Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neuro > Epilepsy + Loss of Consciousness > Flashcards

Epilepsy + Loss of Consciousness Flashcards

1
Q

Wha is a seizure and how do you classify seizures

A

Seizure is abnormal electrical activity in the brain
Where it began
Level of awareness
Other features of seizure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is a focal seizure

A

Specific area of brain affected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is focal aware / simple partial

A

No post ictal phase

Aware during seizure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is focal impaired consciousness / complex partial

A

Post-ictal phase
Aura
Loss of awareness / consciousness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What does aura suggest

A

Temporal lobe involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is generalised seizure

A

Involves both side of brain
Consciousness loss = immediate
Motor vs non-motor
Can be primary or secondary to focal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is secondary generalised

A

Starts on one side in specific area (focal)

Spreads to both lobes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is post ictal phase

A 
Any Sx after seizure 
Headache
Confusion
Myalgia
Temporal weakness following focal seizure in motor cortex (frontal lobe) = Todd's palsy 
Dysphagia if temporal lobe
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are causes of seizure

A

Any insult to brain

Vascular 
Haemorrhage
Stroke
AV malformation
Vasculitis
Severe blood loss 
Metabolic 
Hypoxia - when kept up straight after faint 
Any disturbance esp Na
Hypoglycaemia 
Temperature 
Uraemia 
Infectious 
TB 
Meningitis 
Encephalitis 
Neurosyphillis
HIV

Autoimmune
SLE
Sarcoid

Iatrogenic
TCA
Cocaine 
Tramadol 
Withdrawal - alcohol

Raised ICP
Brain tumour
SOL

Pseudo
Non-epileptic

Other 
Epilepsy 
Febrile convulsion  
Concussive
Arrhythmia - do ECG 
Vaso-vagal attack
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What causes non-epileptic attack

A

Narcolepsy
Migraine
Movement disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do non-epileptic attacks present

A

Well in-between attacks
Frequent prolonged and bizarre movement
May look like tonic-clonic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What do you do if someone is having a seizure

A

Check airway
Apply O2
Place in recovery position
Check O2 and BG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is important in the Hx.

A 
Any warning
What were they doing previous night
Has it happened before
What happened after
Any injury
Tongue biting or incontinence
What happened during attack
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is important in PMH

A 
Head injury
Traumatic birth
Febrile convuslions
Past psychatric
Drug and alcohol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are factors favouring syncope

A 
Occurs upright 
Pallor = common
Gradual onset
Injury is rare
Rapid recovery
Hot / nausea / tinnitus / tunnel vision prior
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What factors favour seizure

What can be raised after

A 
Arise any position
Pallor = uncommon
Sudden
Tongue biting + incontinence
Slow recovery
Precipitant rare
May have raised serum prolactin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What factors favour pseudo-seizure

A 
Pelvic thrusting
Cry after
FH epilepsy 
Don't occur alone
Rapid breathing
Eyes closed 
Gradual onset
Fluctuating motor
Quick return to norma
Widespread convulsions with awareness
Hx mental health 
CNS, CT, MRI and EEG normal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is epilepsy

A

Recurrent tendency to spontaneous intermittent abnormal electrical activity which manifests as seizures
>2 seizures
or >1 + Ix is highly suggestive e.g. EEG changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What type of generalised seizures can you get

A

Tonic clonic - stiff then jerky
Myoclonic - jerky in morning, associated with Juvenile myoclonic epilepsy
Tonic - stiff
Atonic - collapse, associated with Lennox Gastaut
Absence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is focal temporal presentation

A 
HEAD syndrome 
Hallucinations
Epigastric rising / emotional
Automatisms - lip smack / grabbing / fumbling
Deja vu / dysphasia (post-octal)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What do frontal lobe seizures cause

A 
Motor signs and speech 
Head / leg movement
Posturing
Post-ictal weakness
Dysphasia or speech arrest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What do parietal lobe seizures cause

A

Paraesthesia
Tingling
Numbness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What do occipital seizures cause

A

Floaters

Flashes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How does primary generalised usually present

A 
No warning
<25
Myoclonic jerks
Absences 
Hx tonic clonic
Generalised abnormality on EEG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How does focal seizures usually present

A 
Autonomic - high HR / sweating / GI
Awareness
Muscle twitching
Tonic 
Clonic
Repetitive movements
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What should all patients with seizure have

A

Specialist assessment within 2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What do you do if first seizure

A 
Routine bloods 
Blood sugar
ECG
Alcohol levels 
CT head to exclude trauma / bleed 
Only give rescue medication for 1st presentation if Hx of prolonged seizures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What other investigations can be done

A 
Bloods - FBC, U+E, LFT, Ca, bone profile, Mg, glucose 
ECG - exclude heart problems 
MRI if <50 and focal
CT to exclude other causes
Video telemetry

Specialist
EEG - can be used to see different seizure patterns and support Dx
Video EEG = gold standard to Dx
LP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

When are anti-epileptic drugs started

A 
After 2nd epileptic fit or 1st if 
Focal neuro deficit 
Structural abnormality on brain imaging
EEG shows unequivocal activity 
Abnormal neurodevelopment 
Risk unacceptable
May receive stat dose in A+E
30
Q

What is 1st line for focal seizures (opposite to tonic clonic)

