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Neurology > Blackouts, Seizures and Epilepsy > Flashcards

Blackouts, Seizures and Epilepsy Flashcards

1
Q

Define syncope

A

Transient loss of consciousness due to global cerebral hypoperfusion with rapid onset, short duration and spontaneous complete recovery

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2
Q

Categories of syncope

A

Reflex

Orthostatic

Cardiac

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3
Q

Types of reflex syncope

A

Vasovagal

Situational

Carotid sinus

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4
Q

Types of orthostatic syncope

A

Primary autonomic failure

Secondary autonomic failure

Drug-induced

Volume depletion

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5
Q

Types of cardiac syncope

A

Arrhythmias

Structural

PE

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6
Q

What is vasovagal syncope?

A

Triggered by emotion, pain, or stress

“Fainting”

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7
Q

Causes of situational syncope

A

Cough

Micturition

GI

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8
Q

Causes of primary autonomic failure

A

Parkinson’s disease

Lewy body dementia

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9
Q

Causes of secondary autonomic failure

A

Diabetic neuropathy

Amyloidosis

Uraemia

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10
Q

Common syncope-inducing drugs

A

Diuretics

Alcohol

Vasodilators

Antipsychotics

Antidepressants

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11
Q

Investigations for syncope

A

CV exam

Postural blood pressure readings

ECG

Carotid sinus massage

Tilt table test

24hr ECG

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12
Q

How to differentiate between seizures and syncope

A

Thorough history covering:
Risk factors

Triggers

Before episode

During episode

After episode

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13
Q

Risk factors for syncope

A

Heart disease (arrhythmias)

Peripheral neuropathy

Drugs that cause postural hypotension

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14
Q

Risk factors for seizures

A

FHx

Previous history of epilepsy

Head injury

CNS infection

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15
Q

Triggers for syncope

A

Pain

Heat

Exertion

Prolonged standing

Emotion

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16
Q

Triggers for seizures

A

Alcohol

Sleep deprivation

Bright lights

Infections

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17
Q

Syncope: before episode

A

Dizziness

Light-headedness

Nausea

Tunnelled vision

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18
Q

Seizures: before episode

A

Aura

Epigastric rising

Deja vu

Visual/smell disturbances

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19
Q

Syncope: during episode

A

Sudden loss of tone

May have tongue biting and incontinence

Brief duration

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20
Q

Seizures: during episode

A

Tonic-clonic jerking movements

May have tongue biting and incontinence

May be brief or prolonged

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21
Q

Syncope: after episode

A

Complete and rapid recovery

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22
Q

Seizures: after episode

A

Post-ictal confusion and drowsiness

May have Todd’s facial palsy

23
Q

Features of seizures

A

Generalised seizures usually sudden onset

Tongue biting and incontinence may occur

<5 minutes

Post-ictal confusion

24
Q

What are Stokes-Adams attacks?

A

Arrhythmogenic syncope

Abrupt onset

Without waring

May result in significant injury

Myoclonic jerks may occur

25
Features of pseudoseizures
Often prolonged episodes (rarely <1 minute, often >30 minutes) Usually in front of a witness Fluctuating motor activity and seizure-like convulsions Tongue biting rare
26
Classification of focal (partial) seizures
Part of the brain that they involve (e.g. temporal versus frontal lobe seizures) Whether consciousness is impaired (simple versus complex)
27
Types of generalised seizure
Tonic Tonic-clonic Atonic Myoclonic Absence
28
Basic seizure classification | 3 features
Where seizures begin in the brain Level of awareness during a seizure Other features of seizures
29
Describe generalised tonic-clonic seizures
LOC and tonic (muscle tensing) and clonic (muscle jerking) episodes Typically tonic phase precedes clonic phase May be tongue biting, incontinence, groaning and irregular breathing Prolonged post-ictal period where person is confused, drowsy and feels irritable or depressed
30
Management of generalised tonic-clonic seizures
generaLiSed Sodium valproate 2nd line: Lamotrigine or carbamazepine
31
Describe focal seizures
Start in temporal lobes Affect speech, hearing, memory and emotions Hallucinations Memory flashbacks Déjà vu Doing strange things on autopilot
32
Management of focal seizures
foCaL Carbamazepine or lamotrigine 2nd line: sodium valproate or levetiracetam
33
Describe absence seizures
Typically occur in children Patient becomes blank, stares into space and then abruptly returns to normal Unaware of their surroundings and won’t respond Typically 10-20 secs
34
Management of absence seizures
Sodium valproate or ethosuximide
35
Describe atonic seizures ("drop attacks")
Brief lapses in muscle tone Usually <3 minutes Typically begin in childhood
36
What might atonic seizures/drop attacks be indicative of?
Lennox-Gustaut syndrome
37
Management of atonic seizures/drop attacks
Sodium valproate 2nd line: lamotrigine
38
Describe myoclonic seizures
Sudden brief muscle contractions, like a sudden “jump” Usually remain awake during episode Occur in various forms of epilepsy but typically in children as part of juvenile myoclonic epilepsy
39
Management of myoclonic seizures
Sodium valproate Other options: Lamotrigine, levetiracetam or topiramate
40
Investigations in seizures
EEG MRI to diagnose structural problems ECG to exclude cardiac problems
41
Features of temporal lobe focal seizures
HEAD Hallucinations Epigastric rising/Emotional Automatisms (lip smacking/grabbing/plucking) Deja vu/Dysphasia post-ictal
42
Features of frontal lobe seizures
MOTOR Head/leg movements Posturing Post-ictal weakness Jacksonian march SENSORY Paraesthesia
43
Features of occipital lobe seizures
VISUAL Floaters/flashes
44
Management of seizures
Start anti-epileptics following second epileptic seizure Generalised: sodium valproate Focal: carbamazepine
45
Acute management of seizures
If not terminated after 5-10 minutes may be appropriate to administer medication Benzodiazepines e.g. diazepam
46
Driving & seizures
Cannot drive for 6 months following seizure Epileptic patients must be seizure free for 12 months before being able to drive
47
Trying to conceive
Valproate particularly teratogenic
48
Define status epilepticus
Single seizure lasting >5 minutes or >3 seizures in 30 minute period without return to normal in between
49
Management of status epilepticus | in hospital
ABCDE IV lorazepam 4mg, repeated after 10 minutes if the seizure continues (diazepam pre-hospital) If seizures persist: IV phenobarbital or phenytoin If no response, induce general anaesthesia
50
Management of status epilepticus | in community
Buccal midazolam Rectal diazepam
51
Investigations in status epilepticus
Check o2 sats and blood sugar (common and rapidly reversible cause) ABG FBC, U&E, LFT, CRP, calcium and magnesium, clotting Serum and urine save for toxicology Anti-epileptic drug levels should be sent as appropriate
52
What is important before administering glucose in patients with a history of alcohol abuse?
IV pabrinex prior to the administration of glucose to avoid precipitation of Wernicke's encephalopathy or Korsakoff's syndrome
53
Chance of developing MS after single episode of optic neuritis?
50%
54
Optic neuritis features
CRAP Central scotoma RAPD Acuity (unilateral decrease in HR/D) Pain worse on movement

Neurology (20 decks)

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