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NEURO CLERKSHIP > coma/delirium/ and epilepsies > Flashcards

coma/delirium/ and epilepsies Flashcards

1
Q

is delirium caused by a structural or non-structiural dysfunction?

A

non

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2
Q

is the differential for delirium a broad or narrow etiology>

A

broad, look for more than once cause happening at same time.

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3
Q

what is the delirium acronym?

A 
drugs
emotional
low O2
infection
retition of urine
ictal states
undernutrition (wernicke's)
metabolic
subdural cns process
sensory, pain
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4
Q

what is the chief characteristic of delirium?

A

waxing and waning with agitation

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5
Q

iscoma caused by structural or nonstructural causes? what are the 2 exceptions

A

structural

drug induced and status ellipticus

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6
Q

review the most common causes of coma in order?

A 
vascular
trauma
endocrine problem
medications, drugs, ETOH
Infection CNS or non--shock
organ failure
seizure
temperatur disturbance
tumor
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7
Q

what is the order of levels of arousal?

A
  1. alert- eyes open, maintain awake
  2. somnolent- sleepy, maintain awake from arousal
  3. obtunded- sleepy awaken from verbal but can’t stay awake
  4. obtunded- sleep awaken to pain, but can’t stay awake
  5. stupours- cannot arouse to verbal or negative stimulus- grimace
    6comatose- no arousal
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8
Q

what is cushing’s triad?

A

hypertension, bradycardia and respiratory change- seen in acute ICP elevation

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9
Q

where is coma damage with pinpoint pupils?

A

pons

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10
Q

cheyne stokes respirations comes from damage where?

A

deep hemisphere or diencephalon

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11
Q

rhythmic hyperventialtion is from damage where?

A

pulmonary or metabolic

central midbrai or uppe pons

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12
Q

apneusis is from damage where?

A

dorsolateral pontine tegmentum

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13
Q

where is cluster breathing damage?

A

low pons or high medulla

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14
Q

where is ataxic breathing damage?

A

dorsomedial medulla

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15
Q

what is the order from best to worse in arousal of a patients movement?>

A

spontaneous, localizes, withrdrawals, decerebrate ro decorticate posturing, no response

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16
Q

how do we treat elevated ICP?

A 
head of bed up
hyperventialte
hyperosmotic use (mannitol)
neuroanesthetics
ventricular drain (NOT LP)
craniectomy
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17
Q

when do seizures often occur

A

after awakening

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18
Q

what can often provok generalized seizures?

A

sleep deprivation and alcohol

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19
Q

do focal seizures have an alteration of awareness?

A

may not

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20
Q

where do the majority of seizures in adults arise?

A

in the temporal lobe- over 65%

deep mesial structures

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21
Q

what is the most physiologic mimmicker of seizure?

A

syncope

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22
Q

To determine if a seizure is provoked or non-provoked, what does emergency room generally test for?

A

WBC, metabolic profile, drug scree

head CT if damage suspected

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23
Q

does normal neuroimaging exclude seizures?

A

no

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24
Q

Epileptiform discharges are often depicted as what?

A

sharp waves or spikes interictally

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25
Q

What is the sensitivity of a routine EEG?

A

about 30%

26
Q

what increases the sensitivity of a routine EEG?

A

within 1st 24 hours of seizure or sleep deprived EEG

27
Q

drug of choice for abscence seizures?

A

ethosuzimide

28
Q

what anti-convulsants may worsen generalized seizures?

A

carbamazepine, gabapentin, pregabalin, gabatril

29
Q

how many patients can control seizures with meds?

A

2/3

30
Q

valproic acid has what 2 side effects?

A

weight gain and teratogen

31
Q

does topiramate and zonisamide cause weight gain?

A

no weight loss

32
Q

what drugs have fewest effects on newborn infants when mom is taking

A

levitiracetam and lamotrigine

33
Q

if we use surgery for epilepsy, where is the surgery most likely found?

A

mesial temporal, brain for movement or language cannot be removed, neither can both mesial temporal lobes

34
Q

how long must someone go without a seizure in order to drive?

A

3 months- acadamy

6months in iowa- no madatory reporting

35
Q

what type of seizure do we se sudden unexpected death in epilepsy most?

A

generalized tonic-clonic seizures

36
Q

what needs to be excluded when making a diagnosis of epilepsy?

A

physiologic and psychologic mimickers

37
Q

patients failing 2-3 seizure meds should be?

A

referred to an epilepsy center

38
Q

when is epilepsy surgery typically an option?

A

intractable focal seizures

39
Q

does >10 seconds of electrographic change not associated with a clinical event constitute a seizure?

A

yes

40
Q

what is two uprovoked seizures

A

epilepsy if >24hrs apart

41
Q

auromatisms associated with seizures are most commonly found in what 2 places?

A

oral or hand

42
Q

what 3 characteristics of movements are concerning for seizures?

A

symmetry, synchronicity, rhythmicity

43
Q

what are small focal seizures that proceed or predict the onset of a patient’s typical more robust seizures?

A

aura- frequently autonomic or sensory in nature

44
Q

somatosensory auras are frequently what lobe location?

A

parietal

45
Q

psychlogical aura are frquently what lobe related?

A

frontal

46
Q

deja-vu is freq what lobe associated?

A

temporal

47
Q

what are partial seizures without alteration of conciousness?

A

simple partia

48
Q

what are partial seizures with associated alteration of consciousness

A

complex partial

49
Q

what has an onset 3-12 months, with trunk and extremity flexion or extension after waking?

A

infantile spasm

50
Q

what is hypsarrhythmia?

A

high amplitude chaotic background on EEG associated with infantile spasm

51
Q

when are febrile seizures most comon

A

6 mo to 5 y

52
Q

a febrile seizure lasting longer than 15 min is termed?

A

complex- also multiple in 24 hours , small increase in future risk of epilepsy

53
Q

besides ethosuximide, what can we treat absence seizures with?

A

lamotrigine, or valproic acid

54
Q

what is a partial epilepsy characterized by facial clonic seizures and generalized TC seizures freq at night? what does EEG show

A

benign rolandic
bilateral independent centro temporal sharp waves with horizontal dipol

FREQUENTLY UNTREATED

55
Q

when is the onset of mesial temporal lobe epilepsy

A

partial epilepsy usually in teens

56
Q

what increases risk of mesial temporal lobe epilepsy? what is eeg?

A

prolonged febrile seizures

- temporal sharps and temporal intermittent rhythmic delta activity

57
Q

Rx for mesial temporal seizures?

A

medications but frequently surgical resection

58
Q

when does REM parasomnias often occur?

A

last third of the night whereas non-REM occur in first third

59
Q

what is an acute event which frightens caretaker and caracterized by apnea, color change, limpness or rigidity and apparent choking?

A

Apparent life threatening events- not associated with SIDS risk, usually in young children

60
Q

what is described by cyanosis, pallor, and syncope with agitation and frustration in children?

A

breath holding spells

61
Q

what are spells of movement or alteration of consciousness without an EEG correlate?

A

psudoseizure- non-epileptic seizures, conversion disorder.

NEURO CLERKSHIP (7 decks)

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