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
Chronic tx of seizures? (4)
Tx cause
Avoid triggers
Antiepileptic
Neuro consult
Tx w/ Antiepileptic meds begin how?
Monitoring?
Single med, titrate
Follow blood levels
Antiepileptic meds for Focal Seizures? (3)
Carbamazepine (Tegretol)
Phenytoin (Dilantin)
Valproic Acid (Depakote)
Antiepileptic meds for General Tonic-Clonic Seizures? (3)
Val acid
Carbam
Phenty
Antiepileptic meds for General Absence Seizures? (2)
Ethosuximide (Zarontin)
Val acid
Antiepileptic meds for General Myoclonic and Atonic Seizures? (1)
Val acid
Refractory Seizures tx?
Temporal lobectomy
Lesionectomy
Corpus callosotomy
Vagal nn stim (pacemaker)
