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Y3 - Neuro > Blackouts and Seizures > Flashcards

Blackouts and Seizures Flashcards

1
Q

What is the difference between blackouts and seizures?

A

Blackouts are loss of consciousness

Seizures are changes in physical activity or behaviour as a result of changes in the electrical activity in the brain

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2
Q

For a patient who has passed out what do you want to know about before the attack?

A

What were they doing before?

Were any symptoms described experienced before (aura, vasovagal)?2

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3
Q

For a patient who has passed out what do you want to know about during the attack?

A 
Did they lose consciousness?
Were they responsive?
Did they make any movements?
Floppy or rigid?
Did they change colour?
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4
Q

For a patient who has passed out what do you want to know about after the attack?

A

How long did they take to recover?
How did they feel after recovering?
Any sleepiness, confusion or disorientation?
Any weakness or change in sensation?

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5
Q

For a patient who has passed out what do you want to know about the background to the episode?

A

Any triggers?
Has it happened before? When did they start?
How frequent are they?
Were the previous attacks the same as this one?

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6
Q

What are examples of drugs that lower the seizure threshold?

A 
Anaesthetics
IV antibiotics (penicillins, cephalosporins)
Antipsychotics - clozapine
Ciclosporin
Antidepressants
Anticholinesterases
Antihistamines
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7
Q

What investigations should be done for a patient who has collapsed?

A 
Cardio and resp examination
Blood pressure (postural)
ECG
Urine dipstick
Bloods
CT/MRI
Sometimes EEG
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8
Q

When should CT/MRI be done for a patient who has collapsed?

A

If suspected stroke, skull fracture, head injury, deteriorating GCS

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9
Q

When should an EEG be done for a patient who has collapsed?

A

To classify epilepsy or to confirm non-convulsive status

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10
Q

What are the differential diagnoses for a patient who has collapsed?

A

Head injury
Drug induced
Neurological: epilepsy, stroke, CNS infection, SOL
Psychiatric: anxiety, non epileptic attacks
Medical: hypoglycemia, orthostatic hypotension, syncope, drop attacks, stokes adams

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11
Q

What is syncope?

A

Reflex bradycardia with or without peripheral vasodilation

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12
Q

When can a stroke occur in syncope?

A

When the bradycardia and peripheral vasodilation is associated with cerebral hypoperfusion

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13
Q

What is the presentation of syncope?

A

Pre-syncope: light-headednesss, dizziness, sweating, nausea, pallor, tachycardia
The seizure: loss of consciousness, no movement or brief symmetrical colonic jerks with no tonic contraction, no incontinence or tongue biting, lasts about 2 mins
Post-ictal: rapid recovery (<1 min), no prolonged symptoms

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14
Q

What are the causes of syncope?

A

Vasovagal (fear, emotion, pain, standing for too long)
Situational: cough, exercise, micturition
Carotid body hypersensitivity - brought on by minimal exertion e.g. head turning, shaving
Reflex anoxic - when young children hold their breath and faint and fit

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15
Q

What is a Stoke Adams attack?

A

Transient arrhythmias causing reduced cardiac output and loss of consciousness
Attacks can happen multiple times per day and in any posture

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16
Q

What is the presentation of a Stoke Adams attack?

A

Pre-attack: palpitations
Attack: fall to the ground with loss of consciousness, pallor, slow or absent pulses
Recovery within seconds, with associated flushing

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17
Q

What are drop attacks?

A

Attacks of sudden weakness of the legs with no warning or any loss of consciousness
Most are benign and resolve after a few attacks

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18
Q

What are the causes of drop attacks?

A

Idiopathic
Hydrocephalus
Cataplexy

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19
Q

What is the presentation of a drop attack?

A

Attack: sudden weakness in the legs not associated with any warning symptoms, loss of consciousness
Recovery: no associated confusion

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20
Q

Who are drop attacks most often seen in?

A

Elderly women

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21
Q

What is epilepsy?

A

Recurrent tendency to spontaneous, intermittent, abnormal electrical activity in the brain that manifests as convulsions or abnormal behavior

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22
Q

What is needed for a diagnosis of epilepsy?

A

At least 2 events

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23
Q

What are the causes of epilepsy?

A 
Idiopathic
Structural abnormalities due to:
SOL
Stroke
Developmental abnormalities
Head injury
Childhood febrile convulsions
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24
Q

What is an aura?

A

Individualized and stereotyped symptoms that precede the seizure by minutes
E.g. deja vu, flashing lights, tastes or smells, strange feelings

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25
Q

What are the general features of epileptic seizures?

A

Loss of conscious and unresponsive
Lasts <5 mins
Associated with tongue biting and urinary incontinence
Slow recovery associated with confusion, headache, muscle ache, temporary weakness

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26
Q

What is Todd’s palsy?

A

Temporary weakness following an seizure

27
Q

What is a focal seizure?

A

Epileptic seizures that arise due to isolated, increased activity in one region in the brain, with there often being an associated underlying structural abnormality

28
Q

What is a simple focal seizure?

A

A seizure associated with localised symptoms of any nature, no loss of awareness and no post-octal symptoms

29
Q

What is a complex focal seizure?

A

Localised symptoms associated with an aura, loss of awareness and post-octal symptoms

30
Q

What is a focal seizure with secondary generalisation?

A

Localised symptoms that proceed the generalised seizures that are usually convulsive due to spread of electrical activity across the brain

31
Q

What are the symptoms caused by focal symptoms in the temporal lobe?

