Neurology - blackout and fits

Question 1

What about a blackout would make you think it is epilepsy or a non-epileptic attack?

Answer 1

Epilepsy - lateral tongue bites, symmetrical jerking with extended arms, open eyes, slow and confusion post-ictal
NEA - tip of tongue bites, assymetrical jerking, closed eyes, fast recovery

Question 2

Name 3 causes of status epilepticus

Answer 2

Epilepsy - non-adherence or more severe disease

NEA - alcohol, brain infections, hypoglycaemia

Question 3

What is the pathway to treat status epilepticus?

Answer 3

Benzodiazepine - wait 10 mins - benzo again - 10 min - 2nd line antiepileptic - ICU and anaesthesia

Question 4

Name some benzodiazepines

Answer 4

lorazepam, diazepam, midazolam, chlordiazepam

Question 5

Name some 2nd line antiepileptic

Answer 5

carbamazepine, phenytoin, lamotrigine, valporate, phenobarbitol

Question 6

What are 3 timings for diagnosing tonic-clonic status epilepticus?

Answer 6

Time seizure starts
time seizure is beyond the point of being self-limting - 5 min, digagnose
Time damage occurs - 30 mins

Question 7

What is status epilepticus?

Answer 7

30 minutes of seizures or 2 successive seizures without regaining consiousness

Question 8

How would you treat status epilepticus?

Answer 8

benzodiazepium within 30 minutes or IV lorazepam and pheytoin infusion

Question 9

How long does jerking last in each of the causes of blackout and think of other determining factors

Answer 9

syncope - a few secs, quick recovery, triggers to it, pale
epilepsy - < 2 minutes, lateral tongue bites, red/cyanosis, slow recovery
NEA - 10-15 mins, multiple, quick recovery, eye closed, tired after

Question 10

What are the 3 main causes of transient loss of consciousness?

Answer 10

syncope
epilepsy
psycogenic non-epileptic attack

Question 11

What are the 3 main causes of transient loss of consciousness?

Answer 11

syncope
epilepsy
psycogenic non-epileptic attack

Question 12

What would you do in a blackout workup?

Answer 12

ECG, urinalysis, glucose, FBC, U&E, LFT, CRP, CT, MRI

Question 13

What would you suspect if someone presented with blackout and focal signs?

Answer 13

stroke, space occupying lesion, injury, meningitis, encephalitis, subarachnoid haem

Question 14

What is syncope?

Answer 14

transient global cerebral hypoperfusion to 1/2 normal blood flow which results in loss of postural tone and consiousness

Question 15

What are the three types of syncope?

Answer 15

Cardiac
Postural/orthostatic - vasovagal, autonomic failure (e.g. DM, PD, D&V)
Reflex - micturition, defacation, swallowing/coughing

Question 16

What is epilepsy?

Answer 16

paroxysmal event involving hypersyndronus uncoordinated neuronal discharge in brain resulting in abnormal movements, sensations or cognition

Question 17

What is a psychogenic non-epileptic attack?

Answer 17

physiollogicala manifestation or psychlogical stress

Question 18

What are some causes of loss of consiousness without focal seizures?

Answer 18

TOMES
toxins, organ failure, metabolic, endocrine, seizures
Metabolic - COATPEGS: CO2, O2, ammonia, temperature, pH, electrolytes, glucose, serum osmolality

Question 19

How would you treat partial seizures?

Answer 19

Carbamazepine - 70% effective

Question 20

What would you see in a frontal-temporal parital seizure?

Answer 20

deja vu, confusion, difficulty speaking and understanding speech
abnormalities on MRI on fronto-temporal dominant lobe

Question 21

What are the 3 Ps of syncope?

Answer 21

posture, provocation, prodrome

Question 22

What is first line treatment in focal seizures?

Answer 22

carbamezpine, lamotrigine

Question 23

What is first line treatment in tonic clonic seizures?

Answer 23

sodium valporate

Question 24

What is first line treatment in absence seizures?

Answer 24

sodium valporate, ethosuximide

Question 25

What is the safest antiepileptic for pregnant women?

Answer 25

levetiracetam