Localization skills: seizures or involuntary movements Flashcards
Contrast the SX of syncope vs. seizures.
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.
Contrast the SIGNS of syncope vs. seizures.
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.
List some common causes of seizures.
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
Simple partial seizures:
- Is there LOC?
- What types of movements are seen?
no LOC, focal neuro gain of function
i. Motor cortex= jerking, rhythmic movements
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?
i. Temporal lobe = deja vu, amnesia, dysphoric/euphoric feelings, abnormal taste/smell
ii. Parietal lobe = paresthesia, dysesthesia, numbness, vertigo
iii. Occipital lobe = visual hallucinations
How does a complex partial seizure differ from a simple partial seizure?
+ LOC, also has focal neuro GOF (like simple)
What rain region is usually affected by complex partial seizures? (+ name sx)
Medial temporal lobe (usually)
- Staring into space
- Deja vu
- Emotional changes
- Automatisms (actions w/o conscious thought or intention)
Describe generalized absense seizures, and name what you’d see on EEG.
Tx?
LOC several seconds of staring/freezing in place, post-ictal phase; pediatric.
- 3 hz spike and wave
- Ethosuximide (Zarontin)
Describe s/s of generalized tonic clonic/grand mal seizures.
- 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.
What is a postictal state?
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.
Describe a tremor.
- Tremor: spontaneous, rhythmic, oscillatory movements of the hand, limb, head, vocal cords
Describe what brings about the following types of tremors (not their associated dz’s):
- Resting tremor?
- Postural tremor?
- Kinetic tremor?
- Resting: during sitting/reclining
- Postural: during maintenance of limb positions
- Kinetic: during movements to a target
What dz is a/w:
- Resting tremor?
- Postural tremor?
- Kinetic tremor?
- Resting: Parkinson’s disease
- Postural: Essential tremor
- Kinetic: Essential tremor or cerebellar disease
Describe dystonia.
Continual, sustained, painful contractions leading to spasms, turning of limbs
What is focal vs diffuse dystonia?
Focal dystonia = localized (ie Torticollis)
Generalized dystonia = diffuse + disabling (seen in hereditary disorders)
What is choreoathetosis? (break down the 2 parts of the word)
- Chorea: purposeless, random, nonrhythmic movements.
- Athetosis: slow, writhing, continuous movements of distal limbs
What dz/brain region’s lesion are choreoathetosis a/w?
- Huntington’s dz
- Other basal ganglia lesions
Describe what myoclonus is.
Rapid shock-like lightning/ jerking movement, usually bilateral but asynchronous
What diseases (3) are a/w myoclonus?
- Toximetabolic encephalopathy
- Cruetzfeldt-Jacob Dz
- Wilson’s Dz
Describe what a tic is.
Brief, stereotyped, repetitive focal muscle contractions that are semi-purposeful like “scratching an itch” (eyeblink, sniff, facial twitch)
What disease is a/w motor tics?
Tourette’s Disorder IF accompanied by motor tics
What is asterixis?
A tremor of the hand when the wrist is extended, sometimes said to resemble a bird flapping its wings
What conditions are a/w asterixis? (if b/l?) (if u/l?)
- Hepatic/metabolic encephalopathy if bilateral.
- Structural or ischemic lesion if unilateral.
