Functional neurology Flashcards
Do you get a warning with a primary generalised seizure
NO - go immediately with no warning
Triggers for vasovagal syncope
Hot and crowded
Skipped breakfast
Pre-syncopal symptoms of vaso vagal syncope
Nausea and malaise
Hot and clammy
Looked pale
lIGHTHEADED
Receding vision/hearing
Lasts few seconds up to 2 minutes
What does a vaso vagal syncope look like and what is recovery like
Faint - brief myoclonic jerks
Fast recovery - 10-15 mins
Recognised friends
No prolonged post ictal phase
What do you do for a patient presenting with first epileptic fit
This patient is presenting with her first seizure. You would take a full history including asking about drugs and alcohol, any childhood seizures and any family history. You would do a full neurological examination to look for any focal neurology. You would also need to take a full set of bloods to look for any cause. This would include electrolytes, glucose and lactate. You would need to ask for a 12 -lead ECG.
Who do you refer urgently for cardiovascular assessment within 24 hours if total loss of consciousness with:
An ECG abnormality (see recommendations 1.1.2.2 and 1.1.2.3).
Heart failure (history or physical signs).
TLoC during exertion.
Family history of sudden cardiac death in people aged younger than 40 years and/or an inherited cardiac condition.
New or unexplained breathlessness.
A heart murmur
Consider: >65 TLOC without prodrome
Focal seizure awareness
can have awareness or note - depends on where seizure arises
Often have prodrome before seizure - same warning repeating = sam area of brian
Non epilpetic attacks prodrome
Often awareness but cant interact with surroundings
Feel unreal or detatched or rising panic
V variable in prodrome often, longer prodrome than in epilepsy eg 5-10 minutes
How long means a seizure is unlikely epileptic
> 5 minutes
NEAs during attack
Lie still - v unusual in epilepsy
Dont have a tonic phase
very violent jerking eg hip thrusting
What features of a seizure suggest NEA
Gradual onset
Violent thrashing or side to side head movement
Resisting, eyes shut
Rapid breathing esp in run up to attack
What suggests functional vision loss
Preserved pupil reflexes and optico-kinetic nystgamus - eyes flicking when move object
What does eyes open in a seizure suggest
Eileptic - generalised tonic clonic
Where is most common tongue injury in epilepsy vs NEA
Epilepsy - lateral tongue biting
Tongue tip in NEA but har to distinguish
Post ictal phase seizure epiliptix vs non
Epileptic - prolonged post ictal phase - minutes to hours
Groggy confused not recognising location or people, may be aggressive/agitated
NEA - variable - an be fast or prolonged feeling upset/groggy
uSUALLY NOT CONFused and can recongise people
What is hoffmans sign
Involuntary flexion mvement of thumb oor index finger when examiner flicks fingernail of middle finger down
What does hoffmans sign signify
Cercival myelopahty or UMN lesions
What is collapsing weakness - initial power then gives way - a sign of
Functional weakness
What features do patients under 50 have to have for 2 ww colonsocopy
Abdo pain
Bloody stool
Triggers of ectopic heart beats
Alcohol
Caffeine
Stress
Lack of sleep
What would post exertional fatigue lasting >24 hours suggest
Chronic fatigue syndrome
What time period i given to see if opioids will be effective
2-4 weeks
If not effective in this time unlikely will be effective long term
What ype of med is diclofenac
NSAID
Contraindicated in CKD nad COPD
