CLTM - Board Prep Flashcards
CLTM, Long Term Monitoring, EEG, Epilepsy, Surgery, ECoG, grid electrodes, ambulatory EEG, EMU
What does OSHA stand for?
Occupational Safety & Health Administration
What is OSHA’s function?
- Prevent wrong-site surgery
- Protect Patient Health Information
- Insure an environment of patient safety
- Insures an environment of safety for all staff
Insures an environment of safety for all staff
What does CMS stand for?
Centers for Medicare & Medicaid Services
What does CMS administer?
- Medicare & Medicaid
- Medicare, Medicaid & HIPPA
- Affordable Care Act
- Joint Commission Accredidation
Medicare, Medicaid & HIPPA
Dysgeusia
Distortion of sense of taste.
Dystonia
- Sustained muscle contractions
- twisting
- repetitive movements
- abnormal posturing.
Ataxia
Loss of muscle coordination & movement.
causes gait disturbance.
Cataplexy
Sudden loss of consciousness triggered by laughing, crying, or fear.
EEG with Cataplexy
Normal
Narcolepsy
The brain’s inability to regulate sleep-wake cycles.
EEG with narcolepsy
Early onset REM during sleep
Wallenbergs Syndrome
Injury to the lateral medulla, resulting in tissue ischemia & necrosis, with sensory defecits in:
- Trunk & extremities on contralateral side of Injury.
- Face & cranial nerves on the ipsilateral side of the injury.
Dysphagia
Difficulty Swallowing
Vertigo
Dizziness
Nystagmus
Involuntary Rhythmic movement of the eye.
(vertically or horizontally)
Dysarthria
Slurred Speech
Ptosis
Drooping eyelid
Horners Syndrome
The unilateral combination of:
- drooping eyelid (ptosis)
- constricted pupil (miosis)
- decreased sweating (anhidrosis)
- eye redness
Cortical Dysplasia
- Absence Seizures
- Keppra
- Intractable Seizures
- Wests Syndrome
Intractable Seizures
Describe Hyperlexia
Fascination with letters or numbers & advanced reading ability.
Hyperpraphia
Overwhelming urge to write.
Associated with temporal lobe epilepsy.
Hippocampal Sclerosis
Neuronal cell loss & gliosis in hippocampus
Specifically the CA-1 (Cornu Ammonis Area 1) & subiculum.
How do you test for Hippocampal sclerosis
MRI
Hippocampal Sclerosis
- Neocortex of Temporal Lobe
- Globus Pallidus
- Mesial Temporal Lobe Epilepsy
- Supplemental Motor Cortex
Mesial Temporal Lobe Epilepsy
Neocortex of Temporal Lobe
- Medial Temporal Lobe Epilepsy
- Lateral Temporal Lobe Epilepsy
- Mesial Temporal Lobe Epilepsy
- Longitudinal Temporal Lobe Epilepsy
Lateral Temporal Lobe Epilepsy
Generic Dilantin®
Phenytoin
Generic Depakote®
Valproic Acid or Valproate
Side effect of Phenytoin (Dilantin®) withdrawl
Status Epilepticus
Drug of choice for Infantile Spasms
ACTH
Adreno-Cortico-Tropic Hormone
Adrenocorticotropic Hormone
Drug of choice for Juvenile Myoclonic Epilepsy
Depakote®
Valproic Acid / Valproate
Drug of choice for Juvenile Absence Seizures
Ethosuximide / Zarontin®
Drug of choice for Lennox-Gastaut
Depakote® / Valproic Acid / Valproate
Define ACTH
Adreno-Cortico-Tropic Hormone
Adrenocorticotropic Hormone
Drug of Choice for Complex Partial Epilepsy
Keppra® / Levetiracatam
Define Seizure
Sudden involuntary time-limited alteration in behavior, with change in motor activity, autonomic function, consciousness or sensation, accompanied by abnormal electrical discharge in the brain
Define Epilepsy
- more than 2 Seizures
- Nerve cell activity in your brain is disrupted, causing abnormal behavior, sensations, or loss of consciousnes.
