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Clin Med > Neuro Seizures > Flashcards

Neuro Seizures Flashcards

1
Q

define epilepsy

A

at least two unprovoked seizures more than 24HRs apart

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2
Q

define seizure

A

paroxysmal event due to abnormal synchronous charge of CNS neruons

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3
Q

how does a seizure present?

A 
sudden, involuntary movement
OR
sudden loss of consciousness 
OR
BOTH!
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4
Q

two types of focal/partial seizures

*what differentiates them

A
  1. simple partial
  2. complex partial
    *whether PT has impaired consciousness or not
    NOT total LOC—bc that is generalized seizure
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5
Q

impaired awareness usually assoc with which general class of seiures?

A

generalized

  • tonic-clonic
  • tonic
  • clonic

NON-Motor:
-absence

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6
Q

abnormal discharge from ONE discrete section of one hemisphere?

A

focal or partial seizures

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7
Q

simultaneous discharge of both hemispheres

A

generalized

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8
Q

can focal seizures be just motor?

A

no, can be motor or non-motor
*dep which lobe is affected

non-motor: sensory things

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9
Q

can a focal seizure evolve to become a generalized seizure?

A

yes

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10
Q

what is the MC ype of seizure in adults with epilepsy?

A

focal seizures with impaired awareness—complex partial

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11
Q

What clinical characteristics defines seizures as generalized or partial?

A

Generalized seizures are assoc with COMPLETE loss of consciousness

Partial is preserve wakefulness

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12
Q

MC lobe focal seizure arise from

A

temporal

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13
Q

muscular rigidity

A

tonic

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14
Q

rhythmic jerking

A

clonic

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15
Q

MC type of seizure in elderly?

A

partial (focal) seizures

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16
Q

Todd’s paralysis

A

after having a simple partial/focal seizure.. the post-itctal phase PT may develop neurologic deficits that are focal…. such as hemiparalysis lasting minutes—hours

*resolves in 24 hours

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17
Q

some typical CM for focal seizure in general

A

focal sensory, motor OR autonomic s/s: dep on lobe affected

Motor: clonic movements or tonic movements, Jacksonion march

Sensory: paraesthesias, numbness, pain, heat, cold, sensation of movement, olfactory, flashing lights (photopsia)

Autonomic: abdominal (pain, N/V/, hunger), cardiovasc (ST), BP changes, bronchoconstriction

Psycologic: fear, dejavu, hallucinations,

Automatisms: lip smacking, facial grimacing, chewing, manual picking, patting, coordinated movements, or repeating words/phrases—–may then accompany complex partial seizure

*aruas can precede seizure

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18
Q

Jacksonian march

A

motor aspect of partial seizure.. starts in one area (focal) and then spread to other parts of affected limb or body

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19
Q

Automatisms

  • what is it
  • seen with what seizure
A

seen with partial/focal seizures (MC complex partial)

-repetitive behaviors.. ex lip smacking

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20
Q

What seizure is similar in nature to absence seizure in terms of s/s?

A

complex partial

esp with the blank stare or loss of awareness

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21
Q

how to differentiate b/w absence and complex partial seizure?

A

with complex partial—pt can have postictal state where that doesnt happen with absence!

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22
Q

is there an aura preceeding a focal/partial seizure?

A

YES!!!

*aura can be similar to actual seizure itself

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23
Q 
V
I
T
A
M
I
N
S
\+
G
A

tell us causes of seizures

Vascular–stroke, bleed, AVM
Infection–meningitis, encephlaitis, abscess
Trauma–esp penetrating
Autoimmune–CNS vasculitis
Metabolic–hypoglycemia***, hypoNA/CL/MG, hypoxia, drugs OD/withdrawl
Idiopathic–2/3 of new onset seizures!!!
Neoplasms—
Pyschiatric—-
+
G—geneic and developmental

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24
Q

MCC for 2/3 of new onset seizure

A

idiopathic

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25
Q

common drug that can decrease seizure threshold?

A

antihistamines

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26
Q

for any seizure, what lab studies do we want to order

A
  • oxygen sat
  • glucose, cbc, metabolic panel
  • pregnancy
  • Lactate level—elevated w.in 2 hours of tonic-clonic seizure
  • toxins in blood and urine
  • genetic testing (more so outpatient)
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27
Q

what diagnostic tests do we order for any seizure?

A

EKG–arrhythmias

  • neuroimaging—MRI IS SUPERIOR TO CT-NC
  • LP is suspecting men/enceph
  • EEG
28
Q

what must we do prior to LP?

A

head CT!!!!

29
Q

when would an EEG be normal?

