EM Neuro 1 (Seizures)

Question 1

what is status epilepticus?

Answer 1

seizure activity ≥5 minutes, or

2 or more seizures without regaining consciousness between seizures

Question 2

What is refractory status epilepticus

Answer 2

persistent seizure activity despite the IV administration of adequate amounts of 2 antiepileptic agents

Question 3

olfactory or gustatory hallucinations suggest a focus in the

Answer 3

medial temporal lobe

Question 4

what to obtain in the history of a patient with seizures?

Answer 4

preceding aura
onset (abrupt or gradual)

progression of motor activity
localized/generalized
symmetric/asymmetric

loss of bowel or bladder control
presence of oral injury

Question 5

possible precipitating factors for seizures in an epileptic

Answer 5

missed doses of antiepileptic meds
recent alterations in meds

sleep deprivation
increased strenuous activity

infection
electrolyte disturbances
alcohol or substance use of withdrawal

Question 6

what to watch out for after a seizure episode?

Answer 6

glucose level
head or spine trauma
posterior shoulder dislocation

lacerations of the tongue and mouth
dental fracture
pulmonary aspiration

Question 7

distinguishing features of seizures

Answer 7

1. abrupt onset and termination
   - may have auras
   - most last only 1 or 2 mins, unless it’s status epilepticus
2. purposeless movements or behavior during the attack
3. followed by a period of postictal confusion and lethargy
4. lack of recall

Question 8

differential diagnosis for seizures

Answer 8

syncope
pseudoseizures
hyperventilation syndrome
movement disorders
migraine
-most common migraine aura: scintillating  scotoma

Question 9

in a patient with a well-documented seizure disorder who has had a single unprovoked seizure, the only tests that may be needed are

Answer 9

a glucose level and pertinent anticonvulsant medication levels

Question 10

most common cause of a breakthrough seizure

Answer 10

medication noncompliance

Question 11

lumbar puncture in the setting of an acute seizure is indicated if

Answer 11

the patient is febrile or immunocompromised,

or if subarachnoid hemorrhage is suspected and the noncontrast head CT is normal

Question 12

what to do in patients with active seizure

Answer 12

supportive and patient protective measures
turn the patient to the side to reduce the risk of aspiration
clear the airway once the attack subsides (suction, adjuncts)

Question 13

remarks on giving IV anticonvulsive medications during the course of uncomplicated seizure

Answer 13

not necessary or recommended, although the practitioner should be ready to administer these medications if seizures do not terminate

Question 14

remarks on patients with a first unprovoked seizure

Answer 14

Guidelines do NOT recommend hospital admission or initiation of anti-convulsant therapy in the patient with a first unprovoked seizure, as long as the patient has returned to NEUROLOGIC BASELINE

In general, patients with a first unprovoked seizure who have a normal neurologic exam, no acute or chronic medical comorbidities, normal diagnostic testing including noncontrast head CT, and normal mental status can safely be discharged from the ED.

Patients with secondary seizures due to an identifiable underlying condition (e.g. trauma, intracranial hemorrhage, uremia) often require admission and should generally be treated to minimize seizure recurrence.