Dementia & Epilepsy Flashcards
Define what is meant by “dementia”
Dementia is an umbrella term for a progressive deterioration of higher cortical function and has a number of different causes.
When investigating cognitive impairment, what tool can we use to give a baseline score to use in the current assessment and future assessments?
Mini- Mental State Examination
(MMSE)
What investigations can we use to rule out other causes of cognitive impairment when assessing for dementia?
CT-see stroke
MRI- vascular & atrophy detail
FBC- TFTs, Vitamin B12
What tool can we use to clinically destinguish between dementia and delirium?
Confusion assessment method
(CAM score)
How might a brain in someone with demetina look on a CT scan?
Dilated ventricles
Generalised atrophy
With regard to the rate of progression of cognitive decline, explain the differences between:
AD
Vascular dementia
Dementia with Lewy Bodies
AD- slow, steady decline over many years with no recovery
Vascular dementia- step-wise decline in cognitive function, decline related to vascular event
LB dementia- fluctuating decline in cognition which may improve then drop back down
Which drugs can be used to slow the progression of mild-moderate AD in some patients?
Cholinesterase inhibitors
Define what is meant by a “seizure”.
A sudden, irregular discharge of electrical activity in the brain causing a physical manifestation such as sensory disturbance, unconsciousness or convulsions.
Define what is meant by a “convulsion”.
An uncontrolled shaking movement of the body dur to rapid and repeated contraction anf relaxation of muscles.
What is an “Aura” ?
A perceptual disturbance experienced by some prior to a seizure
e.g. a strange light, unpleasent smell, confusing thoughts
What is epilepsy?
A neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness or convulsions, associated with abnormal electrical activity in the brain.
Draw a diagram to show the classification of seizures.
What is the difference between simple and complex partical seizures?
Simple- same consciousness
Complex- consciousness is impaired
What is the most common type of epilepsy?
When does this occur in most people?
Temporal lobe epilepsy
1st/2nd decade
Name the different types of generalised seizure.
How do each of these seizures differ from one another.
Tonic-clonic: (tonic) muscle tension followed by (clonic) convulsions
Absence: “daydreaming” back to conversation/task as if nothing happened
Myoclonic: breif, shock-like muscle jerks
Atonic: loss of muscle tone “drop attack”
Tonic: increases muscle tone
Status epilepticus: continuous epileptic fits without recovery of consciousness inbetween- medical emergency!!!!
What clinical history is important when assessing a patient with ?epilepsy, hx of seizure?
PMH, FH, triggers aura, first sign/symptom
Description of seizure, duration, abrupt/gradual end?
Post-ictal state, tongue biting? incontinence? neurological deficit?
COLLATERAL HISTORY
Give some differential diagnoses for ?seizure.
Vascular: stroke, TIA
Infection: abcess, meningitis
Trauma: intracerebral haemorrhage
Autoimmune: SLE
Metabolic: Hypoxia, electrolyte imbalance, hypoglycaemia
Iatrogenic: Drugs, alcohol withdrawl
Neoplastic: Intracerebral mass
What is the function of EEG use in seizure investigation/epilepsy diagnosis?
What other investigations can be used to exclude any other suspected cause?
To support diagnosis and assess risk of seizure recurrance
Needs to be 2 or more seizures to have diagnosis unless very high recurrance risk
ECG, MRI
What are the initial management steps for seizures?
- ABCDE
- Lorazepam or midazoplam
(PR or buccal) (IV if hosp.)
