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Year 3 Paeds > Faints, fits and funny turns > Flashcards

Faints, fits and funny turns Flashcards

1
Q

What do you want to know when taking a history (9)

A
  • Frequency: how often, single event, recurrent
  • Timing- certain time if the day e.g., during sleep
  • Trigger- tiredness, travel, exercise
  • Warning beforehand- called an aura
  • Duration- how long, if it occurs in clusters, if consciousness was regained halfway through
  • Colour change- pallor, cyanosis
  • Alteration in consciousness- is it impaired
  • Recovery and any symptoms afterwards- does the child behave normally
  • Record accurately- what happened just before, during and after the event
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2
Q
  1. What is a paroxysmal event
  2. Are they epileptic or non-epileptic?
A
  1. A seizure
  2. They can be epileptic or non-epileptic
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3
Q

Are epileptic seizures provoked?

How often do they occur?

Is an acute symptomatic seizure secondary to acute insults classed as epilepsy?

A

epileptic seizures are unprovoked and recurrent

Acute symptomatic seizures secondary to acute insults are NOT epilepsy E.g., if anyone’s blood glucose drops low enough, they will have a seizure

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4
Q

What is the value of EEG?

A

Role of EEG is limited and must be used judiciously, as both false positives and false negatives occur.

EEG only answers what type of seizures not where the seizures are.

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5
Q

Name 8 general descriptions (phenotypes) of seizures

A
  1. Tonic
  2. Clonic
  3. Atonic
  4. Myoclonic
  5. Vacant
  6. Focal seizures complex
  7. Focal seizures simple
  8. Focal with secondary generalisation
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6
Q

Tonic seizure

A

a prolonged period of contraction of one or several muscle groups

Rigidity- Body straightens and stiffens.

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7
Q

Clonic seizure

A

Clonic- rhythmic contractions followed by a slower relaxation phase. (febrile seizures usually tonic-clonic).

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8
Q

Myoclonic seizure

A

brief

fast contraction followed by muscle relaxation

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9
Q

Vacant seizure

A
  • Absences-
  • characterised by arrest of activity
  • are brief and multiple
  • vacant gaze
  • with automatism such as lip smacking, eyelid flickering.
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10
Q

Focal seizure (complex)

A

UNconsciousness

affects certain part of the brain

action doesnt spread and affects discrete parts of the body (e.g., one arm repeatedly contracting)

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11
Q

Focal seizure (simple)

A
  • characterised bY consciousness
  • Affects certain parts of the brain that doesn’t spread
  • Affects discrete parts of the body (e.g., one arm repeatedly contracting)
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12
Q

Focal seizures with secondary generalisation

A

starts in one area and spreads elsewhere (treat with carbamezapine)

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13
Q

Non epileptic conditions (12) non essential bar febrile seizures

A
  • Benign neonatal sleep myoclonus
  • Benign neonatal seizures
  • Hypoglycaemia
  • Day 3 seizures
  • Parasomias
  • Syncope
  • Cyanotic breath holding spells
  • Reflex anoxic seizures (pallid syncope)
  • Sandifer syndrome with GORD
  • Hyperekplexia
  • Daydreaming
  • Febrile seizures, tics, infantile shudder, shivering due to excitement, cataplexy
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14
Q

Cyanotic breath holding spells

A

cyring convulsion and blue spells

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15
Q

Reflex anoxic seizures (pallid syncope)-

A

usually caused by an acute painful event.

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16
Q

Sandifer syndrome with GORD,apnoea and dystonic reaction

A

trying to maintain a dystonic kind of posture to alleviate the symptoms of GORD.

17
Q

Hyperekplexia

A
  • whole body stiffening in response to sudden noise
18
Q

Febrile seizures, tics, infantile shudder, shivering due to excitement, cataplexy

A

condition in which strong emotion or laughter causes a person to suffer sudden physical collapse though remaining conscious)

19
Q

Epileoptic syndromes (5)

A
  1. Infantile spasms (WEST DYNDROME)
  2. Rolandic epilepsy. Benign epilepsy with centro-temporal spikes
  3. Childhood absence epilepsy
  4. Juvenile mycoclonic epilepsy
  5. Febrile seizures/ convulsion
20
Q

Infantile spasms (West syndrome)

A
  • Usually between 4-7 months
  • Sudden jerking of the neck, trunk and limb contraction (Salam attacks)
  • Clusters pf attacks sometimes hundreds per day
21
Q
  • Rolandic epilepsy. Benign epilepsy with centro-temporal spikes
A
  • Typical age 3-12 years
  • From sleep
  • Focal onset- facial or perioral
  • Expressive aphasia or guttural sounds
  • Post-ictal drooling
  • Sensory and/ or motor
  • EEG shows centro-temporal spikes activated by sleep
22
Q
  • Childhood absence epilepsy
A
  • 2-8 years
  • More common in girls
  • Typical clinical features include:
    • Child freezes (typically <5secs)
    • Perioral or periocular flickering movements may be seen
    • Unrousable/ unresponsive during the episode
    • Rapid recovery, as if nothing has ever happened
    • Occurs tens or hundreds times a day
    • EEG shows 3Hz generalised wave form
23
Q
  • Juvenile mycoclonic epilepsy
A
  • 12-18 years onset
  • First generalised tonic-clonic seizures
  • GTC seizures often preceded by myoclonic jerks
  • EEG shows polyspike discharges
  • Awareness retained during myoclonic jerks
24
Q
  • Febrile seizures/ convulsion
A
  • Very common between 6 months- 6 years
  • Seizures that occur in a febrile illness in the absence of intracranial pathology
  • Genetic predisposition- 10% risk in first degree relatives of index case
  • Usually occur in early part of the illness when temp is rising quickly
  • 30-40% risk of recurrence
  • Risk is higher in <1 years
25
Q

Classification of febrile seizures (2)

A
  1. Simple-
    • Generalised tonic-clonic, involves both sides of the brain
    • Brief (less than 15 mins)
    • Full recovery
    • Occur only once per one illness
    • No increased risk of future development of epilepsy
  2. Complex febrile seizures
    • Prolonged >15 mins
    • Focal
    • Multiple seizures in the same illness
    • Persistent cognitive impairment (remain drowsy post-ictal)
26
Q

management of febrile seizures

A
  • Place the child on a safe flat surface, no risk of falling
  • Time- if seizure lasts more than 5 minutes then ring 999 (99% terminate before this time)

Acute management (hospital setting)

  • ABCD
  • Give oxygen
  • Note time
  • Check BM
  • Get IV access if possible- give benzodiazepine if possible (overdose can cause respiratory depression)
  • Follow APLS algorithm if possible
27
Q

infections that usually precipitate febrile seizures

A
  • Urti
  • UTI
  • chest infections

Year 3 Paeds (4 decks)

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