module 7

Question 1

seizure definition

Answer 1

A seizure is abnormal, paroxysmal electrical activity of the brain that is time-limited and results in changes in behaviors with or without abnormal motor activity.1,3,5 It results from a shift in the normal balance of excitation and inhibition within the CNS

Question 2

Focal sezuires

Answer 2

begin in one part of the brain and how they present depends on which part of the brain is affected. They may manifest as:
 uncontrolled movement or stiffening of one part of the body
 unusual sensations or experiences such as déjà vu or ‘auras’
 sensations in the stomach such as ‘butterflies’ or nausea

Question 3

2. Generalised-these seizures

Answer 3

involve electrical activity more widespread over the brain. They may be brief or prolonged.

Question 4

Types of generalised sezuires:

Answer 4

Absence seizures
Myoclonic
Atonic
Tonic
Tonic-clonic

Question 5

 Absence seizures

Answer 5

– non convulsive. The child’s awareness is briefly impaired. They may stare vacantly and their eyes may roll upwards or their eyelids may flutter.

Question 6

 Myoclonic seizures

Answer 6

shock-like jerks of a muscle or a group of muscles, usually lasting for a split second

Question 7

Atonic seizures

Answer 7

sudden loss of or decrease in normal muscle tone and the person often falls to the ground

Question 8

Tonic seizures

Answer 8

greatly increase normal muscle tone and the body, arms, or legs stiffen

Question 9

Tonic- clonic-

Answer 9

During a tonic-clonic seizure a person loses consciousness, their body stiffens (tonic phase). Their limbs then begin to jerk rhythmically (clonic phase). The person may produce excess saliva, may change color, or lose control of their bladder and/or bowel as the body relaxes

Question 10

Status Epilepticus

Answer 10

Generally it is defined as a continuous seizure that exceeds 30 minutes or seizure activity, either consistent or intermittent, without return to baseline mental status / level of consciousness.

Question 11

First line agents for seizure management -

Answer 11

benzodiazepines are widely used to stop seizures. They work by binding to GABA (gamma- aminobutyric acid) receptors in the central nervous system, which in turn hyperpolarises the neuronal membrane – making it more difficult for the neuron to be activated
- midazolam, diazepam, clonazpam

Question 12

Second line agents for seizure management

Answer 12

Phenytoin:
 Phenobarbitone:
 Levetircetam (Keppra)

Question 13

compensatory mechanisms for ICP

Answer 13

 Displacement of cerebrospinal fluid (CSF) - from the cranial cavity into the subarachnoid space around the spinal cord.
 Blood volume displacement - compression of the cerebral venous system displaces venous blood flow from the cranial cavity into the systemic circulation.
 Brain volume displacement - represents decompression and has limited benefits with some ability to compensate in the circumstances of slow growing masses (e.g. tumours, subdural bleeds).

Question 14

high PaCO2 will cause

Answer 14

dilation of the cerebral vessels resulting in increased cerebral blood volume.

Question 15

low PaCO2 will result in

Answer 15

constriction of vessels and produce decrease blood flow and volume.

Question 16

Meningitis is defined as

Answer 16

Inflammation of the covering of the brain and spinal cord (meninges)

Question 17

Meningitis can be classified under the following main categories:

Answer 17

 Bacterial – caused by pus forming bacteria

 Viral – caused by viral pathogens

Question 18

bacterial meningitis

Answer 18

 meningococcal,
 pneumococci group b
 streptococci

Question 19

Viral meningitis

Answer 19

 Enteroviruses
 Coxsackieviruses
 Mumps
 Adenovirus

Question 20

Kerning sign:

Answer 20

 Positive sign – with the hip and knee flexed at 90oC pain is experienced when the attempting to extend the leg.
 pain caused by inflammation of the meninges and spinal roots causes spams of the hamstring when the knee straightened

Question 21

Brudzinski sign:

Answer 21

 is measured positive if the patients hips and knees flex automatically when their neck is flexed
 this is due to the traction being placed on the meninges when flexed.

Question 22

Guillain-Barre syndrome (GBS)

Answer 22

is an acute autoimmune peripheral neuropathy that causes demyelination predominantly in the motor nerves

Question 23

Transverse Myelitis

Answer 23

also presents following a viral infection, which features fevers and lethargy. There is some debate over the pathogenesis of the disease though it appears either to be due to an autoimmune response, direct viral invasion of the spinal cord or an autoimmune vasculitis.