A
  1. if PT not actively seizing (normal or abnm b/w events)

2. some focal/partial seizures

30
Q

EEG always abnormal with?

A

tonic-clonic

31
Q

can an EEG localize a seizure focus?

A

yes

32
Q

do we place things in PTs mouth when they are seizing >

A

no

33
Q

define status ep

A

single, continuous epileptic seizure lasting 5 mins or greater
OR
more than 1 seizure within a 5 min pd w/o recovery in b/w episodes

34
Q

treat seizures over ____ minutes

A

5

35
Q

TX of absence:
1st line
2nd line

A

1st—Ethosuximide (anti-epileptic)

2nd—Valporic acid or lamotrigine

36
Q

Tx with Ethosuximide for….

A

absence seizure

kids

37
Q

MC age group for absence seizure

A

childhood——4-10 yrs

*usually ceases by puberty

38
Q

drop attacks?

at risk for?

A

atonic (generalized) seizure

high risk for head injuries—PT need to wear helmets

39
Q

loss of consciousness followed by rigidity

A

tonic seizure —generalized

40
Q

sudden brief sporadic invol twitching. may be one mucle or a group of muscles
NO loss of consciousness

A

myoclonic—

41
Q

repetitive jerking movements usually lasting <2-3 mins oft assoc with postitacl state

A

clonic seizure—generalized

42
Q

what is increased in the blood after a generalized seizure?

A

prolactin and lactic acid!!!

*good to get these values to see if PT has a real seizure or pseudoseizure

43
Q

Tx for SE:
1st line
2nd line
3rd line

A

1st–IV BEnzos—— **Lorazepam (ativan) (
***midazolam IM if IV cant be established

2nd—-phenytoin or Fosphenytoin if no resp to benzos
3rd line—phenobarbital is no resp to phenytin (NOW IT IS REFRACTORY)

44
Q

MC type of seizure due to metabolic disturbance?

A

tonic-clonic

45
Q

what does EEG look like for tonic phase of seizure

A

Low voltage.. fast acitivity..

46
Q

What does EEG look like for clonic phase of seizure

A

high amplitude interrupted by spike and slow wave pattern

47
Q

EEG looks like for postictal phase

A

diffuse slowing of cerebral activity

48
Q

consciousness impaired with atonic seizure?
postictal phase?
usually associated with_____

A

yes.. about 1-2 seconds
NO postictal confusion state
Normally assoc with epilepsy syndrome

49
Q

sudden, brief loss of consciousness WITHOUT loss of postural tone

A

absence seizure

“daydreamer”

50
Q

is there postictal phase with absence?

A

NO

51
Q

what is the main seizure type in children with epilepsy?

A

absence

52
Q

EGG shows-generalized, symmetric, 3-Hz spike-and-slow-wave discharges that begins and ends suddenly, superimposed on a normal EEG background

A

absence seizure

53
Q

what seizure is assoc with structural CNS abnormalities?

A

atypical absence

*same as absence but with longer pd of LOC and +postical confusion

54
Q

EEG: shows hypsarrhythmia…

A

Epileptic spasms

*seen with infants

55
Q

EEG: diffuse, giant slow waves with a chaotic background or irregular multifocal spikes and sharp waves

A

Hypsarrhythmia—seen in infants with epileptic spasms

56
Q

seizure in a child who is age 3-6MO in the setting of a fever w/o CNS infection

A

febrile seizure

57
Q

MC illness febrile seizures are seen wiht?

A

acute respiratory illnes

58
Q

what is prognosis for febrile seizure? what is likelihod of develop into epilepsy”?

A

good prognosis

very rarely evolve

59
Q

recurrence of febrile seizure?

A

common…30-50% of cases

60
Q

Risk factors that increase likelihood of a febrile seizure to result in epilepsy

A
  • Family history of epilepsy
  • abnormal neurologic or developmental status
  • focal seizure > 15 min
61
Q

age range for febrile seizures

A

6MO-5 years

62
Q

good way to differentiate b/w syncope and seizure?

A

*brief sweating PD before syncope

63
Q

which AED is contra in pregnancy and for PT <2YO

A

Valporic acid

64
Q

What AED is good for febrile seizures and kids in general

A

Phenobarbitol

65
Q

Non-pharmacologic tx for epilepsy?

A
  1. surgery—MC is temporal lobectomy
  2. Vagus nerve stim–refractory
  3. ketogenic diet for peds
66
Q

what is a complication from AEDs?

A

osteoporosis

67
Q

Do PTs with epilepsy have incr/decr mortality?

A

2-3x higher than general public

Clin Med (52 decks)

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