Localization skills: seizures or involuntary movements

Question 1

Contrast the SX of syncope vs. seizures.

Answer 1

Syncope sx: prodrome of dimming vision, tachycardia, diaphoresis, and lightheadedness. Much less amnesia and quicker return to baseline mental status.

Seizure sx: prodrome may be nausea or dizziness, w/anterograde amnesia of events leading up. +/- urinary incontinence, post-ictal confusion/lethargy/irritation.

Question 2

Contrast the SIGNS of syncope vs. seizures.

Answer 2

Syncope: hypovolemic state–check BP for orthostatic hypotension. Cardiac auscultation can provide info about carotid stenosis, aortic regurg, etc.

Seizure: tongue bite mark, rapid RR, bowel/bladder incontinence. Can have elevated WBC.

Question 3

List some common causes of seizures.

Answer 3

i. Cortical lesions (Infarcts, Hemorrhages, Infection, Trauma, Neoplastic)
ii. Recreational drugs (esp cocaine)
iii. Medication/alcohol withdrawal
iv. Febrile seizure
v. Primary epilepsy
vi. Electrolyte disturbances/rapid lowering of Na or glucose

Question 4

Simple partial seizures:

• Is there LOC?
• What types of movements are seen?

Answer 4

no LOC, focal neuro gain of function

i. Motor cortex= jerking, rhythmic movements

Question 5

What sx if simple partial seizure affects temporal lobe?

What sx if simple partial seizure affects parietal lobe?

What sx if simple partial seizure affects occipital lobe?

Answer 5

i. Temporal lobe = deja vu, amnesia, dysphoric/euphoric feelings, abnormal taste/smell
ii. Parietal lobe = paresthesia, dysesthesia, numbness, vertigo
iii. Occipital lobe = visual hallucinations

Question 6

How does a complex partial seizure differ from a simple partial seizure?

Answer 6

+ LOC, also has focal neuro GOF (like simple)

Question 7

What rain region is usually affected by complex partial seizures? (+ name sx)

Answer 7

Medial temporal lobe (usually)

• Staring into space
• Deja vu
• Emotional changes
• Automatisms (actions w/o conscious thought or intention)

Question 8

Describe generalized absense seizures, and name what you’d see on EEG.
Tx?

Answer 8

LOC several seconds of staring/freezing in place, post-ictal phase; pediatric.

• 3 hz spike and wave
• Ethosuximide (Zarontin)

Question 9

Describe s/s of generalized tonic clonic/grand mal seizures.

Answer 9

• LOC, first tonic contraction forcing air out (ictal cry) and arching of back, then clonus with violent jerking, salivation/drooling, tongue biting, post-ictal phase.

Question 10

What is a postictal state?

Answer 10

The altered state of consciousness after an epileptic seizure.

• It usually lasts between 5 and 30 minutes, but sometimes longer in the case of larger or more severe seizures
• Characterized by drowsiness, confusion, nausea, hypertension, headache or migraine, and other disorienting sx.
• Often accompanied by amnesia or other memory defects.

Question 11

Describe a tremor.

Answer 11

• Tremor: spontaneous, rhythmic, oscillatory movements of the hand, limb, head, vocal cords

Question 12

Describe what brings about the following types of tremors (not their associated dz’s):

• Resting tremor?
• Postural tremor?
• Kinetic tremor?

Answer 12

• Resting: during sitting/reclining
• Postural: during maintenance of limb positions
• Kinetic: during movements to a target

Question 13

What dz is a/w:

• Resting tremor?
• Postural tremor?
• Kinetic tremor?

Answer 13

• Resting: Parkinson’s disease
• Postural: Essential tremor
• Kinetic: Essential tremor or cerebellar disease

Question 14

Describe dystonia.

Answer 14

Continual, sustained, painful contractions leading to spasms, turning of limbs

Question 15

What is focal vs diffuse dystonia?

Answer 15

Focal dystonia = localized (ie Torticollis)

Generalized dystonia = diffuse + disabling (seen in hereditary disorders)

Question 16

What is choreoathetosis? (break down the 2 parts of the word)

Answer 16

• Chorea: purposeless, random, nonrhythmic movements.

- Athetosis: slow, writhing, continuous movements of distal limbs

Question 17

What dz/brain region’s lesion are choreoathetosis a/w?

Answer 17

• Huntington’s dz

- Other basal ganglia lesions

Question 18

Describe what myoclonus is.

Answer 18

Rapid shock-like lightning/ jerking movement, usually bilateral but asynchronous

Question 19

What diseases (3) are a/w myoclonus?

Answer 19

• Toximetabolic encephalopathy
• Cruetzfeldt-Jacob Dz
• Wilson’s Dz

Question 20

Describe what a tic is.

Answer 20

Brief, stereotyped, repetitive focal muscle contractions that are semi-purposeful like “scratching an itch” (eyeblink, sniff, facial twitch)

Question 21

What disease is a/w motor tics?

Answer 21

Tourette’s Disorder IF accompanied by motor tics

Question 22

What is asterixis?

Answer 22

A tremor of the hand when the wrist is extended, sometimes said to resemble a bird flapping its wings

Question 23

What conditions are a/w asterixis? (if b/l?) (if u/l?)

Answer 23

• Hepatic/metabolic encephalopathy if bilateral.

- Structural or ischemic lesion if unilateral.