8.2: Dementia And Epilepsy Flashcards
What is the dementia screening tool?
CAM (confusion assessment method)
How will a brain appear with Alzheimer’s?
Narrowed gyri Widened sulci Ventricular dilation Amyloid beta plaques Neurofibrillary tangles
How does Lewy body dementia differ to Alzheimer’s?
Presence of Lewy bodies on cortex and substantia nigra
Fluctuations in degree of cognitive impairment over time (not a steady decline like Alzheimer’s)
Associated with Parkinson’s
Visual hallucination
How should dementia be managed?
Holistic approach
Therapies e.g pets
Memory aids e.g. story boards
Social care
Drugs: cholinesterase inhibitors or memantine (for Alzheimer’s), if vascular dementia tx CVD risk and HTN
What is the difference between focal seizures (simple and complex) versus generalised seizures?
Focal seizures affect only one part of the brain, and is usually due to a focal lesion e.g. tumour or abscess
Simple does not result in loss of consciousness, unlike complex
Generalised seizures are bilateral and have impaired consciousness
What is a tonic clonic seizure?
aka Grand Mal
1st phase of 10-60 seconds = tonic phase. Muscles tense, incontinence, tongue biting, epileptic cry, hypoventilation, eyes open and pupils dilated
2nd phase = clonic phase. Convulsions, eye rolling, tachycardia, hypoventilation
How will the post ictal state of a patient with a tonic clonic seizure differ to a px having an absence seizure?
Post tonic clonic px will feel confused, drowsy, headache
Post absence seizure px resumes activity very quickly
What is an absence seizure?
Aka petit mal
Usually first occurs in childhood
Px will not respond to stimuli, but they are still conscious. May stare and go pale for a few seconds then px returns to normal functioning quickly afterwards
What is a myotonic seizure?
Generalised seizure
Brief shock like muscle jerks
Clonic phase without tonic phase
What is an atonic seizure?
Generalised seizure
Loss of muscle tone
Drop attack
Px usually falls
What factors can bring on a seizure by lowering a patients seizure threshold?
Lack of sleep
Alcohol abuse
Medications e.g. tricyclics antidepressants
What medication is first line for focal seizures?
Carbamazepine
What medication is first line for generalised seizures?
Sodium valproate
What is status epilpeticus?
A medical emergency when epileptic seizures occur continuously without recovery of consciousness in between, or a prolonged seizure > 5 minutes
How is status epilepticus treated?
ABCDE
Exclude hypoglycaemia
IV lorazepam 1st line, can give again after 5 minutes if needed
IV phenytoin if no response (careful cardiac monitoring as can cause arrhythmias, CI if known heart defect or recent MI)
