Blackouts, First seizures and Epilepsy Flashcards
What is the 9 different causes of a black out
Syncope
First seizure
Hypoxic seizure
Concussive seizure (after blow to head)
Cardiac arrhythmia
Non-epileptic attack
Narcolepsy,
Movement disorder,
Migraine
What is the commonest cause of fainting/syncope
Vasovagal syncope:
When you faint because your body overreacts to certain triggers, such as the sight of blood or extreme emotional distress causing your heart rate and blood pressure to drop suddenly
What is the features of syncope
Happens in the upright position
Pallor common
Gradual onset
Rapid recovery
Incontinence rare
Precipitants common
Injury rare
Early symptoms: Light-headed, Nausea Hot, sweating Tinnitus Tunnel vision
Why is injury rare in syncope and common in seizure
Due to gradual onset, patients can get themselves into a safe position avoiding injury, where in a seizure there is no warning do injury is more common
What is the features of seizures
Occur in any posture Pallor uncommon Sudden onset Injury quite common Incontinence common Slow recovery Precipitants rare
What occurs in hypoxic seizures
Continued oxygen deprivation, e.g. when individual kept upright in a faint
Patient has succession of collapses
What is an example of a cardiac arrhythmia that can cause seizure
Long QT syndrome
When would long QT syndrome result in a seizure
Collapse occurs with exercise
When should you consider cardiac arrhythmias as the cause of seizures
When there is a family history of sudden death,
When there is a cardiac history
When collapse occurs with exercise
What can seizures cause over time
Cardiac arrhythmias
What is common features of non-epileptic attacks
Commoner in women than men
Can be frequent
May look bizarre
Can be prolonged
May have a history of other medically unexplained symptoms
May have history of abuse
What does a non-epileptic attack look like
May superficially resemble a generalised tonic-clonic seizure (rigid with jerking)
May resemble a “swoon”- flat on the ground and pale
May involve bizarre movements (thrusting of hips - sexual abuse)
What investigations must take place at a possible first seizure
Blood sugar - rule out as cause of blackout
ECG - what kind of seizure
Consideration of alcohol and drugs
CT head - see structural problems
After diagnosing a first seizure what needs to be discussed with the patient
Enquire about employment and dangerous leisure actuates
Explain driving regulations
What is the driving regulations put in place after a patient has their first seizure
Patient may drive a car after 6 months if their investigations are normal and they have had no further events
They may drive an Heavy good vehicle or Public Service Vehicle after 5 years if their investigations are normal, they have no further events and they are not on anti-epileptic medication
After first seizure, when would an epilepsy diagnosis be made
After a second unprovoked attack
Sometimes on taking the history after a first seizure, it is clear that they have undiagnosed epilepsy
What features in your history suggest undiagnosed primary generalised epilepsy
History of myoclonic jerks, especially first thing in the morning
Absences or feeling strange with flickering lights
What is features in your history suggesting a focal onset epilepsy
History of “deja vu”, rising sensation from abdomen,
Episodes where look blank with lip-smacking,
Fiddling with clothes
Define an epileptic seizure
Epileptic seizure is an intermittent stereotyped disturbance of consciousness, behaviour, emotion, motor function or sensation which, on clinical grounds, is believed to result from abnormal neuronal discharges
Define epilepsy
condition in which seizures recur, usually spontaneously
Where does damage occur in an epileptic seizure
Grey matter
What is the two ILAE Classifications of epilepsy
Generalsed seizures
Focal seizures
What are the 6 different types of generalise seizures
Tonic-clonic seizures
Myoclonic seizures
Clonic seizures
Tonic seizures
Atonic seizures
Absence seizures
What occurs in a tonic-clonic seizure
Usually begins on both sides of the brain, but can start in one side and spread to the whole brain.
A person loses consciousness, body become rigid (tonic) , and jerking movements (clonic) are seen
