Neuro - Pathology (Seizures, Heardaches, & Vertigo) Flashcards
Pg. 485-486 in First Aid 2014 Sections include: -Seizures -Differentiating headaches -Vertigo
What characterizes seizures in general?
Characterized by synchronized, high-frequency neuronal firing. Variety of forms.
What are the 2 major categories of seizures?
(1) Partial (focal) seizures (2) Generalized seizures
What are the 2 types of Partial (focal) seizures?
(1) Simple partial (2) Complex partial
What are the 5 types of Generalized seizures?
(1) Absence (2) Myoclonic (3) Tonic-clonic (4) Tonic (5) Atonic
What defines partial (focal) seizures?
Affect 1 area of the brain
Where do partial (focal) seizures most commonly originate?
Most commonly originate in the medial temporal lobe
What often precedes partial (focal) seizures? What can partial (focal) seizures secondarily do?
Often preceded by seizure aura; can secondarily generalize.
Name and distinguish between the 2 types of partial (focal) seizures.
Types: (1) Simple partial (consciousness intact) - motor, sensory, autonomic, psychic (2) Complex partial (impaired consciousness)
In which types of partial (focal) seizures is consciousness intact versus impaired?
Simple partial (consciousness intact) & Complex partial (impaired consciousness)
What characteristic defines generalized seizures?
Diffuse
Name and distinguish between the 5 types of generalized seizures.
(1) Absence (petit mal) - 3 Hz, no postictal confusion, blank stare (2) Myoclonic - quick, repetitive jerks (3) Tonic-clonic (grand mal) - alternating stiffening and movement (4) Tonic - stiffening (5) Atonic - “drop” seizures (falls to floor); commonly mistaken for fainting
What are other names for petit mal versus grand mal seizures? Under which of the 2 major categories of seizures are they? Distinguish between petit mal and grand mal seizures.
Absence (petit mal) - 3 Hz, no postictal confusion, blank stare; Tonic-clonic (grand mal) - alternating stiffening and movement; Generalized seizures
What kind of seizure is commonly mistaken for fainting? Define it. Under which of the 2 major categories of seizures is it?
Atonic - “drop” seizures (falls to floor); commonly mistaken for fainting; Generalized seizures
What is the defining characteristic of a Myoclonic seizure? Under which of the 2 major categories of seizures is it?
Myoclonic - quick, repetitive jerks; Generalized seizures
What is the defining characteristic of a Tonic seizure? Under which of the 2 major categories of seizures is it?
Tonic - stiffening; Generalized seizures
What is epilepsy? How do febrile seizures relate to epilepsy?
Epilepsy - A disorder of recurrent seizures (febrile seizures are not epilepsy)
What is the definition of Status epilepticus? In general, how is it approached clinically?
Status epilepticus - Continuous seizure for > 30 min or recurrent seizures without regaining consciousness between seizures for > 30 min. Medical emergency.
What are 5 causes of seizures in children?
(1) Genetic (2) Infection (febrile) (3) Trauma (4) Congenital (5) Metabolic
What are 4 causes of seizures in adults?
(1) Tumors (2) Trauma (3) Stroke (4) Infection
What are 5 causes of seizures in the elderly?
(1) Stroke (2) Tumor (3) Trauma (4) Metabolic (5) Infection
Define headache.
Pain due to irritation of structures such as the dura, cranial nerves, or extracranial structures
What are 3 classifications for headaches?
(1) Cluster (2) Tension (3) Migraine
Distinguish between the 3 classifications of headaches in terms of localization.
(1) Cluster - unilateral (2) Tension - bilateral (3) Migraine - unilateral
Distinguish between the 3 classifications of headaches in terms of timing/duration.
(1) Cluster - 15 min-3 hr, repetitive (2) Tension - > 30 min (typically 4-6 hr), constant (3) Migraine 4-72 hr
What are cluster headaches? What symptoms accompany them?
Repetitive brief headaches; Excruciating periorbital pain with lacrimation and rhinorrhea
What syndrome may Cluster headaches induce?
May induce Horner syndrome
In which gender are cluster headaches more common?
More common in males
What are 2 treatment options for Cluster headaches?
(1) Inhaled oxygen (2) Sumatriptan
Give the presence and absence of symptoms that characterizes tension headaches.
Steady pain. No photophobia or phonophobia. No aura.
What are 3 treatment options for tension headaches? What is an additional treatment option for chronic pain?
(1) Analgesics (2) NSAIDs (3) Acetaminophen; Amitriptyline for chronic pain
Define migraine and its associated symptoms.
Pulsating pain with nausea, photophobia, or phonophobia. May have “aura”
What causes migraine?
Due to irritation of CN V, meninges, or blood vessels (release of substance P, CGRP, vasoactive peptides)
What are the 2 treatment categories for migraine? Give at least 2 examples of specific treatments within each category.
(1) Abortive therapies (e.g., triptans, NSAIDs) (2) Prophylactic (propanolol, topiramate, calcium channel blockers, amitriptyline)
What is a mnemonic to remember characteristics regarding migraine?
POUND - Pulsatile,One-day duration, Unilateral, Nausea, Disabling
Besides cluster/tension/migraine, what are 5 other causes of headaches?
Other causes of headache include (1) Subarachnoid hemorrhage (“worst headache of my life”) (2) Meningitis, (3) Hydrocephalus, (4) Neoplasia, and (5) Arteritis
Explain how cluster headaches can be differentiated from trigeminal neuralgia.
Cluster headaches can be differentiated from trigeminal nerve based on duration. Trigeminal neuralgia produces repetitive shooting pain distribution of CN V that lasts (typically) for < 1 minute. The pain from cluster headaches lasts considerably longer (> 15 minutes).
What is Vertigo? Explain its relations to “dizziness” and “lightheadedness”
Sensation of spinning while actually stationary. Subtype of “dizziness,” but distinct from “lightheadedness”
What are the 2 types of Vertigo? Which is more common?
(1) Peripheral vertigo - More common. (2) Central vertigo
In general, what causes Peripheral vertigo? Give 3 examples of such causes.
Inner ear etiology (e.g., semicircular canal debris, vestibular nerve infection, Meniere disease)
In general, what causes Central vertigo? Give 2 examples of such causes.
Brain stem or cerebellar lesion (e.g., stroke affecting vestibular nuclei or posterior fossa tumor)
What positional testing results are associated with Peripheral vertigo?
Positional testing –> delayed horizontal nystagmus
What are 4 clinical finding associated with Central vertigo? In general, what kind of neurological findings are associated with Central vertigo?
Findings: (1) directional change of nystagmus, (2) skew deviation, (3) diplopia, (4) dysmetria… Focal neurological findings.
What positional testing results are associated with Central vertigo?
Positional testing –> immediate nystagmus in any direction; may change directions.