Define Seizure Semiology
- Clinical Manifestations
- Seizure Description
Clinical manifestation of Gelastic Seizures
Laughing
Clinical manifestation for Dacrystic Seizures
Crying
Describe typical ictal progression for partial and convulsive seizures.
Ictal discharge begins with low-voltage fast activity and becomes slower with higher amplitude.
Most common co-morbidity in Gelastic & Dacrystic Seizures
Hypothalamic Hamartoma
Define Todd’s Paralysis
- Partial or complete paralysis following seizure
- Unilateral & may involve speech & vision
- Duration: 30 min - 36 hrs (avg 15hrs)
Seizure begins with a tingling sensation or motor movement in the fingers, then affects movement in the hand and moves on to more proximal areas on the same side of the body with progression to the contralateral side of the body as the event crosses over the corpus callosum.
Name this seizure
Jacksonian March
Jacksonian March:
- Generalized Seizure
- Primary focal, secondarily generalized.
- Complex partial seizure
- Simple partial seizure
Simple partial seizure
Hypsarrhythmia (in pediatrics)
- Complex Partial Seizure
- Hypnogogic Hypersynchrony
- Infantile Spasms
- Tonic Clonic Seizures
Infantile Spasms
Hypsarrythmia (in Adults)
- Lennox Gastaut
- Rasmussens Encephalitis
- Juvenile Myoclonic Epilepsy
- West Syndrome
West Syndrome
Abdominal Epilepsy (Stomach Pain)
- Frontal Lobe
- Temporal Lobe
- Parietal Lobe
- Occipital Lobe
Temporal Lobe
Atonic Seizures
- Olfactory Aura
- Drop Attacks
- Infantile Seizures
- Epileptic Syndrome
Drop Attacks
(Drop Seizures)
Atonic Seizures are also referred to as:
- Affective Epilepsy
- Ataxic Epilepsy
- Akinetic Seizures
- Aphasic Seizures
Akinetic Seizures
Treatment for Intractable Atonic Seizures
Corpus Callosotomy
Corpus callosum is severed to stop seizures.
Intractable Epilepsy (in childhood)
- Febrile Seizures
- Paraneoplastic Neurologic Syndrome
- Lennox Gaustox Syndrome
- Benign Rolandic Epilepsy
Lennox Gaustox Syndrome
Intractable epilepsy (in Infancy)
- Complex Partial
- Absence
- Jacksonian
- Infantile Spasms
Infantile Spasms
Seizure involving visual hallucination of un-formed images (flashing lights, colors)
- Frontal Lobe
- Temporal Lobe
- Parietal Lobe
- Occipital Lobe
Occipital Lobe
Seizure involving bilateral tonic posturing
- Frontal Lobe
- Temporal Lobe
- Parietal Lobe
- Occipital Lobe
Frontal Lobe
Jacksonian March originating in left hand and fingers
- Onset in left temporal lobe (T3)
- Onset in right temporal lobe (T4)
- Onset in left frontal lobe (C3)
- Onset in right frontal lobe (C4)
Onset in right frontal lobe (C4)
Dysgeusia
- Memory
- Taste
- Déjà vu
- Smell
Taste
Seizure or aura involves dysgeusia
- Globus Pallidus
- Amydala
- Insula
- Hippocampus
Insula
Seizure or aura involves formed images or hallucinations
- Globus Pallidus
- Amydala
- Insula
- Amygdala\Hippocampus
