Neurology-Seizure

Question 1

In adults, the most common type of seizure is __ (40%), followed by generalized and simple partial seizures

Answer 1

Complex partial

Question 2

Seizure remission rates: Up to 70% of patients can achieve remission; about half of these (35%) can remain seizure-free without medication

Answer 2

Up to 70% of patients can achieve remission; about half of these (35%) can remain seizure-free without medication

Question 3

Simple partial seizure

Answer 3

Consciousness: normal

Question 4

Partial seizure classification parameters

Answer 4

Level of consciousness

Involvement: motor, sensory,

Question 5

Focal seizure that begins in motor cortex and spreads to rest of motor area; clonic movements that spread proximally (usually up a limb)

Answer 5

Jacksonian march

Question 6

Generalized seizures subtypes

Answer 6

Primary
Secondarily generalized
Absence
Myoclonic
Atonic

Question 7

Broad spectrum anti-seizure drugs (useful for both focal onset and bilateral)

Answer 7

Brivaracetam 
Clobazam 
Felbamate
Lamotrigine
Levetiracetam
Perampanel  
Rufinamide
Topiramate
Valproate
Zonisamide

Question 8

Drugs used primarily for focal-onset seizures (including focal evolving to bilateral convulsive seizures

Answer 8

Carbamazepine
Eslicarbazepine
Ezogabine
Gabapentin
Lacosamide
Oxcarbazepine
Phenobarbital
Phenytoin
Pregabalin  
Tiagabine
Vigabatrin

Question 9

Narrow spectrum anti-seizure drug for absence seizures

Answer 9

Ethosuximide

Question 10

Rx: myoclonic seizure

Answer 10

valproate

Question 11

Rx: partial complex seizure

Answer 11

carbamazepine

Question 12

Rx: generalized seizures (DOCs)

Answer 12

Phenytoin
Carbamazepine
Levetiracetam
Valproate
Phenobarbital

Question 13

A 21-year-old college student is brought to the emergency room by her boyfriend because of unusual behavior. Over the previous 3 days, she has been complaining of headache and has been intermittently confused. On one occasion she reported an unusual smell in the room. She is febrile on admission with an unremarkable general examination. On neurologic examination, she is not oriented to date and has difficulty with short-term recall. At one point she appears to stare into space, and does not respond to voice. Head computed tomography (CT) scan is unremarkable. Electroencephalography (EEG) reveals left temporal lobe slowing with frequent focal spikes. The most important intervention would be

Administration of intravenous phenytoin
Administration of intravenous lorazepam
Administration of ampicillin and ceftriaxone
Administration of acyclovir
Administration of amphotericin

Answer 13

Administration of acyclovir
The clinical picture (headache, fever, unusual smells, confusion) suggests herpes simplex encephalitis in this young woman.
. Herpes affects the medial temporal and frontal lobes, causing temporal lobe epilepsy and memory impairment

Question 14

A 55-year-old diabetic man presents with 2 days of severe right supraorbital pain. Examination reveals complete right ptosis and a 5-mm fixed pupil, with inability to move the eye vertically or inward. Outward movement is spared. The left eye is normal, as is the rest of the examination. The most likely diagnosis is

Diabetic third nerve palsy
Anterior communicating artery aneurysm
Posterior communicating artery aneurysm
Small brainstem stroke
Impending cerebral herniation

Answer 14

Posterior communicating aneurysms (one of the most common locations for aneurysms of the circle of Willis) can present with headache and third nerve palsy. In a diabetic third nerve palsy, there is usually sparing of pupillary reaction.

Question 15

In a diabetic third nerve palsy, there is usually sparing of: .

Answer 15

pupillary reaction

Question 16

An 87-year-old man with long-standing dementia presents with a sudden loss of consciousness and a fall. In the emergency room, he is lethargic with an obvious right hemiparesis. A head computed tomography scan reveals a large left frontal lobar hematoma. He has no previous history of hypertension, but did have a prior intracerebral hemorrhage in a different location 8 months earlier, from which he recovered. The most likely diagnosis is

1. Intracerebral hemorrhage from amyloid angiopathy
2. Intracerebral hemorrhage from rupture of an arteriovenous malformation (AVM)
3. Intraparenchymal rupture of a cerebral aneurysm of the circle of Willis
4. Frontal lobe contusion
5. Intracerebral hemorrhage from metastatic tumor

Answer 16

Amyloid angiopathy is a condition associated with older age and particularly with Alzheimer disease. Amyloid deposition in the cerebral vessels leads to fragmentation and weakening of the vessel walls, resulting in lobar hemorrhages, which are often recurrent. AVMs and aneurysms are more common causes of intracranial hemorrhage in younger patients.

Metastatic tumor can cause multiple lobar hemorrhages, but it is unlikely a patient would recover from such a hemorrhage because the tumor would likely continue to grow.