Epilepsy and Trauma / Stroke Flashcards
Types of post-traumatic seizures (2) and relative risk of epilepsy
Early (within first week): 10%
Late (after first week): 86%
Seizure prophylaxis in head injury
Mixed, but AAN recommends 1-week treatment in ADULTS with SEVERE brain injury
Not in children
Likelihood of Seizures as presenting symptom of stroke in:
Neonates
Children
Adults
Neonates - 80%
Children - 30%
Adults - Rare (no percentage in book)
Risk of epilepsy after stroke in
Pediatric
Adult
Pediatric: up to 40%
Adult: 5%
Classification of Post-stroke seizure and why
Early (within first week)
Late (after first week)
- even one late post-stroke seizure has high risk of recurrence >50%
Board “buzz word” classic EEG finding in stroke
Lateralized period discharges (LPDs, formerly PLEDS)
Classification of Traumatic brain injury (Mild, moderate, severe) based on :
Duration
Presence of structural brain injury
- Most common malformations associated with Epilepsy (2)
- Common Malformation NOT associated with seizures
- Other factors increasing suspicion for causing seizures (3)
Most common malformations to cause seizures:
- Arteriovenous malformations (AVM)
- Cavernous malformations
Developmental venous anomalies (DVAs) are typically incidental
Factors increasing epileptogenic risk
- surrounding hemorrhage
- gliosis
- encephalomalacia
5-year risk for seizure in incidentally diagnosed Vascular malformations
- AVM
- AVM + hemorrhage
- AVM in temporal lobe
- CM
- CM + Hemorrhage
- CM in temporal lobe
- AVM: 8%
- AVM + Hemorrhage: 23%
- AVM in temporal lobe: increased risk
- CM: 4-6%
- CM+ hemorrhage: 4-6%
- CM in temporal lobe: no increased risk
Developmental venous anomalies (and presenting symptom):
% incidental (on MRI)
% with focal neurologic deficits
% with symptomatic bleeding
% with seiuzures
% unclear
% incidental: 61%
% with focal neurologic deficits: 6%
% with symptomatic bleeding 6%
% with seizures 4%
% unclear: 23%
Post-traumatic seizures: Factors increasing risk for developing epilepsy (and one that doesn’t)
- Late (after first week) - 86%
- Seizures in combination with moderate or severe TBI
- Epileptiform discharges on EEG doesn’t necessarily increase likelihood of epilepsy