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*Nervous System - Pathology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

3 components to the patients account of episodes of collapse?

A
  • History preceding events (context/timing; posture)
  • History of event itself (warning symptoms; level of awareness/recollection)
  • Afterwards (first recollection; SEIZURE MARKS = prolonged disorientation, tongue biting, incontinence, muscle pains)
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2
Q

What is a good thing to ALWAYS try to get when assessing episodes of collapse? What r the components of this?

A

Witness account !!

  • How were they before (context)
  • Description of episode (eyes open or closed; description of abnormal movements; pallor, alteration in breathing pattern; pulses); duration of LOC; time to recovery)
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3
Q

3 categories of syncope?

A

REFLEX (neuro-cardiogenic)
ORTHOSTATIC
CARDIOGENIC

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4
Q

Expand on Reflex (neuro-cardiogenic) Syncope

A
  • taking blood/medical situations

- cough, micturation

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5
Q

Expand on Orthostatic Syncope

A
  • Dehydration, medication related (anti-hypertensive)

- Endocrine, autonomic nervous system

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6
Q

Expand on Cardiogenic Syncope

A
  • Arrhythmias, aortic stenosis
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7
Q

Give the typical syncopal history - preceding events, event itself, afterwards

A 
Preceding: 
- Stimulus = bloods taken, defacation 
- Context = only in bathroom, only when standing 
Event itself:
- Warning i.e. felt lightheaded/clammy/vision blacking out
Afterwards:
- Very brief LOC 
- ‘came round as I hit the ground’
- fully orientated quickly 
- clammy/sweaty
- urinary incontinence
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8
Q

In syncope how can further similar events be aborted?

A

By sitting

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9
Q

Give typical witness account of syncope

A
  • looked pale
  • went floppy
  • may have been a few brief jerks
  • brief LOC
  • rapid recovery (if prolonged was patient propped up)
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10
Q

How should syncope be assessed?

A

EXAMINATION (heart sounds, pulse, postural BPs)
ECG (look for heart block, QT ratio)
May need 24HR ECG (may need to see cardiology if recurrent; consider tilt table)

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11
Q

Give typical patient account of CARDIOGENIC syncope - preceding events, event itself, afterwards

A 
Preceding:
- on exertion 
Event:
- chest pain, palpitations, SOB
After:
- chest pain, palpitations, SOB
- came round quickly - recovery may be longer
- clammy/sweaty
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12
Q

Give typical witness account of CARDIOGENIC syncope

A
  • went floppy
  • grey/ashen white
  • seemed to stop breathing
  • unable to feel pulse
  • may have been few brief jerks
  • variable duration of LOC
  • rapid recovery
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13
Q

What is the assessment of CARDIOGENIC syncope

A
  • family history (important!!)
  • examination (heart sounds, pulse)
  • ECG (look for heart block, QT ratio)
  • refer to cardiology urgently/admission for telometry
  • may need 24 hr ECG/ECHO/prolonged monitoring
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14
Q

What is epilepsy?

A

Tendency to recurrent seizures
Usually used if patient has more than one unprovoked seizure (or if after one investigations suggest recurrence - abnormality on imaging or EEG)

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15
Q

What causes a seizure in the body?

A

Background electrical activity of neurones is disrupted

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16
Q

7 things that can provoke seizures?

A 
Alcohol withdrawal 
Drug withdrawal 
Within few days after head injury 
Within 24 hrs of stroke 
Within 24hrs of neurosurgery 
With severe electrolyte disturbance 
Eclampsia
17
Q

What are the 2 basic classifications or seizures?

A

Generalised

Focal

18
Q

Give the 5 types of generalised seizures

A 
Absence seizures 
Generalised tonic-clonic seizures 
Myoclonic seizures 
Juvenile myoclonic epilepsy 
Atonic seizures
19
Q

Give the 4 types of focal seizures

A

Simple partial seizures
Complex partial seizures
Secondary generalised
By localisation of onset (temporal lobe, frontal etc)

20
Q

Give the differences between primary generalised and focal epileptics in terms of warning, age range and EEG findings

A

PG - no warning; F - may get an ‘aura’
PG - <25 yrs; F - can be any age because can be any focal brain abnormality
PG - EEG generalised abnormality; F - EEG focal abnormality

21
Q

What might be seen in a history of someone with primary generalised epilepsy?

A
  • May have history of absences and myoclonic jerks as well as GTCS e.g. in juvenile myoclonic epilepsy
  • May have family history
22
Q

What investigation may show the cause in focal seizures?

A

MRI

23
Q

What can simple partial and complex partial seizures become?

A

Secondary generalised

24
Q

Give typical patient account of TONIC-CLONIC seizure - preceding, event, afterwards

A 
Preceding:
- unpredictable, tend to cluster 
- PMH - complications at birth, Feb conv, trauma, meningitis, brain injury 
Event:
- maybe vague warning; irritability 
After:
- lateral (severe) tongue biting, incontinence 
- first recollection ambulance/hosp
- muscle pain
25
Q

Give typical witness account of TONIC CLONIC seizure

A
  • groaning
  • rigid (tonic), then generalised jerking all 4 limbs (clonic)
  • eyes open (staring, roll upwards)
  • foaming at mouth
  • jerking for few mins the groggy 15-30 mins
  • agitated after
  • may have cluster of episodes - stopping n starting
26
Q

Who are absence seizures often found in?

A

Children (unaware of them)

27
Q

What can absence seizures be provoked by?

A 
Hyperventilation 
Photic stimulation (e.g. light through trees of car)
28
Q

What do absence seizures look like?

A

Sudden arrest of activity for a few secs, brief staring, possibly eyelid fluttering, then re-start what they were doing

29
Q

Who is juvenile myoclonic epilepsy found in? What is it provoked by?

A

Adolescents/young adults (provoked by alcohol, sleep deprivation)

30
Q

What seizures can Juvenile Myoclonic epilepsy patients have?

A

Absence

GTC

31
Q

What will Juvenile Myoclonic epilepsy patients often experience?

A

Morning myoclonus - drop things in morning, brief jerks

*Nervous System - Pathology (13 decks)

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