condition 2 Flashcards
defintion in epilepsy/ seizures
recurrent tendency to spontaneous, intermittent, abnormal electrical activity activity in part of the brain manifesting as seizures
epilepsy is not a diagnosis but a symptom with many underlying causes
what are the different types of seizure
generalised - simultaneous onset of electrical discharge throughout cortex with no localising features referable to only one hemisphere, there are other smart subtype within generalised seizures
- absence seizures - brief pauses
- tonic-clonic seizures - loss of consciousness, limbs stiffen (tonic), then jerk (clonic)
- myoclonic - sudden jerk of limb, face or trunk
- atonic - sudden of muscle tone causing fall
partial - focal onset with features referable to a part of one hemisphere, they are other different type within partial
- simple partial seizure - awareness is unimpaired with focal motor, autonomic or psychic symptoms
- awareness is impaired
- partial seizure with secondary generalisation - electrical disturbance which starts focally spreads widely causing a secondary generalised seizures which is typically convulsive
how common is seizure/epilepsy
5-10 cases per 1000 but 5-30% of these are misdiagnosed
causes of seizure or epilepsy
idiopathic (2/3) often familial structural - cortical (cerebrum) scarring eg head injury years before onset - developmental - space-occupying lesion - stroke - hippocampal sclerosis - sarcoidosis -SLE - polyarteritis nodosa
non-epileptic causes of seizures
- trauma
- stroke
- haemorrhage
- raised ICP
- alcohol or benzodiazepine withdrawal
- metabolic disturbance - hypoxia, hyper/hypo-natraemia/gycaaemia, hypocalcaemia, uraemia
- liver disease
- infection
- drugs
symptoms of seizures/epilepsy
prodrome - symptoms preceding the seziure by hours or days such as change in mood or behaviour
aura - part of the seizure of which the patient is aware and may precede its other manifestations eg odd feeling in the gut or flashing lights or strange smells
psot-ictally - heachace, confusion, myalgia, sore tongue, temporary weakness (seizure in the motor cortex)k dysphagia ( seizure in temporal lobe)
what are the specific symptoms for generalised tonic clonic seizures
sudden fall stiff limbs jerking loss of consciousness tongue biting incontinence
differential for seizures
syncope cardiac arrhythmias TIA migraine benign paroxysmal vertigo acute encephalopathy panic attacks aggressive outburst eg related to learning disability
further invest for seizures
EEG - only supportive to diagnosis, should only be performed after the second epileptic seizures, sleep EEG can be more accurate
MRI
bloods - to exclude other causes
ECG
treatment for seizures
drugs are not advised following one fit unless there is a high risk of recurrence. drug treatment should only start after 2nd attack and after discussion with patient
tonic-clonic - sodium valproate or lamotrigine (carbamazepine or topiramate - 2nd line)
absence - sodium valproate, lamotrigine or ethosuximide
tonic, atonic and myoclonic - same as generalised tonic clonic but avoiding carbamazepine and oxcarbazepine, topiramate 2 line
DVLA should be notify when epilepsy
what are some complications for epilepsy
SUDEP - Sudden Unexplained Death in Epilepsy
definition for meningitis
acute inflammation of the meninges and the underlying subarachnoid CSF –> medial emergency
how common is meningitis
2500/year bacterial and 5000/year viral
what are the 2 subtype of meningitis
infective and non-infective
what are some of the pathogens included in infective meningitis
bacterial - neisseria meningitides, strep pneumonia, staph aureus, haemophilius influenze type B (rare in the UK due to vaccine)
viral - enteroviruses, herpes simplex, varicella zoster, Mumps, HIV
fungal - in immunosuppressed
parasitic - eosinophilic meningitis
what are some causes of meningitis in non-infective category
malignant cells
intrathecal drugs (durgs injected in the spinal cord)
blood from SAH
sarcoidosis
SLE
Behcet’s disease (a rare immune-mediated small-vessel systemic vasculitis that often presents with mucous membrane ulceration and ocular problems.)
symptoms of meningitis
headache, leg pains, cold hands and feet
abnormal skin colour
meningism - stiff neck, photophobia seizures focal CNS signs petechial rash - non-bleeding signs of galloping sepsis - slow cap refill, low BP, pyrexia, tachycardia
prognosis of meningitis
viral meningitis usually self-limiting and resolves within 4-10 days might leave headache months after
differential for meningitis
SAH encephalitis other causes of pyrexia/severe infection intracranial abscess septicaemia (blood poisoning)
further investigations for meningitis
bloods - FBC, U&Es, LFT, glucose, coagulation
blood culture
throat swab - one for bacterial and one for viral
stool samples - for viral
LP - measure opening pressure - normally 7-18cm, typically 14-30 in meningitis), send samples for MC+S, gram stain, protein estimation, glucose, virology, only do this when not contraindicated (eg inc ICP, focal signs, papilloedema, truma, middle ear pathology, major coagulaopathy)
CT
what are the appearance of CSF for meningitis
pyogenic (bacterial only) - cloudy, polymorphs mainly with some lymphocytes, glucose half plasma, inc protein