A

Carbamazepine

Lamotrigine

31
Q

What is 2nd line for focal

A

Levetiracetam

Sodium valproate

32
Q

What is 1st line generalised tonic clonic

A

Sodium valproate

Lamotrigine in young women

33
Q

What is 2nd line

A

Carbamazepine
Lamotrigine
Levetiracetam

34
Q

What is 1st line in absence

A

Sodium valproate

Ethosuximide

35
Q

What is 2nd line

A

Lamotrigine

36
Q

What is 1st and 2nd line myoclonic

A

Sodium valproate = 1st line

Levetiracetam = 2nd line

37
Q

What should you avoiding myoclonic and atonic

A

Carbamazepine - also doesn’t work in absence

38
Q

What do you use for atonic

A

Sodium valproate

Lamotrigine

39
Q

What are common SE of AED

A

All cause CNS depression
- Drowsy
- Cerebellar toxicity (ataxia / dysarthria / diplopia)
Rash / SJS
Aplastic anaemia
IN OSCE ALWAYS WARN ABOUT RASH / SIGNS OF INFECTION
All induce p450 except valproate which inhibits

Foetal abnormlaity
N+V
Ataxia
Tremor
Weight gain
Hair loss
40
Q

What should you do when starting AED

A

Use one drug
Build up dose over 2-3 months till seizure is controlled
Switch to another

41
Q

What are other options

A

CBT
Surgery if focus identified
Vagal nerve stimulation
DBS

42
Q

What are driving regulations for seizure

A

If first seizure = 6 months
Or seizure free 1 year
Or only nocturnal seizures 3 years
10 years and on no AED if HGV

43
Q

What do you do if still believe to be driving

A

Report DVLA

44
Q

What is SUDEP

A

Sudden Unexplained Death in Epilepsy

More common in uncontrolled

45
Q

What are RF for epilepsy

A 
FH
Learning difficulty
Cerebral palsy
TS
Mitochondrial diseases
46
Q

How do absence seizures typically present

A

Last few seconds
Quick recovery
Child unaware
Good prognosis

47
Q

What can provoke

A

Hyperventilation

Stress

48
Q

How do you Dx

A

EEG

49
Q

What is status epileptics

A

Prolonged tonic clonic seizure
Seizure lasting >5 minutes or >3 seizures in 1hour with no return to baseline
No recovery
Often no Hx of epilepsy

50
Q

What can cause

A

Stroke
Tumour
Alcohol
Trauma

51
Q

What does it cause

A

Irreversible damage to brain cells

52
Q

What do you do after 5 minutes of seizing

A

Buccal Midazolam or rectal diazepam if in community
Another dose after 5 minutes
IV lorazepam if have access= next line
Repeat after 10 minutes

If hospital
ABCDE
Check BG and Rx
Consider thiamine 
Get IV access
53
Q

What is 2nd line if no response within 10 minutes

A

Sodium valproate
Phenytoin - require cardiac monitoring
Levetriactem IV

54
Q

What is 3rd line if no response after 30 minutes

A

Anaesthesia to shut of brain activity

RSI - propofol

55
Q

What is restless leg syndrome

A 
Spontaneous LL movement 
Urge to move (akathisia) 
Typically occurs at night
Worse at rest
May have associated paraesthesia
56
Q

What are RF

A 
FH
Iron deficiency anaemia
CKD - Uraemia
DM
Pregnancy
57
Q

How do you Dx

A

Clinical

Bloods for anaemia

58
Q

How do you Rx

A 
Walking / stretching 
Treat anaemia
Dopamine agonist = 1st line (ropriprazole / aripriprazole) 
Benzodiazpine = diazepam 
Gabapenitn
59
Q

What can cause collapse / LOC

A 
Vasovagal = most common
Situational
Carotid sinus hyperactivity 
Hypoxia
Epilepsy
Arrhythmia
Hypoglycaemia
DKA
Alcohol / drugs
Sepsis 
Raised ICP
MI
Blood loss
Stroke 
Anxiety 
Drop attack
Factitious
60
Q

How do you investigate initially

A

CVS + neuro exam
BP lying and standing
ECG + 24 hour holter
FBC, U+E, Mg, Ca, glucose

61
Q

What are other tests

A 
Tilt table
EEG
ECHO
CT / MRI
ABG
62
Q

What does drop in CO2 suggest

A

Hyperventilation

63
Q

What lowers seizure threshold

A 
Focal brain damage 
Toxins
Drug withdrawal / alcohol withdrawal 
Metabolic
Sleep deprivation
Stress
Non-adherance to meds
64
Q

When do you consider stopping AED’s

A

After 2 years seizure free

Withdraw over 2-3 months

65
Q

What is most important to rule out first if in status

A

Hypoxia

Hypoglcyaemia

66
Q

Epilepsy in pregnancy

A 
Folic acid
Sodium valproate = avoid
Lamotrigine = 1st line
Levetricatam = 2nd line 
Most AED transferred in breast milk
Enzyme inducing AED make progesterone only pills unreliable and OCP lowers levels
67
Q

How does sodium valproate work

A

Increases GABA = relaxing

68
Q

What are SE

A 
p450 inhibitor 
Teratogenic
Liver damage
Hair loss
Tremor
69
Q

What are SE of carbamazepine

A

Agranulocytosis
Aplastic anaemia
p450 inducer

70
Q

SE of phenytoin

A

Folate and vit D deficiency
Megaloblastic anaemia
Osteomalacia

71
Q

SE of lamotrigdine

A

SJS

Leukopenia

Neuro (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions