Meningitis and Seizures Flashcards
what is a seizure?
- a transient occurrence of signs/symptoms due to abnormal excessive or synchronous neuronal activity in the brain
- an involuntary contraction of muscles caused by abnormal electrical brain discharges
what are typical motor phenomena associated with seizure definition?
- lip smacking
- eye deviation
- automatisms
- tonic, clonic, myoclonic, or ionic clonic activity
what are symptoms usually perceived by the patient with a seizure?
- problems with perception, emotion, memory
- deja vu or jamais vu
- fear or anxiety or elation
when do seizures in children peak in incidence?
-during neonatal period and infancy
what percentage of children will have febrile seizures?
5%
these are seizures associated with fevers
what percentage of children and adolescents are diagnosed with epilepsy?
1%
what can cause seizure activity?
- CNS disorder
- structural defect
- disorder that causes CNS dysfunction (injury, infection, electrolyte disturbance, toxins, brain tumor)
- unknown etiology
what are some neurological causes of altered level of consciousness?
- infection of the brain and meninges
- increased ICP
- trauma
- hypoxia
- poisoning
- seizures
- substance abuse
- endocrine or metabolic disturbances
- electrolyte imbalances
- acid-base imbalance
- brain tumor
- stroke
what is meningitis?
-inflammation of the meninges
what causes meningitis?
bacterial or viral infection
though the source of infection can occur anywhere, where is the most common source of infections that cause meningitis?
the respiratory tract
what is more common: bacterial or viral meningitis?
viral
which is more serious bacterial or viral meningitis?
bacterial
how does the initial infection occur in neonates with meningitis?
in the birth canal and spreads hematogenously
what are sources of secondary bacterial meningitis infections?
- otitis media
- nasal sinus infection
- CNS infection after head trauma or surgery
what are the three most common sources of meningitis in children between the ages of 2 months and 12 years?
- haemophilus influenza b
- streptococcus pneumoniae
- neisseria meningitis
what are the two most common causes of meningitis in neonates?
group B strep
ecoli
what happens in the development of bacterial meningitis?
- bacteremia often spreads the infection agent to CNS
- WBCs accumulate covering the surface of the brain
- exudate covers brain and brain becomes hyperemic and edematous
- if infection spreads to ventricles CSF can become obstructed and cause increased ICP and hydrocephalus
what characterized viral (aseptic) meningitis?
- headache
- fever
- irritability
- inflammation
- no bacteria grows when culture taken from cerebrospinal fluid but may be increased blood cells and proteins
how is viral meningitis treated?
- usually it spontaneously resolves within 10 days, however symptoms may be treated
- treat headache and fever
- make sure well hydrated and getting electrolytes
- if increased ICP, run less than 100% fluid maintenance
what is Brudzinski’s sign?
- a physical symptom of meningitis
- neck stiffness causes patient’s knees and hips to flex when neck is flexed
- occurs because of meningeal irritation
what is Kernig’s sign?
- a physical symptom of meningitis
- severe stiffness of the hamstrings caused by inability to straighten leg when hip flexed 90 degrees
- occurs because of meningeal irritation
what are some symptoms of meningitis?
- fever
- lethargy
- confusion
- irritability
- bulging fontanelles
- poor feeding or sucking
- high pitched cry
- apnea
- seizures
how is bacterial meningitis diagnosed?
- lumbar puncture (expect to see WBC in cerebrospinal fluids if bacterial)
- blood work
- CT
how is bacterial meningitis treated?
- antibiotics
- corticosteroids via IV (dexamethasone)
- fluid restriction (2/3 maintenance because of increased ICP)
- NPO (need strict ins and outs)
what is encephalitis?
- inflammation of the brain
- usually referring to inflammation caused by infection or toxin
what age group has the highest incidence of encephalitis?
-children under the age of 1
what are some causes of encephalitis?
- herpes simplex virus
- enterovirus
- epstein barr
- ticks
- mosquitos
- measles
- mumps
- chickenpox
- rubella
- mononucleosis
what is the mortality rate of untreated patients with herpes encephalitis?
70%
even with treatment mortality remains at 30%
how can neonatal herpes simplex virus encephalitis be prevented?
- by performing c-section delivery if mother has vaginal herpes
- providing contact drainage
- taking secretion precautions
- third-trimester therapy for mother acyclovir 400 mg 3 times per day
what are symptoms of encephalitis?
- severe headache
- nausea/vomiting
- stiff neck
- fever
- dizziness
- ataxia
- convulsions/seizures
- sensory disturbances
- drowsiness
- coma
how can herpes encephalitis be diagnosed?
- CT scan and MRI
- EEG
- lumbar puncture, culture of CSF
- blood work
even if treated and not fatal, what is a serious outcome common in neonates who have had herpes encephalitis?
-permanent neurologic sequelae
how is encephalitis treated?
- antiviral medication
- corticosteroids
- anticonvulsants (PRN)
- antipyretics
what is epilepsy?
- at least two unprovoked seizures happening more than 24 hours apart
- one unprovoked seizure and high probability of further seizures
- seizures with no other etiology
what is a partial seizure?
- aka focal seizure
- only occurs in one part of the brain
- a specific area in one cerebral hemisphere
- can spread to generalized
what is a simple partial seizure?
- no change in LOC occurs
- person will be aware of and remember events
- can have motor, autonomic, or sensory symptoms
what can cause a simple partial seizure?
- focal damage
- tumor or lesion
- brain abscess
- AV malformation
what is a complex partial seizure?
- may begin with or without an aura
- symptoms may include altered LOC or mental status
- may have tonic clonic movement on one side of the body
- followed by a period of confusion, lethargy, and sleep
what are causes of complex, partial seizures?
- lesions
- trauma
- sclerosis
- av malformations
what is a generalized seizure?
- a seizure that affects both cerebral hemispheres from the beginning of the seizure
- result in a loss of conciousness
what are types of generalized seizures?
- generalized tonic clonic
- myoclonic
- absence
- atonic
- infantile spasms
what are types of partial seizures?
simple
complex
what is an absence seizure?
- a type of generalized seizure
- involves lapses of awareness, sometimes with staring
- begin abruptly and last only a few seconds
how are absence seizures treated?
valproic acid
when do absence seizures typically onset?
age 3-12
what is an atonic seizure?
- a generalized seizure
- causes an abrupt loss of muscle tone
- causes head drop, loss of posture, or sudden collapse
what is a myoclonic seizure?
- a type of generalized seizure
- rapid, brief contractions of bodily muscles
- usually occur on both sides of body at same time
what is a tonic clonic seizure?
-a generalized seizure
-begin with stiffening of limbs (tonic phase)
followed by jerking of the limbs and face (clonic phase)
what is used to differentiate seizures from?
-an EEG
how may seizures be treated?
- ativan
- oxygen
what are infantile spasms?
- onset by 3 months
- may occur with altered LOC
- occur in clusters of 5-150/day
- increase in intensity and duration over time
what is vigabatrin used to treat?
- infantile spasms
- usually the first line of treatment
- works in about 60% of patients
- can cause permanent vision loss
what are the mainstays of treatment for infantile spasms?
- vigabatrim
- steroids
what steroids are used to treat infantile spasms?
ACTH injections or high dose prednisone
-these have lots of side effects including irritability, weight gain, hypertension and immune suppresion
what is a ketogenic diet and what is it used to treat?
- used to treat seizures
- is a low carb, high fat diet that is carefully measured
what is a ketogenic diet and what is it used to treat?
- used to treat seizures
- used with children under the age of 8 years
- is a low carb, high fat diet that is carefully measured
- 90% fat, adequate protein, low carb
- ketosis produced by the diet is believed to produce anticonvulsant effects
how are seizures diagnosed?
- EEG
- CT of head
- MRI
- CBC
- liver function tests
- metabolic screen
- BGM
- LP
how are seizures diagnosed?
- EEG
- CT of head
- MRI
- CBC
- liver function tests
- metabolic screen
- BGM
- LP
how is a diagnosis of epilepsy made?
- based primarily on descriptions from family or videos made by parents
- based on history decide if epileptic or non-epileptic
- EEG
- further investigation to rule other things out, etc as needed
how may seizures be treated?
- medications
- ketogenic diet
- extratemporal cortical resection
- a functional hemispherectomy
what gabaergic drugs are used as anti-epileptic medications?
- phenobarbitol
- benzodiazepines
- vigabatrin
- gabapentin
what Na channel agents are used as anti-epileptic medications?
- tegretol (carbamazepine)
- dilantin
what mixed action medications are used as anti-epileptic medications?
- lamotrigine
- zonisamide
- valproic acid
- topiramate
- ethosuximide
- levetiracetam
what are some side effects of phenobarbitol?
- sedation or irritability
- hyperactivity
- ataxia
- rash
- decreased bone density
what is carbamazepine (tegretol) used to treat?
- focal onset seizures
- it is only available in oral preparation
what are side effects of carbamazepine (tegretol)
- allergic rash
- neutropenia
- interaction with macrolide antibiotics
- sedation
- ataxia
what is phenobarbitol used to treat?
- most types of seizures
- first line of medications in children under 2
- given IV or PO
- usually maintenance does of 4-6mg/kg/day
- needs to be loaded to treat status epilepticus
what is a condition phenytoin (dilantin) is used to treat in children, but only in hospital?
-for seizures
what are side effects of IV phenytoin (dilantin)?
- bradycardia
- hypotension
- skin necrosis
- gingival hypertrophy
- allergic rash
- syncope
what is a use of valproic acid in children?
- treatment of seizures
- it is a broad spectrum anticonvulsant
what are some side effects of valproic acid?
- weight gain
- alopecia
- hepatitis
- pancreatitis
- thrombocytopenia
- is a teratogen, causing harm to infants and causing birth defects
what is vigabatrin (sabril) used to treat in infants?
- infantile spasms
- may initially cause sedation
- need to monitor for peripheral vision loss
which antiepileptic drugs lower oral contraceptive efficiency?
- phenobabrbitol
- phenytoin
- carbamazepine
- oxcarbazapine
- topiramate
which antiepileptic medications have no effect on oral contraceptives?
- valproic acid
- lamotrigine
- gabapentin
what is some anticipatory guidance a nurse should give a family before discharging a child with epilepsy?
- what do look for (what does seizure look like)
- what to do if/when a seizure occurs
- medication side effects, medication teaching
- emergency plan
- may want to have child sleep in or near parents room
- where to call with questions
- dental care
- activities (driving, sports?)
what is a cyanotic breath holding spell?
- occurs between 6 and 18 months of age, may persist longer
- triggered in awake child by pain, fright, or frustration
- child will stop crying, become cyanotic, then pass out
- often associated with tonic stiffening or convulsive activity
- relationship to iron deficiency
what is a traumatic brain injury?
an injury where impact transfers energy through the skull and meninges to the brain
disrupts normal brain functioning
cerebral edema begins immediately and increases for the next 72 hours
increase in ICP and cerebral ischemia worsen injury
what are some post-concussion symptoms
- they depend on severity of concussion
- mild - tiring easily, memory loss, easily distracted, difficulty concentrating, irritability - last up to 6 weeks
- moderate - long term attention problems, issues with problem solving and processing info, behavior problems like irritability and impulsivity
- acute - brain swelling, neurologic or cognitive deficits, death
what are the three stages of a seizure?
aura - before seizure,
ictus - the seizure itself
postictal state
what happens in the postictal stage of a seizure?
after seizure. may have numbness, headache, fatigue, drowsiness, partial paralysis, confusion, agitation, loss of consciousness, loss of bowel/bladder control
what happens in the ictus stage of a seizure?
-this is the seizure itself
what happens in the aura stage of a seizure?
- may alert person a seizure is coming.
- may have unusual feelings or sensations
- nausea
- distorted emotions,
- perceived sounds/tastes/smells
when can a child who has had a concussion return to sports?
-after being cleared by a physician
