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Neuro > Loss of Consciousness Seizures/epilepsy > Flashcards

Loss of Consciousness Seizures/epilepsy Flashcards

1
Q

First approach to the unconscious patient

A
  1. Is it safe for me to intervene
  2. How much time do I have?
    A-Airways
    B-Breathing
    C-circulation
  3. DEFG (dont ever forget glucose)
  4. Where is the problem?
    - GCS
  5. Bloods U&es, ABGs, LFTS
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2
Q

Causes

A

Faints
Fits
Funny Turns

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3
Q

Faints

A

lack of blood to the brain

vasovagal due to activation of parasympathetic nerve sstem

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4
Q

Fits

A

electrical discharge/ seizure

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5
Q

Non-epileptic events

A

(psuedo seizures)
People whos reaction to life events (metabolic, psychological, trauma) have lead to a dissociation/ episode of epileptic event with or without movement

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6
Q

What helps differentiate Blackouts ?

A
  1. Patient (before, during, after)
  2. Eye witness (before, during, after)
  3. Other questions (risk factors, other seizures)
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7
Q

Features of syncope

A

Trigger- commonly
Prodrome- always, reduced BP, RR and clammy
Onset-gradual (over minutes) Duration- 1-30 seconds Convulsion- Brief, mild twitches Incontinence- uncommon
Lateral tongue bite- very rare Colour- Very pale
Post Ictal confusion- rare

Recovery- rapid. Fall- Slump. May bite the tip of the tongue

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8
Q

Features of seizure

A
  • Trigger- rare (light, HV)
  • Prodrome – common (deja vu, foreboding, lightheaded)
  • Onset- usually sudden
  • Duration- 1-3 minutes ( the longer the more likely it will be a stroke)
  • Convulsive jerks -> tonic clonic seizures, prolonged
  • Incontinence- common
  • Lateral tongue biting- common
  • Colour change-pale, red and blue (flushed)
  • Post ictal confusion- common (disorientated in ambulance)
  • Recoveryslow
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9
Q

Defnition of Seizure

A

Sustained and synchronised electrical discharge in the brain causing signs and symptoms

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10
Q

Definition of epilepsy

A

Tendency to have recurrent unprovoked seizures >1

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11
Q

Classification of seizures

A

Focal or Generalized

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12
Q

Focal /partial seizure definition

A

Focal onset, with features referable to part of one hemisphere (motor, sensory & psychological phenomenon & loss of awareness)

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13
Q

Generalized seizure definition

A

Simultaneous onset of electrical discharge throughout cortex, with no localizing features refereable to only one hemisphere

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14
Q

Types of generalized seizures

A

Absence seizures- Brief (,10s) pauses e.g suddenly stops talking in mid-sentence then carries on where left off

Tonic-clonic seizures : limbs stiffen (tonic) then jerk (clonic). May have one without the other. Post-ictal confusion/drowsiness LOSS OF CONSCIOUSNESS

Myoclonic seizures: sudden jerk of a limb, face or trunk. Patient may be thrown suddenly to the ground.

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15
Q

Clinical approach to the first seizure

A
  1. Clinical diagnosis (get the history)
  2. Investigations
    - ECG-> cardiac cause
    - EEG (electroencephalogram)
    - MRI- Everyone
  3. Risk of recurrence
    - provoked ( 3-10%)
    - Un-provoked - 30-50%
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16
Q

Causes of epilepsy

A

2/3 are idiopathic

Structural: cortical scarring (head injury), developmental, space occupying lesion, stroke

Others: TB, sarcoidosis

Non-epileptic causes: trauma, stroke, alcohol

Metabolic disturbances: Hypoxia, liver disease, infection, drugs

17
Q

Diagnosis

A
  1. Are these really seizures? - description from eye witness and patient?
  2. What type of seizure is it?
  3. Any triggers ?
18
Q

Status epilepticus definition

A

A seizure that will carry on for five minutes or 15 minutes without response to treatment

19
Q

Treatment of status epilepticus

A
  1. Is it a seizure?
  2. Immediate management - ABC
  3. If > 5 minutes
    a. BG, Oximetry, Bloods, Clotting symstems, AED levels
    b. Inital therapy
    - IV Benzodiazepine if still over 5 minutes then repeat benzodiasepine
    - treat potential causes (IV glucose for hypoglycaemia, IV thiamine if alchol abuse)
  4. Still continues for further 5 minutes
    - IV dosing with Phenytoin or valproate
  5. Seziure still continues then
    - admitt to ITU
    - Monitor with EEG
    - Sedation with general anesthetic
20
Q

Long-term Seizure prevention treatment

A

recurrence risk after 1 seizure =
Low risk = no indication for treatment
high risk= If serious head injury or develomental problem then requirement for treatment

Reccurence after 2 seizures
= 55-60%
- once fulfilled diagnosis then treatment indicated

21
Q

Types of seizure prevention drugs

A
  1. Reduce pre-synaptic excitability
    a. Voltage-gated Na+ channel antagonist (carbamazepine, lamotrigrine)
    b. Voltage-gated K+ channel agonist (retigabine)
  2. Stops neurotransmitter release
    a. SV2A vesicle antagonist (levetiracetam)
    b. Voltage-gated Ca2+ channel antagonist (pregablin and gabapentin)
  3. GABA-ergic system agonists
    a. GABA metabolism inhibitor (valproate, vigabatrin)

b. GABA transporter antagonist (tiagabine)

  1. Reduces post-synaptic excitability
    a. GABA receptor agonist (benzodiazepines)

b. AMPA and NMDA receptor antagonist

Neuro (16 decks)

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