Exam 3 Seizures Flashcards
Seizures are?
Sudden, excessive electrical discharges in brain
Causes uncontrolled mvmt, disorientation, LOC
Epilepsy is?
Recurrent seizures from chronic, underlying syndrome
Seizures caused by? (10)
1) Trauma: hypoxia, injury
2) Congenital defects
3) Metabolic: hypogly/Na+, hypo/hyperCa2+, uremia, Reye’s
4) Infection
5) Drugs or w/d
6) Toxins: lead, organophos
7) Neoplasm
8) Vascular: CVA, HTN, arteritis, sickle
9) Degenerative neuro dz
10) Fever in kids
Ictal?
Interictal?
Postictal?
During seizure
Between seizures
After seizure
Clonic?
Tonic?
Clonic-Tonic?
Repetitive, flex/ext
Rigid, continuous tension
Both
Epileptogenic?
Epileptiform?
Factors that ↓ threshold = more seizures
Having appearance of seizure activity
Simple Partial Seizures Presentation?
No ∆ in LOC
Can interact
Recalls event
Specific signs depend on focal area of brain
Simple Partial Seizures:
Motor sxs?
Sensory sxs?
Temporal lobe sxs?
Occipital lobe sxs?
Motor:
Jackson = Clonic mvmt start in hand/foot -> progress thru limb
Todd’s = Paralysis lasting min to hrs
Sensory: Paresthesia, Numbness
Temporal: Deja vu, Epigastric discomfort
Occ: Flashing lights, visual ∆
Complete Partial Seizures presentation?
Combo of focal motor/sensory w/ altered consciousness
Fluctuation in attitude, attention, behavior, memory
Epigastric/Abd sensations
Complete Partial Seizures:
Heralding sign?
Ictal phase?
Postictal phase?
P pre-seizure aura
Sudden arrest of behavior/motionless stare,
Automatisms (chewing, smacking, outbursts, runnning)
Confusion, amnesia
Generalized Seizures located where?
Bilat from both hemi simultaneously
Absence Seizure is?
Onset?
Duration?
Presentation?
Sudden LOC w/o loss of postural control
Childhood
Seconds
Subtle, bilat automatisms
No post confusion
Tonic-Clonic Seizure presentation:
Tonic? (3)
Clonic? (3)
Post? (4)
Sudden LOC, falls down
Tonic:
10-40 sec
Rigid, eyes roll back, moan/cry
Cyanosis, ↑ BP/HR/Pupils
Clonic:
30 sec - 3 min
Jerking, frothing
Lose bowel/bladder
Post: Min - hrs Confused/sleepy HA Amnesia
Status Epilepticus is?
EMERGENCY
Continuous or multiples w/o regaining consciousness
Status Epilepticus can lead to?
Card/Resp dysf
Metabolic dysf
Hyperthermia
Brain damage if > 2 hrs
Generalized Myoclonic Seizure is?
C seen with? (3)
Sudden, brief generalized mm contraction of limbs/trunk
Metabolic dis
Degenerative CNS dz
Anoxic brain injury
Atonic Seizure is?
Presentation?
a/w?
Sudden loss of postural tone
1-2 sec
Brief LOC impairment
Brief head drop/nod
No post confusion
Other forms of epilepsy
Hx should include what questions about the seizure? (6)
Actually a seizure? Local or general? Consciousness impaired? Tonic-Clonic mvmts? Sustain injury? Loss of bowel/bladder?
Physical exam should include checking what for injury? (5)
Tongue Scalp Neck Back Extremities
Seizure labs? (6)
CBC UA CMP Serum Mg Tox screen Syphillis
Seizures specialized tests? (5)
EEG = KEY DIAG TEST Cranial CT/MRI and CXR for all new Lumbar punct Cx (blood, urine, CSF) PET/SPECT if refractory
Seizure DDX? (6)
Syncope Psych dis Metabolic dis TIA Sleep dis Mvmt dis
Acute treatment of seizures: Immediate?
ABC
Turn on side
Protect head
Acute treatment of Status Elip? (7)
If not responding?
IV loraz/diazepam IV phosphenytoin/phenytion IV 50% Glu IV Narcan IV Thiamine 100 mg STAT labs Cardiac monitoring
IV phenobarb/Midazolam
