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Pathology II > EXAM 1 Seizures > Flashcards

EXAM 1 Seizures Flashcards

1
Q

What is the condition of having 2 or more episodes of seizures?

A

Epilepsy

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2
Q

A paroxysmal (sudden, violent) event due to abnormal excessive or synchronous neuronal activity in the brain? i.e. group of neurons firing simultaneously, muscles contracting

A

Seizure

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3
Q

Highest incidence of seizure occurs when?

A

Early childhood and late adulthood

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4
Q

Etiology of sz in Neonates (under 1 month)?

A

Perinatal hypoxia and ischemia

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5
Q

Etiology of sz in infants and children (1 month to 12 years) ?

A

Febrile sz

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6
Q

Etiology of sz in older adults ( >35 years)?

A

Cerebrovascular disease

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7
Q

The pathophysiology of sz is still unknown (idiopathic) but some speculate it to be due to loss of _______ neurons.

A

Inhibitory neurons

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8
Q

Other pathophysiology of sz include 1) Excitatory glutamatergic synapses and 2) excitatory amino acid neurotransmitters (glutamate , aspartate). Both are used for neuronal excitation but what do they enhance?

A

They enhance functional efficacy of ionotropic N-methyl-D-aspartate (NMDA) and metabotropic (Grp 1) receptors.

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9
Q

What abnormal tissues in the brain promote novel hyperexcitable synapses (localized area of hyperexcitable tissue) that can cause sz?

A

1) tumor, 2) AVM (brain arteriovenous malformation), 3) dead area (infarct, nonfunctional tissue)

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10
Q

Genetic Factors (surprise surprise!) can cause at least 20% of sz. Don’t memorize gene names but know that they are related to genes coding for ______.

A

Ionic channel proteins

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11
Q

What is the role of the substantia nigra, SN? Hint: RAM

A

It is part of the midbrain above the brainstem that controls Rewards, Addiction, Movement.

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12
Q

What is the role of the SN and GABA (inhibitory) in seizures?

A

A common feature in generalized seizures is a marked increase in metabolic activity in the SN, this increased activity can be associated with activated GABAergic nerve terminals that suppress sz propagation since GABA inhibits nigral efferents (outward conduction). Refer to slide 10.

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13
Q

What is kindling?

A

It is repeated subconvulsive stimulation which can lead to generalized convulsion. i.e. development of epilepsy after brain injury.

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14
Q

What are general characteristics of focal sz?

A

1) electrical discharges in small group of dysfunctional neurons in one lobe/hemisphere only
2) associated with warning before episode “aura”
3) Types:
simple focal sz: no LOC (loss of consciousness)
complex focal sz: results in LOC

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15
Q

What are characteristics of generalized sz?

A

1) diffuse abnormal discharges from both hemispheres
symmetrically involved
2) no warning! or aura
3) always LOC!

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16
Q

What is the manifestation of focal sz in the frontal lobe?

A

Jacksonian sz aka “marching sz” starts from distal extremity and marches to face on the same side of the body.

17
Q

What is the manifestation of focal sz in the parietal lobe?

A

“Weird sensation” tingling/ jerking of leg/arm/face

18
Q

What is the manifestation of focal sz in the occipital lobe?

A

Visual changes (flashing lights, spots) and vomiting

19
Q

What is the manifestation of focal sz in the temporal lobe?

A

Lasts a few seconds and easily missed; Changes in emotions, altered behavior, memory (deja vu), lip smacking/chewing

20
Q

What are the 3 types of focal sz?

A

1) Simple focal seizure
2) Complex focal seizure
3) Secondary generalized seizures

21
Q

Simple focal sz associated with what signs and symptoms?

A

motor signs, sensory symptoms, autonomic symptoms, and psych symptoms

22
Q

Motor signs for simple focal sz include:

A

1) w/ or w/o march (starts in small area than marches or spreads)
2) versive (characterized by sustained, forced simultaneous head and eye movements )
3) postural (change in position, extremities)
4) phonatory (incomprehensible speech, sounds)

23
Q

Sensory symptoms for simple focal sz include:

A

somato-sensory, visual, auditory, olfactory, vertiginous (vertigo), gustatory (taste)

24
Q

Autonomic symptoms for simple focal sz include:

A

emesis (vomiting), pallor, diaphoresis (sweating), pupil dilation, piloerection (goose bumps), incontinence

25
Q

Psych symptoms for simple focal sz include:

A

dysphasia (difficulty in speech), dysmnesic (confusion, memory impairment), affective (emotions such as flat, angry), illusions, structured hallucinations (deja vu)

26
Q

What are the two types of complex focal sz?

A

1) simple partial sz onset followed by impaired consciousness/ LOC
- w/ or w/o automatism (involuntary, repetitive movements)

2) LOC at onset
- LOC only
- LOC and automatisms

27
Q

What are the 6 types of generalized sz?

A

Absence seizure, Myoclonic seizure, Tonic seizure, Clonic seizure, Tonic-clonic seizure - stages, Atonic seizure

28
Q

What type of generalized sz involves sudden onset, interruption of ongoing activities, blank stare, brief upward rotation of eyes, last a few seconds?

A

Absence sz

29
Q

What type of generalized sz involves jerking of arms, shoulders, head; sudden shock-like, occurs when going to or awakening from sleep, exacerbated by volitional movement (action myoclonus) ?

A

Myoclonic sz

30
Q

What type of generalized sz involves rigid violent muscle contraction, limbs fixed in strained position, noises - expelling air through closed mouth?

A

Tonic sz

31
Q

What type of generalized sz involves sudden loss of postural muscle tone lasting 1-2 seconds, brief LOC without postictal confusion, associated with epilepsy syndrome (other diseases related to epilepsy) ?

A

Atonic sz

32
Q

Tonic-Clonic sz is a type of generalized sz. What are its stages? (3)

A

1) Tonic Phase: LOC- falls, sudden tonic contraction of respiratory muscle (stridor/moan), flexors and extensors contracting simultaneously, uses a lot of ATP!!
2) Clonic Phase: grunting respiration, sudden muscle relaxation, goes into deep sleep and awakens sore
3) Postictal State- confusion, fatigue

33
Q

What is another name for Tonic-Clonic sz?

A

Grand mal sz

34
Q

This is a special kind of sz that involves continuous seizures or repetitive, discrete seizures with LOC in the interictal period (between seizures)

  • duration is >5 minutes -> 25min! very dangerous
  • A lot of ATP wasted, lactic acid build-up leads to muscle soreness, even stroke/ MI

What sz am I?

A

Status Epilepticus

35
Q

During a seizure the action potential is excessively higher than the normal action potential of firing neurons.

A

Refer to slide 4 graph =)

Pathology II (10 decks)

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