Approach to Seizures Flashcards
What are the different types of underlying pathological processes underpinning a space occupying brain lesion?
Haematoma
Cancer
Abscess
Fibrosis
Cysts
Ischaemic infarction
What are the different types of haematomas possible in the brain?
Arterial - epidural
Venous - subdural
Subarachnoid
Haemorrhagic stroke
What effect can cancer have on the brain?
CSF blockage
Metastases
Compression
Simply being there
What are the different types of abscesses that can be present in the brain?
TB
Helminthes
Malaria
What is the rule of thumb regarding a patient with a history of cancer and neurological symptoms?
Anyone who has had cancer in the past and has neurological symptoms has mets until proven otherwise
When identifying where the problem is for a neurology patient, what are the possible topographies?
Unilateral
Contralateral
Bilateral
Localised
What is sudden onset headache until proven otherwise?
Subarachnoid haemorrhage
When are subarachnoid haemorrhages most likely to occur?
During straining/exertion
If a headache due to a subarachnoid haemorrhage resolves suddenly, what is this period referred to as?
Lucid interval
What is the time course of a subarachnoid haemorrhage?
Get a small bleed and then bigger bleeds
Which investigations are ordered for a suspected subarachnoid haemorrhage?
CT scan
Lumbar puncture to test for blood
What are the priorities in history taking for a neurology patient?
Characterise the presenting symptoms
Identify associated symptoms
Identify the risk factors
What is the context
Allergies
Social history
What information must be known about a patients medication history?
What are you on?
Do you take it?
When did you start?
Any complications?
How often do you take it?
Changes in dosage/medications?
What have you tried before? Medications often change as new ones emerge
Who manages your medications? Family, GP, Specialist?
Do you know what these medications are for?
What are 3 different conditions a patient could be describing when they report feeling dizzy?
Vertigo
Presyncope
Dysequilibrium
What are 2 different conditions a patient could be describing when they report slurred speech?
Dysarthria
Dysphasia
What are 3 different conditions a patient could be describing when they report feeling numbness?
Anaesthesia
Paraesthesia
Paresis
What are 5 different conditions a patient could be describing when they report having memory problems?
Short-term memory
Word-finding
Navigation
Concentration
Problem solving
If a neurological problem has an acute (minutes) tempo and aetiology, what are the 2 most probable causes?
Trauma
Vascular
If a neurological problem has a sub-acute (days to weeks) tempo and aetiology, what are the 2 most probable causes?
Metabolic/toxic
Inflammatory/infectious
If a neurological problem has a chronic (months to years) tempo and aetiology, what are the 2 most probable causes?
Degenerative
Neoplastic
What are the 5 different aetiologies of neurological problems?
Acute (minutes)
Sub-acute (days to weeks)
Chronic (months to years)
Relapsing-Remitting or Episodic
Fluctuating
What are some associated features of an anatomical syndrome at the spinal cord?
Limb weakness: motor level?
Limb/trunk sensory deficit: crossed? sensory level?
Bladder/bowel dysfunction
What are the associated features of migraine?
Throbbing headache
Visual phenomena
Nausea
Photophobia/Phonophobia
What question should always be asked of a patient presenting with migraine?
Is this the same type of migraine you have experienced in the past? If not, then something else could be going on
What questions should a doctor be asking themselves when a patient reports having had a seizure?
Was it an epileptic seizure?
Were there any provoking factors?
Was it their first seizure (or just the first GTCS)?
What is the risk of recurrence
What investigations should be carried out for a patient who has had a seizure?
GLUCOSE
Vitals
Hypoxia and hypoglycaemia
Bloods
EEG
CT
What investigations are often normal but may aid in prognosis and classification of a seizure?
MRI
EEG
What is an epileptic seizure?
A clinical manifestation of abnormal, excessive, synchronised electrical discharge of neurons of the cerebral cortex
What is epilepsy?
One of many disorders characterised by a tendency to have recurrent, unprovoked epileptic seizures; often (not always) demonstrated by two seizures occurring more than 24 hours apart
Which type of epileptic seizure is most commonly brought to medical attention?
Generalised tonic-clonic
Which non-epileptic phenomena serve as differential diagnoses for epileptic seizures?
Syncope
Migraine
TIA
Movement disorders
Sleep disorders
Endocrine disorders
Psychogenic
How do you distinguish between syncope and a GTCS?
Warning symptoms: presyncopal, focal seizure (aura)
Eyes: closed/open
Colour: pale/cyanosed
Convulsions: duration
Tongue-biting: no/yes
Urinary incontinence: no/yes
Post-ictal confusion/obtundation/amnesia
What can provoke a seizure?
Electrolyte disturbance, e.g., hyponatraemia
Hypoglycaemia
Drugs & alcohol (intoxication/withdrawal)
Acute cerebral insult: trauma, encephalitis, stroke, surgery
What are the characteristics of a temporal lobe seizure?
Déjà vu
Olfactory/gustatory hallucinations
Rising epigastric sensation
Lapses of awareness with hand fidgeting, lip smacking
Delayed return to full alertness (obtundation)
What are the characteristics of an absence seizure?
Brief staring spells
Rapid return to full alertness
What are the characteristics of a myoclonic jerks/seizure?
Single twitches, whole body
Usually in the morning (shortly after waking)
What are the risk factors for epilepsy?
Family history of epilepsy
Childhood febrile seizures
Perinatal event or abnormal early development
Other previous brain insult: trauma, stroke, encephalitis
