1a Flashcards
ictal headache localizes to
ipsilateral temporal/occipital
Ictal fear/cry localizes to?
amygdala, cingulate
gustatory aura (metal/rubber taste) localizes to?
insular region, rolandic operculum, parietal region
olfactory aura localizes to?
anterior mesial temporal/uncinate
deja vu localizes to?
mesiotemporal (no side)
orgasmic aura
non dominant mesiotemporal or parasagittal regions
ictal autoscopy (out of body sensation)?
non dominant parietal lobe
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
head and eye deviation AFTER generalization?
ipsilateral focus (FEF)
fencing position
contralateral frontal lobe of the raised arm
sign of 4?
contralateral temporal lobe of the extended arm
Y sign
supplementary sensori-motor area
hyperkinetic seizre
frontal lobe
ictal smile
nondominant parietal
ictal pouting/frown
“chapeaux de gendarme”, frontal lobe (mesial frontal, anterior cingulate)
manipulative unilateral limb automatism
ispilateral
nonmanipulative unilateral limb automatism
contralateral
oral automatisms (smacking,sucking, swallowing)
temporal lobe/inferomesial/hippocampal
ictal cough
dominant hemisphere
post-ictal cough
nondominant temporal
unilateral eye blink
ipsilateral hemisphere
bilateral eye blink
occipital
gelastic epilepsy
hypothalamic, mesial temporal, frontal cingulate
ictal weeping/crying
mesiotemporal/mesiofrontal
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.
