Loss of consciousness Flashcards
3 factors that can lower seizure threshold in those susceptible to them
- severe disease
- dehydration
- infection
Transient loss of consciousness due to a postural change is likely to be due to
vasovagal syncope
4 features of syncope
- light headedness
- nausea
- vomiting
- greying out of vision
clues to focal onset seizures (3)
- unexplained smell
- deja vu
- focal muscle jerking/twitching
first memory upon arrival for:
a) syncopal blackout
b) epileptic seizures
a) regain awareness and memory for events quickly
b) may remember nothing
4 features favouring epileptic seizures
- tongue biting
- urinary + faecal incontinece
- pain
- injuries
physical signs of syncope
- pale
- sweaty
- light headedness
- nausea
physical signs of focal onset seizure
- focal twitching
- forced head turning
- eye deviation
- blank staring
rhythmic clonic jerks following rigid tonic phase: jerking movements reduces in amplitude and frequency
generalised tonic clonic seizures
brief myoclonic jerks of low amplitude and less rhythmic
syncope
condition of recovery following
a) syncope
b) seizure
c) NEAD
a) rapid recovery
b) 15 min drowsy
c) pseudosleep = prolonged unresponsiveness
6 investigations in a seizure/LoC
- vital signs
- oxygenation
- ECG
- blood tests
- BM reading
- CT scan
Electrolyte abnormalities that can cause seizures (2)
- hyponatraemia
- hypocalcaemia
complex and simple describe what?
consciousness in a seizure
temporal lobe seizures can involve:
- memory disturbances: e.g. deja vu
- hallucinations
- automatism
- psychic phenomena
types of hallucinations in temporal lobe seizures
- olfactory
- auditory
examples of automatism
- lip smacking
- absent mindedly plucking at clothes
- repetitive mumbling
e.g. of more complex automatism
getting undressed with no or only partial awareness/recollection
causes of epilepsy
- birth history
- febrile convulsions
what is atrophy and scarring of the temporal lobe called
Mesial temporal sclerosis
what are the risk factors for children with febrile convulsions going on to develop MTS or epilepsy?
- prolonged + severe febrile convulsions
- multiple attacks
- transient hemiparesis
- atypical age for febrile convulsion
- minor pyrexia at the time of febrile convulsion
- fhx epilepsy
typical age of febrile convuslsions
18 months
syncope is …
loss of consciousness caused by a lack of cerebral blood flow
3 P’s of pre-syncopal features:
P - Positional: upright position
P - Provoking factors: pain, emotional shock, dehydration
P - Prodromal feeling: light headedness, dizzy, visual blurring, ringing in ears
physical features of NEAD? (6)
- violent shaking of arms + legs
- head shakes from side to side
- upset + cries on coming round
- pelvic thrusting
- back arching
- preserved consciousness
Epilepsy is …
a recurrent tendency to spontaneous, intermittent, abnormal electrical activity in part of the brain
examples of aura
- strange feeling in gut
- deja vu
- strange smells
- flashing lights
post ictal features of seizures
- headache
- confusion
- myalgia
- dysphasia
structural causes of epilepsy (4)
- cortical scarring
- poor cerebral developmemt
- SOL
- stroke
non epileptic causes of seizures
- trauma
- stoke
- haemorrhage
- raised ICP
- alcohol/benzo withdrawal
What is a generalized seizure and what are the types (5)
Electrical discharge throughout both sides, LoC immediately
- Absence
- Tonic-Clonic
- Myoclonic
- Atonic
- Infantile spasms
3 types of Partial seziures
- Simple
- Complex
- Partial seizure with secondary generalisation
1st and 2nd line treatment for Partial seizures
1) Lamotrigine
2) Na valporate
1st line treatment for generalised seziures
Na valporate
localising features for frontal lobe partial seizure
- head/leg movements
- posturing
- post ictal weakness
localising feature for parietal lobe partial seizure
paraesthesia
localising feature for occipital lobe partial seizure
flashers + floaters
3 features of simple partial seizures
- awareness is unimpaired
- focal symptoms
- no post ictal symptoms
what age group are absence seizures mostly seen in
features?
3-10 year olds
suddenly stops speaking mid sentence and then carried on where left off
Investigations following a generalised seizure:
- EEG
- Blood glucose
- FBC
- Electrolytes
- Toxicology screen
- CT head (if presence of neurological deficits)
- Serum prolactin
- LP (if concerns of primary CNS infection)
when should anti-epileptic medication be commenced?
Following 1 seizure if any of the following are present:
- patient has a neurological deficit
- Brain imaging: structural abnormality
- EEG findings
- Patient or family members consider the risk of having another epileptic seizure to be unacceptable
how does Na Valporate work to reduce seizure activity
increases GABA activity
Side effects of Na Valporate, as per the penumonic
V - Valporate A - apetite increase L - Lfts watch over first 6m P - Pancreatitis O - Oedema R - reversible alopecia A - Ataxia T - Teratogenecity, tremor, thrombocytopaenia E - Encephalopathy due to high ammonia
common side effects of Lamotrigine (3)
- blurred vision
- aggression
- dry mouth
severe complication of Lamotrigine
Skin rash: stevens johnson syndrome
4 side effects of carbamazepine
- drowsiness
- dizziness
- headache
- double vision
DVLA guidance regarding switching anti-epileptic medications
stop driving for 6 months due to recognised risk of breakthrough seizures
2 medications that lower seizure thresholds
- amitryptyline
- tramadol
metabolic disturbances that can lower seizure thresold
- hypoglycaemia
- hyponatraemia
medically refractory epilepsy is
seizures that have failed to come under control with at least 2 different anticonvulsant drugs
