epilepsy

hypothalamic, mesial temporal, frontal cingulate

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ictal weeping/crying

mesiotemporal/mesiofrontal

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genital automatisms

ipsilateral hemisphere

ictal/postictal drinking

nondominant temporal lobe

ictal nystagmus

contralateral frontal/occipital lobe

ictal spitting

nondominant temporal

post-ictal nose wiping

ipsilateral temporal lobe (90% PPV)

ictal tachycardia and bradycardia

no value, sometimes brady can be assoc with medial temporal lobe

ictal dyspnea

insula

ictal emesis

nondominant temporal lobe/anterior insula

ictal urinary urge

nondominant temporal

piloerection

ipsilateral temporal (dominant hemisphere)

vertigo

insular-temporal-parietal junction

epigastric rising

temporal>orbitofrontal>cingulate

ictal speech arrest

dominant temporal

postictal aphasia

dominant temporal

ictal speech preservation or ictal prosody change

nondominant temporal

guttural vocalizations (moaning, grunting)

frontal lobe (orbitofrontal/parasagittal)

ictal humming or singing

temporal or pre-frontal (no clear side)

mesial vs lateral temporal lobe seizures?

mesial: earlier age, rising epigastric, fear, olfactory feeling, autonomic changes (flushing, dyspnea), contralateral dystonic hand posture, ipsilateral manual automatisms, oral automatisms. Lateral: older age, vertigo/auditory/visual aura, early evolution into unilateral clonic activity and head turn

insular seizures?

laryngeal discomfort, vomiting, hypersalivation, perioral warmth, dysarthria/dysphonia

When describing focal slowing, want to include?

- location - abundance (rare, intermittent, frequent, continuous) - frequency in Hz - Pattern(poly/monomorphic)

Which RDA is associated with focal seizures?

TIRDA; high PPV for TLE

OIRDA is assoc with

childhood absence epilepsy or other genetic generalized epilepsy syndromes

Photoparoxysmal response is assoc with?

75% have a generalized epilepsy syndrome

hypsarythmia is characterized by

chaotic pattern, high amplitude, slow, abundant multifocal spikes, +/- electrodecrements

nystagmus/saccadic eye movements?

PARIETAL eye fields (contralateral)

Abdominal/gustatory/olfactory auras: symp zone/EZ?

insula/MT Lobe

Ictal apnea: symp zone?

amygdala/HC MT lobe

ictal piloerection/goosebumps: symp zone?

amygdala MT lobe

Deja vu/ Jamais-vu: symp zone/EZ?

entorhinal/perirhinal coretx: MT lobe

Experiential aura: symp zone/EZ?

mesio/basal/limbic cortex MT Lobe

fear aura : symp zone/EZ?

amygdala MT lobe

Auditory illusions/halluciniation: symp zone/EZ?

lateral neocortex/STG Lateral temporal lobe

Visual illusions/hallucinations: symp zone/EZ?

lateral neocortex/temporo-occipital junction

alteration of size (macropsia/micropsia)/color (dyschromatopsia) /shape (metamorphopsia)/ movement (kinetopsia): symp zone/EZ?

lateral neocortex of the temporal lobe

Most automatisms do not have lateralizing value: unless : unilateral ictal automatism associated with contralateral dystonic hand?

usually contralateral to the side of the dystonic hand, and suggestive of MTLE (because part of the focus propogates to the ipsilateral insula which contracts the other limb)

Oroalimentory aura: consists of swallowing, lip smacking, kissing/tongue movements?

usually lateral temporal lobe

When someone is dialeptic during a seizure this means?

Complete LOA: unable to follow commands + unable to recall Can be dom or nondom temporal lobe

When someone has preserved awareness?

Able to follow commands/talk + unable to recall Highly lateralizing to the *nondominant* temporal lobe

ictal vomiting

usually nodom temp lobe

nose wiping?

must be less than 60 seconds after the sz. usually MTLE and ipsilateral to the hand

ictal or peri-ictal cough?

no lateralizing value, but assoc with temporal lobe epilepsy

ictal blinking if unilateral

ipsilateral to the epileptic zone, temp lobe epilepsy

peri ictal water drinking?

EZ non dominant temporal lobe epilepsy

gelastic seizure?

no lateralizing value assoc with HH, frontal and temporal lobe

aphasic seizure?

usually lateralizes to dominant hemisphere, temporal lobe

there is a negative motor area on the dominant hemisphere, slightly anterior to Brocas. It is anterior to the SSMA

just know.

bilateral asymmetric tonic seizure: Abduction/elevation of the arms and flexion at the elbow

BILATERAL WITH preserved awareness which is rare SZ: supplementary sensory motor area EZ: mesial frontal, basal frontal or mesial parietal.

areas associated with hyperkinetic seizures?

anterior cingulate, frontopolar, orbitofrontal, opercular insular Basically the whole frontal lobe.