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Year 4 - Neuro And Special Senses > Neuro - Acute management and theory of epilepsy > Flashcards

Neuro - Acute management and theory of epilepsy Flashcards

1
Q

Management of epilepsy: outline the algorithm for seizure management

A
  • A-E assessment + test glucose
  • IV lorazepam 4mg (wait 5-10 mins)
  • IV lorazepam 4mg (wait 5-10 or until patient is in established status epilepticus)
  • Phenytoin infusion 20mg/kg at a max rate of 50mg/min + call ITU when decision is made to use phenytoin
  • Anaesthetists arrive and perform rapid sequence induction with thiopental

*If IV access not possible: 10mg IM midazolam or 4mg Rectal diazepam

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2
Q

What is the definition of status epilepticus?

A

> 5 mins of continuous seizure or 2+ seizures without full recovery within 30 minutes

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3
Q

Outline some important tasks you should be performing whilst managing a patient in status epilepticus

A
  • Find and read notes
  • Ask nursing staff lorazepam + phenytoin (takes a while to prepare)
  • A-E assessment
  • Cannula + bloods (U+E, LFT, FBC, CRP, cultures, glucose, clotting screens anti-epileptic medication levels (if known epileptic) + toxicology screen (urine)
  • ABG (look at blood glucose)
  • Assign someone to keep time
  • Administer O2
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4
Q

What tasks should you perform post seizure? Should you offer neuro-imaging?

A
  • Give pabrinex (if relevant) + IV fluids
  • Chase blood results
  • Attempt Hx + collateral
  • CT head, blood cultures, blood alcohol level

Neuroimaging is not routinely done for idiopathic generalised epilepsy (people are allowed 1 seizure) - indications for imaging:

  • Onset of epilepsy as adults
  • Evidence of focal onset
  • Seizure continuing despite 1st line tx (lorazepam)
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5
Q

What is the definition of a seizure?

A

-Paroxysmal, synchronous and excessive discharge of neurones in the cerebral cortex manifesting as a stereotyped disturbance in consciousness, behaviour, emotion, motor function or sensation. It is if sudden onset, last secs-mins, usually ceases spontaneously and may recur.

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6
Q

What is the difference between epilepsy and acute symptomatic seizures?

A
  • Epilepsy: condition where there is a propensity to have recurrent and unprovoked seizures
  • Seizures occurring solely in association with precipitants (fever in kids, metabolic disturbance, alcohol/drug abuse, acute head injury) are treated differently.
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7
Q

Name some risk factors for seizures

A
  • > 50% have no cause found
  • Childhood and adolescence (idiopathic)
  • HTN: 50-70ya
  • Vascular changes, alcohol abuse, tumours, head injury
  • +ve FHx
  • Withdrawal of AEPs
  • Infectious causes: encephalitis, meningitis
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8
Q

What are focal seizures?

A
  • Arise from localised areas of cerebral cortex

- 60% arise from temporal lobes, rest mainly from frontal lobes

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9
Q

What are the features of a temporal lobe seizure?

A
  • Aura: epigastric sensation, olfactory/gustatory hallucination, autonomic sx (change in BP/pulse), affective sx (fear) and deja vu
  • Seizure: motor arrest, absence, automatisms (lip smacking, fidgeting, chewing)
  • Lasts 1-2 mins
  • Post-ictal confusion is common
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10
Q

What are the features of a frontal lobe seizure?

A
  • Aura: abrupt onset with variable aura (indescribable), forced thinking, ideation always or emotional manifestations
  • Seizure: vocalisations/shrill cry, violent/sexual/bizarre automatisms, cycling of legs
  • Very brief seizure eg 30s
  • Post-ictal confusion is brief with rapid recovery
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11
Q

What are the features of a parietal lobe seizure?

A
  • Somatosensory symptoms common:paraesthesia, numbness, prickling, vertigo, distortions of space
  • Automatism and secondary generalisation may occur
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12
Q

What are the features of a occipital lobe seizure?

A
  • Visual hallucinations common: flashing lights, geometrical figures, complex hallucinations of objects/people
  • May get automatisms and secondary generalisation
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13
Q

What is a focal aware seizure?

A
  • Consciousness not impaired (localised discharge)
  • Typically brief with focal sx
  • Ensure to rule out structural brain lesion (stroke, tumour, abscess)
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14
Q

What is a focal seizure with impaired awareness?

A
  • Similar sx to focal aware but need impairment of consciousness (but without loss of postural control - pt remains standing)
  • Usually 2-3 mins but can be hours
  • Pt usually amnesic of event
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15
Q

What are the types of generalised seizures?

A
  • Tonic-clonic
  • Absence
  • Myoclonic
  • Atonic
  • Tonic
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16
Q

What are the features of a tonic-clonic seizure?

A
  • Usually no warning - may be preceded by increasing frequency of myoclonic jerks - LoC and pt falls to ground
  • Tonic phase: 10 sec - stiff body, flexed elbows and extended legs
  • Clonic phase: 1-2 mins of violent generalised shaking, open and rolled back eyes, tongue bitting +/- incontinence
  • Postictal confusion: v difficult to rouse, headaches, myalgia and retrograde amnesia
17
Q

What are the features of a absence seizure?

A
  • Typical onset between 4-14 ya
  • Attacks can occur several times per day, last 5-15 s - patient suddenly stares vacantly +/- eye blinking and myoclonic jerks
  • Diagnosed after complained of inattentive child - EEG shows 3per second spike and wave complexes
  • Atypical absences seizures are associated with more severe epileptic syndromes (eg Lennox-Gastaut)
18
Q

What are the features of a myoclonic seizure?

A

Abrupt, brief involuntary movements of some or all parts of the body
*Not all myoclonus is a result of epilepsy

19
Q

What are the features of a atonic and tonic seizures?

A
  • Rare, generalised seizures (drop attacks) in severe epilepsy syndromes
  • Atonic: sudden loss of postural muscles - pt falls
  • Tonic: sudden increase in muscle tone - pt becomes rigid and falls
20
Q

What is idiopathic generalised epilepsy?

A
  • Group of epileptic disorders that are believed to have a strong underlying genetic basis (often have fhx of epilepsy), typically manifests between early childhood and adolescence
  • Patients typically otherwise normal and have no structural brain abnormalities
  • Seizures: absent, myoclonus, and primary generalised tonic-Clonic
  • Risk factors: sleep deprivation and alcohol

Year 4 - Neuro And Special Senses (38 decks)

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