Neural Tube Defects

Question 1

anencephaly

Answer 1

occurs when the cranial end of the neural tube fails to close
- absence of cerebral cortex

Question 2

spina bifida occulta

Answer 2

bony defect only

Question 3

meningocele

Answer 3

only meninges herniate

- no neural tissue

Question 4

myelomeningocele

Answer 4

spinal cord and meninges herniate

- nerve damage and paralysis

Question 5

myeloschisis

Answer 5

cleft spinal cord resulting from failure of the neural folds to close normally in the formation of the neural tube

Question 6

what is characteristic of macrocephaly

Answer 6

sundowning sign of eyes

Question 7

who commonly gets seizures?

Answer 7

extremes of age

Question 8

pathophysiology of seizures

Answer 8

imbalance between inhibitory and excitatory neurotransmitters resulting in abnormal brain activity in the brain

Question 9

epilsepy

Answer 9

recurrent seizures due to a genetically determined or idiopathic/cryptogenic cause

Question 10

when are seizures not epilepsy

Answer 10

when they are provoked

Question 11

convulsion

Answer 11

refers to the spasmodic (tonic) and/or jerky, contract-relax (clonic) movement associated with some seizures

Question 12

aura

Answer 12

neurological symptoms that might occur directly before a seizure

Question 13

prodrome

Answer 13

can occur hours to a few days prior to the seizure

Question 14

postictal phase

Answer 14

time period immediatly after a seizure; patient may be drowsy, confused, usually has no memory of the event

Question 15

status epilepticus

Answer 15

refers to a continuous seizure or serial seizures without return to conciousness between seizures

Question 16

tonic phase

Answer 16

state of muscle contraction with excessive muscle tone

Question 17

clonic phase

Answer 17

state of alternating contraction and relaxation

Question 18

diagnosis of seizures

Answer 18

EEG is very important (only 23% of people have abdmoralities on first EEG)

Question 19

generalized seizures

Answer 19

both hemispheres, complete LOC

Question 20

partial (focal) serizures

Answer 20

occur in one hemisphere but can become generalized secondarily
no or complete loss of conciusness

Question 21

types of partial seizures

Answer 21

simple (NO LOC)

complex (altered state of conciousness)

Question 22

absence seizures

Answer 22

• generalized seizures
• LOC
• vacant, unresponsive stare for a short period of time (30 seconds)

Question 23

tonic seizures

Answer 23

• generalized seizures

- generalized muscle contraction

Question 24

clonic seizures

Answer 24

• generalized

- cycles of regularly repeating contraction and relaxation typically of 2-3 per second

Question 25

myoclonic seizures

Answer 25

- generalized | - extremely brief muscle contraction experienced as an electric shock

Question 26

atonic

Answer 26

- generalized | - loss of muscle tone

Question 27

simple partial seizures

Answer 27

-NO LOC -sensory and perceptual manifestations (epigastric rising)

Question 28

complex partial seizures

Answer 28

- altered consciousness | - repetitive semi-perposeful movements=motor automatisms

Question 29

manifestations of partial seizures

Answer 29

- jacksonian march | - sensory/autonomic/psychiatric

Question 30

pseudoseizures

Answer 30

- common in young females - can be interrupted by sensory stimuli - falls but extends arms - keeps eyes closed tightly - avoid painful stimuli or cover face

Question 31

psychotropics

Answer 31

bubroprion

Question 32

opioids

Answer 32

meperidine | propoxyphene (davron)

Question 33

antimicrobials

Answer 33

antimalarials

Question 34

chemo

Answer 34

MTX | chlorambucil

Question 35

anesthetics

Answer 35

ketamine | lidocaine

Question 36

who gets febrile seizures

Answer 36

children 6-36 months peak at 18 months boys

Question 37

what kind of seizure is a febrile seizure

Answer 37

70-75% simple type (complicated)

Question 38

characteristics of a complex febrile seizure

Answer 38

- focal - lasts longer than 10 min - can have long postictal phase - likely to recur within 24 hours

Question 39

RF for febrile seizures

Answer 39

height of the temperature

Question 40

risk of recurrence of febrile seizures

Answer 40

- 30-40% will have a recurrence (less than 10 % will have 3 or more) - lower temperature at the time of the first seizure - shorter interval between the onset of the fever and the initial seizure - first febrile seizure that is complex

Question 41

are antipyretic meds effective prophylactic tx?

Answer 41

NO

Question 42

what child has a 24% risk of having another seizure within the next year and a 45% risk over the next 4 years?

Answer 42

child who is neurologically normal, no prior neruo illness and has an unprovoked seizure

Question 43

most common cause of seizures in adults

Answer 43

alcohol withdrawl

Question 44

when should neuro imagine be done after an adult seizure?

Answer 44

- to exclude structural brain abnormality if first seizure clearly not provoked - CT preferred

Question 45

who gets anticonvulsant drug therapy?

Answer 45

reserved for patients who are at increased risk of recurrant seizures

Question 46

valproic acid (depakote)

Answer 46

first line for all except absence (2nd line)

Question 47

phenytoin (Dilantin)

Answer 47

first for all but absence

Question 48

phenobarbital (luminal)

Answer 48

first line for all but absence

Question 49

topiramate (topamax)

Answer 49

first line for all but absence

Question 50

ethosuximide (zarontin)

Answer 50

first line for absence

Question 51

iamotrigine (lamictal)

Answer 51

first line for partial

Question 52

oxycarbazepine (trileptal)

Answer 52

first line for partial

Question 53

carbamazepine (tegretol)

Answer 53

first line for partial complex and tonic-clonic

Question 54

what is the goal for seizure drug therapy?

Answer 54

single drug therapy

Question 55

status epilepticus

Answer 55

-single unremitting seizure with a duration longer than 5-10 min or frequent stacking of seizures without recovery in the middle

Question 56

treatment of status epilepticus

Answer 56

valium (also available in rectal gel)