A 
Commonly associated with Hx of febrile convulsions
Dysphasia
Déjà vu
Flashbacks
Emotional disturbance
Odd tastes or smells
Visual and auditory hallucinations
Movements such as lip smacking, chewing, swallowing, grabbing, fumbling and singing
32
Q

What are the symptoms caused by focal symptoms in the frontal lobe?

A

Dysphasia
Posturing movements
Subtle changes in behaviour
Jacksonian seizure (twitching movements of the upper limbs that spread to the face and lower limbs, commonly associated with Todd’s Palsy)

33
Q

What are the symptoms caused by focal symptoms in the parietal lobe?

A

Sensory disturbance such as numbness and tingling

34
Q

What are the symptoms caused by focal symptoms in the occipital lobe?

A

Visual phenomena such as spots, lines and flashes

35
Q

What is a generalised seizure?

A

Epileptic seizures that occur due to simultaneous abnormal electrical activity in multiple parts of the brain

36
Q

Who most often present with generalised seizures?

A

Younger patients - usually <30

37
Q

What are generalised seizures often triggered by?

A

Flashing lights, sleep deprivation

38
Q

What are the different patterns of generalised seizures?

A

Tonic clonic
Absence
Myoclonic
Atonic

39
Q

What are the different phases in a tonic clonic seizure?

A

Tonic: patient falls, becomes rigid and cyanosed, stop breathing, tongue biting and incontinence can occur, lasts about 1 min
Clonic: after tonic phase, asymmetrical convulsive jerks, eyes roll back and breathing starts again, lasts a few minutes
Post-ictal: confusion, drowsiness, muscle ache and headache common

40
Q

What are the features of an absence seizure?

A

Seizure manifests as a brief lapse of awareness in which the patient stops what they are doing and stares blankly

41
Q

What happens to an EEG in an absence seizure?

A

Spike and wave at 3Hz

42
Q

What are the features of an myoclonic seizure?

A

Seizures that manifest as clonic-like jerks without the tonic contraction

43
Q

What is juvenile myoclonic epilepsy?

A

Usually seen around puberty
Associated with early morning myoclonic seizures and day-time absences
Most go on to develop tonic clonic
EEG: photosensitive poly spike and wave

44
Q

What is an atonic seizure?

A

Seizures that manifests as sudden loss of all muscle tone with maintenance of consciousness, which differentiates it from narcolepsy

45
Q

How is epilepsy diagnosed?

A

Mostly clinical
CT/MRI to identify structural abnormality
Sometimes EEG

46
Q

When is an EEG done?

A

To classify epilepsy
Confirm non-epileptic attacks
Evaluate patients being considered for surgery
To confirm non convulsive status epilepticus

47
Q

What is the management for generalised absence seizures?

A

1st line: valproate orr ethosuximide

2nd line: topiramate, levetiracetam

48
Q

What is the management for generalised myoclonic seizures?

A

First line: valproate, levetiracetam, clonazepam

Second line: lamotrigine, topiramate

49
Q

What is the management for generalised atonic or tonic clonic seizures?

A

Valproate, levetiracetam, topiramate, lamotrigine

50
Q

What is the management for focal seizures?

A

First line: carbamazepine

Second line: lamotrigine, valproate, topiramate

51
Q

What are side effects of sodium valproate?

A 
Nausea
Tremor
Oedema
Teratogenicity
Ataxia
Encephalopathy, liver failure
Ect
52
Q

What are the side effects of lamotrigine?

A 
Maculo-papular rash
Stephen Johnson syndrome
Diplopia and photosensitivity
Tremor
Agitation
53
Q

What are the side effects of topiramate?

A

Sedation
Dysphasia
Weight loss

54
Q

What are the side effects of levetiracetam?

A

Mood swings

Depression

55
Q

What are the side effects of carbamazepine?

A 
Makes generalised seizures worse
Lucopenia
Drowsiness
Double or blurred vision
Impaired balance
56
Q

What is SUDEP, and what causes increased risk?

A

Sudden unexplained death in epilepsy

Poorly controlled epilepsy, patient smokes, drinks and uses illicit drugs

57
Q

What needs to be taken into account for women with epilepsy?

A

Avoid valproate
Contraception efficacy will be reduced
Most anticonvulsants have risk of congenital abnormalities (risk reduced by taking folate)

58
Q

What is status epilepticus?

A

Seizure that has lasted more than 5 minutes
Multiple seizures within 30 minutes
Second seizure that occurs before full neurological recovery from the first

59
Q

What are triggers for status epilepticus?

A 
Infection
Head injury
Eclampsia
Abrupt withdrawal of anti convulsants
Metabolic upset: hypoglycemia, hyponatremia
60
Q

What is the management for status epilepticus?

A

ABCDE
1st line: IV Lorazepam (2-4mg, max doses: 2)
2nd line: Phenytoin
3rd line: General anaesthesia

61
Q

What is non-epileptic attack disorder?

A

Functional seizures that are largely mediated at the subconscious level
Have a strong association with past trauma, especially childhood sexual abuse.

62
Q

What are the features of a seizure in non-epileptic attack disorder?

A

Excessively long seizures lasting 10-20 minutes
Coordinated, symmetrical, florid convulsions with large movements
Maintenance of normal breathing and awareness
No associated tongue biting or incontinence
Made worse by use of anti convulsants

63
Q

How is diagnosis made for non-epileptic attack disorder?

A

Suggested by normal examination, negative investigations and seizures being uncontrollable with the use of a variety of anti convulsant drugs
Linguistic analysis
EEG
Admission to epilepsy unit for medium to long term monitoring

64
Q

What is the management for non-epileptic attack disorder?

A

Counselling and psychological therapies

Y3 - Neuro (14 decks)

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