Neuro - Pathology (Seizures, Heardaches, & Vertigo)

Question 1

What characterizes seizures in general?

Answer 1

Characterized by synchronized, high-frequency neuronal firing. Variety of forms.

Question 2

What are the 2 major categories of seizures?

Answer 2

(1) Partial (focal) seizures (2) Generalized seizures

Question 3

What are the 2 types of Partial (focal) seizures?

Answer 3

(1) Simple partial (2) Complex partial

Question 4

What are the 5 types of Generalized seizures?

Answer 4

(1) Absence (2) Myoclonic (3) Tonic-clonic (4) Tonic (5) Atonic

Question 5

What defines partial (focal) seizures?

Answer 5

Affect 1 area of the brain

Question 6

Where do partial (focal) seizures most commonly originate?

Answer 6

Most commonly originate in the medial temporal lobe

Question 7

What often precedes partial (focal) seizures? What can partial (focal) seizures secondarily do?

Answer 7

Often preceded by seizure aura; can secondarily generalize.

Question 8

Name and distinguish between the 2 types of partial (focal) seizures.

Answer 8

Types: (1) Simple partial (consciousness intact) - motor, sensory, autonomic, psychic (2) Complex partial (impaired consciousness)

Question 9

In which types of partial (focal) seizures is consciousness intact versus impaired?

Answer 9

Simple partial (consciousness intact) & Complex partial (impaired consciousness)

Question 10

What characteristic defines generalized seizures?

Answer 10

Diffuse

Question 11

Name and distinguish between the 5 types of generalized seizures.

Answer 11

(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

Question 12

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.

Answer 12

Absence (petit mal) - 3 Hz, no postictal confusion, blank stare; Tonic-clonic (grand mal) - alternating stiffening and movement; Generalized seizures

Question 13

What kind of seizure is commonly mistaken for fainting? Define it. Under which of the 2 major categories of seizures is it?

Answer 13

Atonic - “drop” seizures (falls to floor); commonly mistaken for fainting; Generalized seizures

Question 14

What is the defining characteristic of a Myoclonic seizure? Under which of the 2 major categories of seizures is it?

Answer 14

Myoclonic - quick, repetitive jerks; Generalized seizures

Question 15

What is the defining characteristic of a Tonic seizure? Under which of the 2 major categories of seizures is it?

Answer 15

Tonic - stiffening; Generalized seizures

Question 16

What is epilepsy? How do febrile seizures relate to epilepsy?

Answer 16

Epilepsy - A disorder of recurrent seizures (febrile seizures are not epilepsy)

Question 17

What is the definition of Status epilepticus? In general, how is it approached clinically?

Answer 17

Status epilepticus - Continuous seizure for > 30 min or recurrent seizures without regaining consciousness between seizures for > 30 min. Medical emergency.

Question 18

What are 5 causes of seizures in children?

Answer 18

(1) Genetic (2) Infection (febrile) (3) Trauma (4) Congenital (5) Metabolic

Question 19

What are 4 causes of seizures in adults?

Answer 19

(1) Tumors (2) Trauma (3) Stroke (4) Infection

Question 20

What are 5 causes of seizures in the elderly?

Answer 20

(1) Stroke (2) Tumor (3) Trauma (4) Metabolic (5) Infection

Question 21

Define headache.

Answer 21

Pain due to irritation of structures such as the dura, cranial nerves, or extracranial structures

Question 22

What are 3 classifications for headaches?

Answer 22

(1) Cluster (2) Tension (3) Migraine

Question 23

Distinguish between the 3 classifications of headaches in terms of localization.

Answer 23

(1) Cluster - unilateral (2) Tension - bilateral (3) Migraine - unilateral

Question 24

Distinguish between the 3 classifications of headaches in terms of timing/duration.

Answer 24

(1) Cluster - 15 min-3 hr, repetitive (2) Tension - > 30 min (typically 4-6 hr), constant (3) Migraine 4-72 hr

Question 25

What are cluster headaches? What symptoms accompany them?

Answer 25

Repetitive brief headaches; Excruciating periorbital pain with lacrimation and rhinorrhea

Question 26

What syndrome may Cluster headaches induce?

Answer 26

May induce Horner syndrome

Question 27

In which gender are cluster headaches more common?

Answer 27

More common in males

Question 28

What are 2 treatment options for Cluster headaches?

Answer 28

(1) Inhaled oxygen (2) Sumatriptan

Question 29

Give the presence and absence of symptoms that characterizes tension headaches.

Answer 29

Steady pain. No photophobia or phonophobia. No aura.

Question 30

What are 3 treatment options for tension headaches? What is an additional treatment option for chronic pain?

Answer 30

(1) Analgesics (2) NSAIDs (3) Acetaminophen; Amitriptyline for chronic pain

Question 31

Define migraine and its associated symptoms.

Answer 31

Pulsating pain with nausea, photophobia, or phonophobia. May have “aura”

Question 32

What causes migraine?

Answer 32

Due to irritation of CN V, meninges, or blood vessels (release of substance P, CGRP, vasoactive peptides)

Question 33

What are the 2 treatment categories for migraine? Give at least 2 examples of specific treatments within each category.

Answer 33

(1) Abortive therapies (e.g., triptans, NSAIDs) (2) Prophylactic (propanolol, topiramate, calcium channel blockers, amitriptyline)

Question 34

What is a mnemonic to remember characteristics regarding migraine?

Answer 34

POUND - Pulsatile,One-day duration, Unilateral, Nausea, Disabling

Question 35

Besides cluster/tension/migraine, what are 5 other causes of headaches?

Answer 35

Other causes of headache include (1) Subarachnoid hemorrhage (“worst headache of my life”) (2) Meningitis, (3) Hydrocephalus, (4) Neoplasia, and (5) Arteritis

Question 36

Explain how cluster headaches can be differentiated from trigeminal neuralgia.

Answer 36

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).

Question 37

What is Vertigo? Explain its relations to “dizziness” and “lightheadedness”

Answer 37

Sensation of spinning while actually stationary. Subtype of “dizziness,” but distinct from “lightheadedness”

Question 38

What are the 2 types of Vertigo? Which is more common?

Answer 38

(1) Peripheral vertigo - More common. (2) Central vertigo

Question 39

In general, what causes Peripheral vertigo? Give 3 examples of such causes.

Answer 39

Inner ear etiology (e.g., semicircular canal debris, vestibular nerve infection, Meniere disease)

Question 40

In general, what causes Central vertigo? Give 2 examples of such causes.

Answer 40

Brain stem or cerebellar lesion (e.g., stroke affecting vestibular nuclei or posterior fossa tumor)

Question 41

What positional testing results are associated with Peripheral vertigo?

Answer 41

Positional testing –> delayed horizontal nystagmus

Question 42

What are 4 clinical finding associated with Central vertigo? In general, what kind of neurological findings are associated with Central vertigo?

Answer 42

Findings: (1) directional change of nystagmus, (2) skew deviation, (3) diplopia, (4) dysmetria… Focal neurological findings.

Question 43

What positional testing results are associated with Central vertigo?

Answer 43

Positional testing –> immediate nystagmus in any direction; may change directions.