Epilepsy Flashcards
3 components to the patients account of episodes of collapse?
- 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)
What is a good thing to ALWAYS try to get when assessing episodes of collapse? What r the components of this?
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)
3 categories of syncope?
REFLEX (neuro-cardiogenic)
ORTHOSTATIC
CARDIOGENIC
Expand on Reflex (neuro-cardiogenic) Syncope
- taking blood/medical situations
- cough, micturation
Expand on Orthostatic Syncope
- Dehydration, medication related (anti-hypertensive)
- Endocrine, autonomic nervous system
Expand on Cardiogenic Syncope
- Arrhythmias, aortic stenosis
Give the typical syncopal history - preceding events, event itself, afterwards
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
In syncope how can further similar events be aborted?
By sitting
Give typical witness account of syncope
- looked pale
- went floppy
- may have been a few brief jerks
- brief LOC
- rapid recovery (if prolonged was patient propped up)
How should syncope be assessed?
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)
Give typical patient account of CARDIOGENIC syncope - preceding events, event itself, afterwards
Preceding: - on exertion Event: - chest pain, palpitations, SOB After: - chest pain, palpitations, SOB - came round quickly - recovery may be longer - clammy/sweaty
Give typical witness account of CARDIOGENIC syncope
- 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
What is the assessment of CARDIOGENIC syncope
- 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
What is epilepsy?
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)
What causes a seizure in the body?
Background electrical activity of neurones is disrupted
7 things that can provoke seizures?
Alcohol withdrawal Drug withdrawal Within few days after head injury Within 24 hrs of stroke Within 24hrs of neurosurgery With severe electrolyte disturbance Eclampsia
What are the 2 basic classifications or seizures?
Generalised
Focal
Give the 5 types of generalised seizures
Absence seizures Generalised tonic-clonic seizures Myoclonic seizures Juvenile myoclonic epilepsy Atonic seizures
Give the 4 types of focal seizures
Simple partial seizures
Complex partial seizures
Secondary generalised
By localisation of onset (temporal lobe, frontal etc)
Give the differences between primary generalised and focal epileptics in terms of warning, age range and EEG findings
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
What might be seen in a history of someone with primary generalised epilepsy?
- May have history of absences and myoclonic jerks as well as GTCS e.g. in juvenile myoclonic epilepsy
- May have family history
What investigation may show the cause in focal seizures?
MRI
What can simple partial and complex partial seizures become?
Secondary generalised
Give typical patient account of TONIC-CLONIC seizure - preceding, event, afterwards
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
Give typical witness account of TONIC CLONIC seizure
- 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
Who are absence seizures often found in?
Children (unaware of them)
What can absence seizures be provoked by?
Hyperventilation Photic stimulation (e.g. light through trees of car)
What do absence seizures look like?
Sudden arrest of activity for a few secs, brief staring, possibly eyelid fluttering, then re-start what they were doing
Who is juvenile myoclonic epilepsy found in? What is it provoked by?
Adolescents/young adults (provoked by alcohol, sleep deprivation)
What seizures can Juvenile Myoclonic epilepsy patients have?
Absence
GTC
What will Juvenile Myoclonic epilepsy patients often experience?
Morning myoclonus - drop things in morning, brief jerks