Amygdala \ Hippocampus
Seizure or aura involves formed images or hallucinations
- Posterior temporal lobe
- Anterior temporal lobe
- Occipital Lobe
- Frontal lobe
Posterior temporal lobe
Seizure or aura involves tingling sensation of right hand\ arm
- Anterior Parietal lobe-right
- Anterior Parietal lobe-left
- Posterior Frontal lobe-right
- Posterior Frontal lobe-left
Anterior Parietal lobe - left (Contralateral)
Seizure or aura involves right eye deviation and head deviation with posturing
- Anterior Temporal lobe-left
- Anterior Parietal lobe-left
- Posterior Frontal lobe-right
- Posterior Frontal lobe-left
Posterior Frontal lobe - left
Seizure or aura involves epigastric sensations & salivation
- Insular-orbital frontal cortex
- Hippocampus
- Limbic system
- Mid-temporal lobe
Insula-orbitofrontal cortex
Seizure or aura involves epigastric sensations & salivation
- Insular-orbital frontal cortex
- Hippocampus
- Amygdala-opercular region
- Mesial aspect of the temporal lobe
Amygdala-opercular region
Seizure aura involving olfactory (Smell) hallucinations
- Insular-orbital frontal cortex
- Hippocampus
- Prefrontal Lobe
- Anteromedial temporal lobe
Anteromedial temporal lobe
Seizure aura involves olfactory (Smell) hallucinations
- Insular-orbital frontal cortex
- Anterior Parietal lobe
- Amygdala-opecular region
- Occipital lobe
Amygdala-opecular region
Non-purposeful stereotyped and repetitive behaviors such as picking, fumbling, patting aura , lip smacking, chewing and swallowing:
- Automatism
- Aura
- Dysplasia
- Apraxia
Automatism
What does SUDEP stand for
Sudden Unexpected Death in Epilepsy
What are the 6 criteria for diagnosis of SUDEP
The 6 criteria for SUDEP
- Suffered from Epilepsy (unprovoked seizures)
- They were in reasonable state of health
- Occurred suddenly
- During normal activities & circumstances
- No obvious cause of death found
- Not a direct cause of seizure or status epilepticus
Hippocampal Sclerosis is the most common type of neuropathological damage seen in individuals with:
- Absence Seizures
- Temporal Lobe Epilepsy
- Grand Mal Seizures
- Jacksonian March
Temporal Lobe Epilepsy
Which of the following is associated with** Hippocampal Sclerosis?**
a. Simple Partial Seizures
b. Complex Partial Seizures
c. Generalized Seizures
d. Status Epilepticus
Complex Partial Seizures
Age of onset & peak age for Absence Seizures
- *Onset**: 3-12 yrs
- *Peak**: 6-7 yrs
Absence 3.6.7.12
Age of onset for Juvenile Myoclonic Epilepsy
Onset: 12-18 yrs
Juvenile 12.18
Age of onset & peak age for Benign Rolandic Epilepsy
- *Onset**: 2-13 yrs
- *Peak**: 9-10 yrs
Rolandic 2.9.10.13
Age of onset & peak age for Benign Occipital Epilepsy
- *Onset**: 15 months - 15 yrs
- *Peak**: 4-8 yrs
Occipital 15.4.8.15
Age of onset & peak age for Wests Syndrome (Infantile Spasms)
- *Onset**: < 1yr
- *Peak**: 3-7 mo.
