Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

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
How does focal seizures usually present
``` Autonomic - high HR / sweating / GI Awareness Muscle twitching Tonic Clonic Repetitive movements ```
26
What should all patients with seizure have
Specialist assessment within 2 weeks
27
What do you do if first seizure
``` 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 ```
28
What other investigations can be done
``` 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
29
When are anti-epileptic drugs started
``` 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
What is 1st line for focal seizures (opposite to tonic clonic)
Carbamazepine | Lamotrigine
31
What is 2nd line for focal
Levetiracetam | Sodium valproate
32
What is 1st line generalised tonic clonic
Sodium valproate | Lamotrigine in young women
33
What is 2nd line
Carbamazepine Lamotrigine Levetiracetam
34
What is 1st line in absence
Sodium valproate | Ethosuximide
35
What is 2nd line
Lamotrigine
36
What is 1st and 2nd line myoclonic
Sodium valproate = 1st line | Levetiracetam = 2nd line
37
What should you avoiding myoclonic and atonic
Carbamazepine - also doesn't work in absence
38
What do you use for atonic
Sodium valproate | Lamotrigine
39
What are common SE of AED
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
What should you do when starting AED
Use one drug Build up dose over 2-3 months till seizure is controlled Switch to another
41
What are other options
CBT Surgery if focus identified Vagal nerve stimulation DBS
42
What are driving regulations for seizure
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
What do you do if still believe to be driving
Report DVLA
44
What is SUDEP
Sudden Unexplained Death in Epilepsy | More common in uncontrolled
45
What are RF for epilepsy
``` FH Learning difficulty Cerebral palsy TS Mitochondrial diseases ```
46
How do absence seizures typically present
Last few seconds Quick recovery Child unaware Good prognosis
47
What can provoke
Hyperventilation | Stress
48
How do you Dx
EEG
49
What is status epileptics
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
What can cause
Stroke Tumour Alcohol Trauma
51
What does it cause
Irreversible damage to brain cells
52
What do you do after 5 minutes of seizing
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
What is 2nd line if no response within 10 minutes
Sodium valproate Phenytoin - require cardiac monitoring Levetriactem IV
54
What is 3rd line if no response after 30 minutes
Anaesthesia to shut of brain activity | RSI - propofol
55
What is restless leg syndrome
``` Spontaneous LL movement Urge to move (akathisia) Typically occurs at night Worse at rest May have associated paraesthesia ```
56
What are RF
``` FH Iron deficiency anaemia CKD - Uraemia DM Pregnancy ```
57
How do you Dx
Clinical | Bloods for anaemia
58
How do you Rx
``` Walking / stretching Treat anaemia Dopamine agonist = 1st line (ropriprazole / aripriprazole) Benzodiazpine = diazepam Gabapenitn ```
59
What can cause collapse / LOC
``` 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
How do you investigate initially
CVS + neuro exam BP lying and standing ECG + 24 hour holter FBC, U+E, Mg, Ca, glucose
61
What are other tests
``` Tilt table EEG ECHO CT / MRI ABG ```
62
What does drop in CO2 suggest
Hyperventilation
63
What lowers seizure threshold
``` Focal brain damage Toxins Drug withdrawal / alcohol withdrawal Metabolic Sleep deprivation Stress Non-adherance to meds ```
64
When do you consider stopping AED's
After 2 years seizure free | Withdraw over 2-3 months
65
What is most important to rule out first if in status
Hypoxia | Hypoglcyaemia
66
Epilepsy in pregnancy
``` 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
How does sodium valproate work
Increases GABA = relaxing
68
What are SE
``` p450 inhibitor Teratogenic Liver damage Hair loss Tremor ```
69
What are SE of carbamazepine
Agranulocytosis Aplastic anaemia p450 inducer
70
SE of phenytoin
Folate and vit D deficiency Megaloblastic anaemia Osteomalacia
71
SE of lamotrigdine
SJS | Leukopenia

Neuro (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions