Black-outs Flashcards
important history of collapse
before: any trigger? sitting standing?
collapse itself: recollection/conscious? warning symptoms?
after: first recollection. tongue biting. incontinence? muscle pains?
what compliment to the patient’s history may be useful
a 3rd party account
3 categories of syncope (passing out)
reflex
orthostatic
cardiogenic
dehydration is what type of syncope
orthostatic
arrhythmia is what type of syncope
cardiogenic
what type of syncope occurs when someone sees a needle or blood
reflex
what type of syncope is triggered by peeing
reflex
endocrine causes of syncope fit into what category
orthostatic
how does cardiac syncope cause you do pass out
there is a low cardiac output so poor brain perfusion
what is syncope
passing out due to poor brain perfusion
how does epilepsy cause a black out
neuronal excitation that is abnormal
what is epilepsy
a tendency to recurrent seizures
5 primary generalised seizures
Absence Generalised tonic-clonic Juvenile myoclonic Atonic Myoclonic (AGJAM)
what is a seizure
sudden, uncontrolled electrical disturbance in the brain
what differs in the time preceding a primary generalised seizures vs a focal/partial seizure
primary have no warning; partial can have an aura
which seizure type is most common <25 years
primary generalised
what is a focal seizure
it is focussed to just one part of the brain
features of a generalised tonic clonic seizure
groaning sound tonic phase (rigid) clonic phase (jerking of all limbs) eyes are open, maybe rolled back foaming lasts a few minutes but groggy for ~30 after
PMH associated with generalisd tonic clonic seizures
complications in birth
brain trauma
meningitis
true/false tongue biting and incontinence are common in tonic clonic seizures
true
what happens in an absence seizure
sudden arrest of activity maybe with staring or eye-lid fluttering
true/false tonic clonic seizure have a trigger
false - they’re unpredictable
true/false absence seizures have a trigger
true - commonly hyperventilation or photo stimulation (like how you always think of epilepsy)
true/false absence seizures have a trigger
true - commonly hyperventilation or photo stimulation (like how you always think of epilepsy)
triggers of juvenile myoclonic epilepsy
alcohol and sleep deprivation
when in life does juvenile myoclonic epilepsy present
adolescence/early adulthood
features of juvenile myoclonic seizures
can be like absence or GTC seizures
a teen keeps on dropping things and experiencing brief jerks in his limbs in the morning. what does he have
juvenile myoclonic epilepsy - this is a features called early morning myoclonus
two key types of partial seizure
simple and complex
what happens during a simple focal seizure
strange feeling intense fear/joy stiffness/twitching in parts of body de ja vu tingling in legs/arms unusual smells/tastes
what are simple focal seizures also known as
auras
what can a simple focal seizure be a sign of
another seizure is about to happen
features of a complex focal seizure from patient perspective
- may begin with a simple focal seizure (rising feeling in tummy, de ja vu etc)
- seizures occurs and they have no recollection of it
- disorientated afterwards
which type of seizures do you remain conscious of
simple focal
features of a complex focal seizure from witness account
- sudden arrest of activity
- staring blankly
- lip smacking/picking at clothes
investigations that can be done in seizures
EEG
CT/MRI (can show a focal lesion)
Video-telemetry (EEG + video)
22% of people with _____ have epilepsy
learning disabilities
first line drug treatment of primary generalised epilepsies
sodium valproate, lamotrigine and levetiracetam
first line drug treatment of focal or secondary seizures
lamotrigine, carbamazepine, levetiracetam
what drug that may be used to treat trigeminal neuralgia and trigeminal autonomic cephalalgia is used in treatment of focal/secondary seizures
carbamazepine
2 drugs used in primary generalised and focal seizures
lamotrigine and levetiracetam
ethosuximide is only used in which seizure type
absence seizures
when is lorazepam or midazolam used in epilepsy
to treat acutely (and in status epilepticus)
what is status epilepticus
prolonged/recurrent tonic clonic seizures lasting <30 mins with no recovery period between
1st line treatment of status epilepticus
midazolam, lorazepam, diazepam (same as for normal seizures in acute)
2nd line for status epilepticus
valproate
3rd line for status epilepticus
anaesthesia
how long does someone have to wait after a single seizure to be allowed to drive again
6 months (5 years heavy goods!)
true/false to be allowed to drive a heavy goods/public vehicle they must be seizure free for 5 years and be on medication
true
when are epileptic patients allowed to drive a car
only when they are seizure free for a year
OR
have had only post-sleep seizures for a year
how long till an epileptic have drive a heavy goods or public vehicle
10 years seizure free!