Infant/West 0.3.7.1
Age of onset & peak age for Lennox Gastaut
- *Onset**: 1-8 yrs
- *Peak**: 3-5 yrs
Lennox 1.3.5.8
Age of onset for Landau Kleffner
Onset: 2-12 yrs
Landau 2.12
Name the two **epilepsy syndromes** that **have** a cognitive delay (**mental retardation**) as a **characteristic**
- West Syndrome (Infantile Spasms)
- Lennox-Gastaut
Name the epilepsy syndrome that is characterized by speech arrest
Landau-Kleffner
Which of the following is typically associated with non-epileptic seizures:
- Episode lasting < two minutes
- Episode lasting > two minutes
- Episode of tongue biting
- Episode of tongue thrusting
Episode lasting over two minutes
Which of the following is typically associated with non-epileptic seizures:
- Blinking
- Lip smacking
- Side to side head movements
- Eye deviation to the right
Side to side head movements
Which of the following is typically associated with non-epileptic seizures:
- Teeth breakage
- Severe tongue biting
- Biting the inside of the mouth
- Biting the tip of the tongue
Biting the tip of the tongue
Which of the following is typically associated with non-epileptic seizures:
a. Bicycling actions of all limbs
b. Pelvic thrusting & Weeping
c. Picking or pulling at clothing
d. Masturbation
Pelvic thrusting & Weeping
Which of the following is typically associated with non-epileptic seizures:
- Blinking
- Staring
- Eye deviation
- Eyes dosed
Eyes closed
Brainstem Lesion:
- Spindle Coma
- Beta Coma
- Alpha Coma
- Theta Coma
Alpha Coma
Mesencephalic Lesion:
- Spindle Coma
- Beta Coma
- Alpha Coma
- Theta Coma
Spindle Coma
Locked-in Syndrome:
- Spindle Coma
- Beta Coma
- Alpha Coma
- Theta Coma
Alpha Coma
Alpha Coma Prognosis
- Poor
- Good
- Great
- Unknown
Poor
Spindle Coma Prognosis
- Poor
- Good
- Great
- Unknown
Good
Beta Coma Prognosis
- Poor
- Good
- Great
- Unknown
Good
Describe the reactivity of Alpha Coma
Non-reactive (EEG does not change with painful stimuli)
Name the coma type which involves paralysis of the lower cranial nerves.
Alpha Coma
Level of consciousness with Alpha Coma
Awake & Alert
S.I.R.P.I.Ds
- Slow irregular rhythmic polyphasic epileptiform discharges of sleep
- Sharp intermittent rhythmic polyphasic epileptiform discharges
- Stimulus Induced Rhythmic or Periodic or Ictal Discharges
- Spikes In REM Presenting Entirely with Delta
Stimulus Induced Rhythmic or Periodic or Ictal Discharges
S.I.R.P.I.Ds
- REM Sleep disorder
- Acute Brain Injury
- Brain Stem Infarction
- Brain Tumor
Acute Brain Injury
Define Long-Term Potentiation (LTP)
- Lasting enhancement in signal transmission between neurons from synchronus stimulation.
- Phenomena of synaptic plasticity, & ability of chemical synapses to change their strength.
- Widely considered one of the cellular mechanisms that controll learning & memory.
Hippocampus
- Limbic System
- Reticular Formation
- Lymphatic System
- Cortical System
Limbic System
4 functions of the Hippocampus
- Short term memory
- Long Term Memory
- Spatial navigation
- Inhibition
Long Term Potentiation
- Neural Matrix
- Neural Tissue
- Neural Network
- Neural Plasticity
Neural Plasticity
Define Neural Plasticity
Changes in neural pathways & synapses from changes in behavior, environment or bodily injury.
Function of the Parahippocampal Gyrus
Memory Encoding & Retrieval
Functions of the Amygdala
Memory & Emotion
Resting Membrane Potential of a neuron
a. -70 µV
b. -70 mV
c. -70 mA
d. -70 µA
-70 mV (mV=Millivolts)
EPSPs & IPSPs
- Cortical Pyramidal Cells
- Frontal Lobe
- Neocortex
- Deep Brain Structures
Cortical Pyramidal Cells
Excitatory postsynaptic potential & Inhibitory postsynaptic potential
Define HIPAA
Health Insurance Portability & Accountability Act
Function of HIPAA
Protects a patient’s oral, written or electronic health information (PHI) from being disclosed.
HIPAA requires that all medical record sharing to be preceded by:
- Oral or written authorization from patient
- Oral or written authorization from patient or patients family
- Written authorization from patient
- Written authorization from patient or the patients family
Written authorization from patient
Preferred stimulator type for direct cortical stimulation in epilepsy surgery
Bipolar, constant-current
Preferred intensity range of stimulation for direct cortical stimulation in epilepsy surgery
0-20 mA (mA=milliamps)
Describe stimulation period for direct cortical stimulation in epilepsy surgery
1-10 seconds
Define the threshold range typically used to define function over the motor cortex for direct cortical stimulation in epilepsy surgery
2-5 mA (mA=milliamps)