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Communication and Clinical Reasoning > Approach to Seizures > Flashcards

Approach to Seizures Flashcards

1
Q

What are the different types of underlying pathological processes underpinning a space occupying brain lesion?

A

Haematoma

Cancer

Abscess

Fibrosis

Cysts

Ischaemic infarction

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2
Q

What are the different types of haematomas possible in the brain?

A

Arterial - epidural

Venous - subdural

Subarachnoid

Haemorrhagic stroke

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3
Q

What effect can cancer have on the brain?

A

CSF blockage

Metastases

Compression

Simply being there

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4
Q

What are the different types of abscesses that can be present in the brain?

A

TB

Helminthes

Malaria

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5
Q

What is the rule of thumb regarding a patient with a history of cancer and neurological symptoms?

A

Anyone who has had cancer in the past and has neurological symptoms has mets until proven otherwise

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6
Q

When identifying where the problem is for a neurology patient, what are the possible topographies?

A

Unilateral

Contralateral

Bilateral

Localised

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7
Q

What is sudden onset headache until proven otherwise?

A

Subarachnoid haemorrhage

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8
Q

When are subarachnoid haemorrhages most likely to occur?

A

During straining/exertion

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9
Q

If a headache due to a subarachnoid haemorrhage resolves suddenly, what is this period referred to as?

A

Lucid interval

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10
Q

What is the time course of a subarachnoid haemorrhage?

A

Get a small bleed and then bigger bleeds

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11
Q

Which investigations are ordered for a suspected subarachnoid haemorrhage?

A

CT scan

Lumbar puncture to test for blood

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12
Q

What are the priorities in history taking for a neurology patient?

A

Characterise the presenting symptoms

Identify associated symptoms

Identify the risk factors

What is the context

Allergies

Social history

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13
Q

What information must be known about a patients medication history?

A

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?

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14
Q

What are 3 different conditions a patient could be describing when they report feeling dizzy?

A

Vertigo

Presyncope

Dysequilibrium

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15
Q

What are 2 different conditions a patient could be describing when they report slurred speech?

A

Dysarthria

Dysphasia

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16
Q

What are 3 different conditions a patient could be describing when they report feeling numbness?

A

Anaesthesia

Paraesthesia

Paresis

17
Q

What are 5 different conditions a patient could be describing when they report having memory problems?

A

Short-term memory

Word-finding

Navigation

Concentration

Problem solving

18
Q

If a neurological problem has an acute (minutes) tempo and aetiology, what are the 2 most probable causes?

A

Trauma

Vascular

19
Q

If a neurological problem has a sub-acute (days to weeks) tempo and aetiology, what are the 2 most probable causes?

A

Metabolic/toxic

Inflammatory/infectious

20
Q

If a neurological problem has a chronic (months to years) tempo and aetiology, what are the 2 most probable causes?

A

Degenerative

Neoplastic

21
Q

What are the 5 different aetiologies of neurological problems?

A

Acute (minutes)

Sub-acute (days to weeks)

Chronic (months to years)

Relapsing-Remitting or Episodic

Fluctuating

22
Q

What are some associated features of an anatomical syndrome at the spinal cord?

A

Limb weakness: motor level?

Limb/trunk sensory deficit: crossed? sensory level?

Bladder/bowel dysfunction

23
Q

What are the associated features of migraine?

A

Throbbing headache

Visual phenomena

Nausea

Photophobia/Phonophobia

24
Q

What question should always be asked of a patient presenting with migraine?

A

Is this the same type of migraine you have experienced in the past? If not, then something else could be going on

25
Q

What questions should a doctor be asking themselves when a patient reports having had a seizure?

A

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

26
Q

What investigations should be carried out for a patient who has had a seizure?

A

GLUCOSE

Vitals

Hypoxia and hypoglycaemia

Bloods

EEG

CT

27
Q

What investigations are often normal but may aid in prognosis and classification of a seizure?

A

MRI

EEG

28
Q

What is an epileptic seizure?

A

A clinical manifestation of abnormal, excessive, synchronised electrical discharge of neurons of the cerebral cortex

29
Q

What is epilepsy?

A

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

30
Q

Which type of epileptic seizure is most commonly brought to medical attention?

A

Generalised tonic-clonic

31
Q

Which non-epileptic phenomena serve as differential diagnoses for epileptic seizures?

A

Syncope

Migraine

TIA

Movement disorders

Sleep disorders

Endocrine disorders

Psychogenic

32
Q

How do you distinguish between syncope and a GTCS?

A

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

33
Q

What can provoke a seizure?

A

Electrolyte disturbance, e.g., hyponatraemia

Hypoglycaemia

Drugs & alcohol (intoxication/withdrawal)

Acute cerebral insult: trauma, encephalitis, stroke, surgery

34
Q

What are the characteristics of a temporal lobe seizure?

A

Déjà vu

Olfactory/gustatory hallucinations

Rising epigastric sensation

Lapses of awareness with hand fidgeting, lip smacking

Delayed return to full alertness (obtundation)

35
Q

What are the characteristics of an absence seizure?

A

Brief staring spells

Rapid return to full alertness

36
Q

What are the characteristics of a myoclonic jerks/seizure?

A

Single twitches, whole body

Usually in the morning (shortly after waking)

37
Q

What are the risk factors for epilepsy?

A

Family history of epilepsy

Childhood febrile seizures

Perinatal event or abnormal early development

Other previous brain insult: trauma, stroke, encephalitis

Communication and Clinical Reasoning (2 decks)

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