Neurology-Seizure Flashcards
In adults, the most common type of seizure is __ (40%), followed by generalized and simple partial seizures
Complex partial
Seizure remission rates: Up to 70% of patients can achieve remission; about half of these (35%) can remain seizure-free without medication
Up to 70% of patients can achieve remission; about half of these (35%) can remain seizure-free without medication
Simple partial seizure
Consciousness: normal
Partial seizure classification parameters
Level of consciousness
Involvement: motor, sensory,
Focal seizure that begins in motor cortex and spreads to rest of motor area; clonic movements that spread proximally (usually up a limb)
Jacksonian march
Generalized seizures subtypes
Primary Secondarily generalized Absence Myoclonic Atonic
Broad spectrum anti-seizure drugs (useful for both focal onset and bilateral)
Brivaracetam Clobazam Felbamate Lamotrigine Levetiracetam Perampanel Rufinamide Topiramate Valproate Zonisamide
Drugs used primarily for focal-onset seizures (including focal evolving to bilateral convulsive seizures
Carbamazepine Eslicarbazepine Ezogabine Gabapentin Lacosamide Oxcarbazepine Phenobarbital Phenytoin Pregabalin Tiagabine Vigabatrin
Narrow spectrum anti-seizure drug for absence seizures
Ethosuximide
Rx: myoclonic seizure
valproate
Rx: partial complex seizure
carbamazepine
Rx: generalized seizures (DOCs)
Phenytoin Carbamazepine Levetiracetam Valproate Phenobarbital
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
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
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
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.
In a diabetic third nerve palsy, there is usually sparing of: .
pupillary reaction
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
- Intracerebral hemorrhage from amyloid angiopathy
- Intracerebral hemorrhage from rupture of an arteriovenous malformation (AVM)
- Intraparenchymal rupture of a cerebral aneurysm of the circle of Willis
- Frontal lobe contusion
- Intracerebral hemorrhage from metastatic tumor
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.
