Cognition & Senses 2: Seizures & Head Trauma Flashcards
GENERALIZED seizure…
____-___ ___ SEIZURE
BILATERAL vs. UNILATERAL
ASYMMETRICAL vs. SYMMETRICAL
usually associated with ____ ____
TONIC-CLONIC MOTOR SEIZURE
BILATERAL
SYMMETRICAL
usually associated with AUTONOMIC PHENOMENA
FOCAL SEIZURE
aka ___ SEIZURE
only ____ of the ___ is involved
animal is typically ____ but the ___ can be ALTERED
+/- may or may not be present?
aka PARTIAL SEIZURE
only HALF of the HEMISPHERE is involved
animal is typically CONSCIOUS but MENTATION can be ALTERED
+/- MOTOR ACTIVITY MAY OR MAY NOT BE PRESENT
IDIOPATHIC SEIZURES..
= definition
there are NO…
= has SUSPECTED GENETIC BASIS for SEIZURE ACTIVITY with often underlying TRANSIENT FUNCTIONAL or NEURO-CHEMICAL ABNORMALITY
there are NO IDENTIFIABLE STRUCTURAL ABNORMALITIES IN THE BRAIN
SYMPATOMATIC EPILEPSY definition
CRYPTOGEIC EPILEPSY definition
SYMPATOMATIC EPILEPSY = RECURRENT SEIZURES for which a STRUCTURAL CAUSE is found
CRYPTOGENIC EPILEPSY = RECURRENT SEIZURES thought to be SYMPTOMATIC but NO ETIOLOGY FOUND
how long can the POST-ICTAL state last in DOGS?
how long can the POST-ICTAL state last?
= after a seizure, can last up to 72 HOURS in DOGS
what is a CLUSTER SEIZURE?
= having 2 OR MORE SEIZURES within a 24 HOUR PERIOD
what is STATUS EPILEPTICUS?
= a seizure/ICTAL EVENT >5 minutes OR >3 GENERALIZED SEIZURES within a 24 HOUR PERIOD
6 DDxs for SYMPTOMATIC SEIZURES?
- NEOPLASIA
- MENINGOENCEPHALITIS of UNKNOWN ETIOLOGY
- INFECTIOUS ENCEPHALITIS
- VASCULAR
- ANOMALOUS (HYDROCEPHALUS)
- DEGENERATIVE
REACTIVE SEIZURES…
= definition?
5 DDxs?
= seizures resulting from an EXTRACRANIAL CAUSE and includes METABOLIC & TOXIC DISORDERS
5 DDxs?
1. HEPATIC ENCEPHALOPATHY
2. HYPOGLYCEMIA
3. HYPOCALCEMIA
4. THIAMINE DEFICIENCY
5. TOXIN
RECTAL TEMP after a GENERALIZED SEIZURE?
abnormal POST-ICTAL behaviors? (2)
tends to be HYPOTHERMIC
abnormal POST-ICTAL behaviors?
1. POLYDIPSIA
2. ACTING AS IF BLIND
when does a LONG SEIZURE cause DELETERIOUS ___ & ___ EFFECTS?
CEREBRAL & SYSTEMIC EFFECTS
seizures >5 MINUTES
4 SYSTEMIC diseases that can occur from LONG SEIZURES? which one is RARE?
3 INTRACRANIAL changes that can occur from LONG SEIZURES?
4 SYSTEMIC?
1. HYPOXEMIA
2. ACIDEMIA
3. MYOCARDIAL INJURY
4. DIC (RARE)
3 INTRACRANIAL
1. CEREBRAL HYPOXIA
2. EDEMA
3. INCREASED ICP
DIAGNOSTICS for SEIZURES?
PCV/TS?
BLOOD GLUCOSE?
LACTATE?
STICK BUN or NOVA CREATININE?
ECG MONITORING?
RADS? what view?
PCV/TS = usually DEHYDRATION
BLOOD GLUCOSE = can be HYPOGLYCEMIC from INSULINOMA
LACTATE = can be INCREASED from MUSCLE ACTIVITY
STICK BUN or NOVA CREATININE = assess for RENAL or PRE-RENAL DYSFUNCTION
ECG MONITORING = to ID CARDIAC ARRHYTHMIAS as CAUSE OF EXTRACRANIAL SEIZURE
THORACIC RADS = if RESPIRATORY SYSTEM ABNORMALITIES to RULE OUT PULMONARY EDEMA
seizure WORK-UP to RULE OUT…
CBC/chem?
BRAIN MRI?
CSF ANALYSIS?
