Blackouts, Seizures & Epilepsy Flashcards
What is a Blackout?
A transient loss of consciousness.
What is a Collapse?
An abrupt loss of postural tone with/without a loss of consciousness.
What is Syncope?
A transient loss of consciousness, caused by global impairment or cerebral hypoperfusion, resulting in a collapse.
Give 3 examples of Reflex Syncope.
- Vasovagal (Neurocardiogenic) Syncope.
- Situation Syncope.
- Carotid Sinus Syncope.
Give 1 example of Cardiac Syncope.
- Stokes-Adams Attacks.
Give 4 examples of Orthostatic Syncope.
- Orthostatic Hypotension.
- Primary Autonomic Failure.
- Secondary Autonomic Failure.
- Drug-Induced Autonomic Failure.
Aetiology of Vasovagal Syncope.
Reflex bradycardia with/without peripheral vasodilation that is provoked by emotion, pain or standing too long.
How does a Situation Syncope differ from Vasovagal Syncope?
Same symptoms but with a clear precipitant e.g. Cough Syncope, Effort Syncope (usually cardiac cause e.g. Aortic Stenosis), Micturition Syncope (commoner in men at night).
What happens in Carotid Sinus Syncope?
Hypersensitive baroreceptors cause excessive reflex bradycardia with/without vasodilation on minimal stimulation e.g. head-turning/shaving.
What happens in Stokes-Adams Attacks?
Transient arrhythmias e.g. Bradycardia due to complete heart block can cause a reduced CO and loss of consciousness.
What are the causes of Autonomic Failure?
Primary - Parkinson’s Disease, Lewy body Dementia.
Secondary - Diabetic Neuropathy, Amyloidosis, Uraemia.
Drug-Induced - Diuretics, Alcohol, Vasodilators.
Give 4 other causes of Syncope.
- Anxiety - Hyperventilation, Paraesthesiae, Tremor.
- Hypoglycaemia - rare in non-Diabetics.
- Drop Attacks - without LOC; mostly leg weakness but can be hydrocephalus, cataplexy or narcolepsy.
- Factitious - Pseudoseizures, Munchausen’s.
Investigations of Syncope (1).
Cardiac Assessment (ECG) if recurrent syncope/falls.
Acute Management of Syncope (5).
- Position on back.
- If breathing, restore blood flow to brain by raising legs above heart (30cm).
- Loosen belts, collars and constrictive clothing.
- Don’t make person get up quickly.
- ABCDE.
What is a seizure?
Transient episode of abnormal electrical activity in the brain.
What is Epilepsy?
An umbrella term for a condition where there is a recurrent tendency to spontaneous, intermittent, abnormal electrical activity in part of the brain, manifesting as seizures. Convulsions are the motor signs of electrical discharges.
Epidemiology of Epilepsy (1).
2/3 have achieved satisfactory seizure control with anti-epileptics.
What is a Post-Ictal Phase?
Patients feel drowsy and tired for at least 15 minutes.
Describe the pathophysiology of Seizures (2).
- Clusters of cortical neurones become temporarily impaired and become hyper excitable.
- The electrical discharges can be due to excessive excitation or limited inhibition : either faster/longer activation of Glutamate NMDA Receptors or dysfunctional GABA receptors.
Aetiology of Epilepsy (2B).
- Primary (2/3 - Idiopathic).
- Secondary - Cerebral Palsy, Tuberous Sclerosis, Mitochondrial Diseases.
2B. Structural Causes - Cortical Scarring (Head Injury), SOLs, Strokes, Vascular Malformations.
What is the New Basic Seizure Classification based on?
- Where does the seizure begin in the brain?
- How is the level of awareness during a seizure?
- What other features are present?
What is a convulsion?
Motor manifestation of a seizure.
What type of seizure is usually associated with aura (in the prodromal phase)?
Focal Seizure.
Give 4 post-ictal features.
- Headache.
- Confusion.
- Myalgia/Temporary Weakness e.g. Todd’s Palsy.
- Dysphasia.