CBC/chem = to RULE OUT METABOLIC/TOXIC DISEASES
BRAIN MRI = to RULE OUT STRUCTURAL DISEASES
CSF ANALYSIS = if ABNORMAL, use NEUROIMAGING TO NARROW DDxs
3 initial steps for SEIZURE MANAGEMENT?
name ONE example that’s best for the last one
- ADMINISTER O2
- PLACE IV CATH if NOT IN PLACE ALREADY
- BENZODIAZEPINES
–> –PAM SUFFIX, DIAZEPAM IS BEST
giving DIAZEPAM for SEIZURE MANAGEMENT…
____-ACTING; reaches TARGET PLASMA CONCENTRATION in…
wait at least ___ ___ BETWEEN BOLUSES
half-life?
3 routes of ADMINISTRATION?
we should give this when the patient is experiencing ___ ___
FAST-ACTING; reaches TARGET PLASMA CONCENTRATION in 10-20 MINUTES
wait at least 5 MINUTES BETWEEN BOLUSES
half-life? = 3 HOURS
3 routes of ADMINISTRATION?
1. IV
2. RECTAL
3. INTRANASAL
we should give this when the patient is experiencing STATUS EPILEPTICUS
giving MIDAZOLAM for SEIZURE MANAGEMENT..
half-life when compared to DIAZEPAM?
3 routes of administration? which has the BEST ABSORPTION & BIOAVAILABILITY?
we should give this when the patient is experiencing ___ ___
SHORTER HALF-LIFE THAN DIAZEPAM at 1-2 HOURS
3 routes?
1. IM INJECTABLE = BEST ABSORPTION/BIOAVAILABILITY
2. NASAL MUCOSA
3. BRAIN via CRIBIFORM PLATE
we should give this when the patient is experiencing STATUS EPILEPTICUS
what should we use as a LONG-TERM MAINTENANCE DRUG for SEIZURES?
2 routes of administration? which has LESS sedative side effects?
how does it work?
distribution to CNS takes UP TO ___ ___ AFTER administartion
we should use BARBITURATES (PHENOBARBITAL)
2 routes?
1. IV
2. IM = LESS SEDATIVE SIDE EFFECTS
how does it work? = GABA RECEPTORS ARE ENHANCED to INCREASE INHIBITORY ACTIVITY
distribution to CNS takes UP TO 30 MINS after administration
BLOODWORK schedule for PHENOBARBITAL? (2)
- check blood levels 2-3 WEEKS AFTER STARTING MAINTENANCE DOSE, then EVERY 6 MONTHS AFTER
- recheck blood levels 2-3 WEEKS AFTER DOSE ADJUSTMENTS
why should we CHECK T4 PRIOR to giving ____?
PHENOBARBITAL
can INCREASE METABOLISM OF THYROID HORMONES
LEVETIRACETAM
aka brand name?
used for…
half-life?
CAUTION giving to patients with…
aka KEPPRA
used for LONG-TERM MAINTENANCE of SEIZURES
half-life = 3 HOURS
CAUTION giving to patients with RENAL DZ
what is the LAST RESORT for SEIZURE Tx?
why?
INHALANT ANESTHESIA
why? = CESSATION OF PHYSICAL MANIFESTATION OF SEIZURE ONLY
TRUE/FALSE
you SHOULD NOT give ZONISAMIDE for SEIZURE Tx with PHENOBARBITAL because it will COMPETE WITH IT for LIVER METABOLISM
TRUE
TRUE/FALSE
ZONISAMIDE has a HALF-LIFE of 5 hours
FALSE, 15 HOUR HALF-LIFE!
TRUE/FALSE
POTASSIUM BROMIDE has a HALF-LIFE of 25 DAYS after RECTAL LOADING
FALSE, ORAL ADMINISTRATION = 25 DAYS
TRUE/FALSE
dogs with SEIZURES due to TOXICOSIS have a MORE FAVORABLE OUTCOME than dogs with SYMPTOMATIC EPILEPSY
TRUE
TRUE/FALSE
failure to CONTROL SEIZURES within 8 HOURS OF ONSET seems to NEGATIVELY AFFECT OUTCOME
FALSE, 6 HOURS
CUSHING’S TRIADE
formula? & define the terms
3 steps that can lead to an emergency?
CPP = MAP - ICP
CEREBRAL PERFUSION/BLOOD FLOW = BP - ICP
3 steps?
1. when ICP increases, then CEREBRAL BLOOD FLOW DECREASES
2. increased CO2 triggers INCREASED MAP
3. SYSTEMIC HYPERTENSION then causes REFLEX BRADYCARDIA –> REQUIRES INTERVENTION
