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Cns > paroxysymal > Flashcards

paroxysymal Flashcards

1
Q

what is the presentation of tonic clonic seizure?

A

static muscle contractions (tonic) followed by intense muscle contraction punctuated by brief relaxations (clonic) for up to 1 minute
it can take 3-5 minutes to regain consciousness after this

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2
Q

what is the onset of tonic clonic seizures?

A

abrupt

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3
Q

What is the most important diagnostic if a child complains of a stiff neck, fever and headache?

A

lumbar puncture CSF to rule out meningitis

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4
Q

what defferentiates chronic pain from acute pain?

A

Pain with longer duration than the normal healing process (by 3 or 6 months)
Pain without a peripheral source or origin
serves no adaptive purpose
often refractory to treatment

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5
Q

what is the cause of chronic pain?

A

may be nociceptive or neuropathic (of peripheral origin) or both
may be idiopathic
may be from injury or malignancy

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6
Q

What is the pathogenesis of chronic pain?

A
  1. disruption of nociceptive pathways of peripheral nerve, spinal cord, brainstem or cerebrum
  2. plasticity of neuronal pathways= sprouting axons and loss of inhibitory interneurons
  3. strong psychosomatic and emotional components based on previous experience
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7
Q

what is the definition of acute pain?

A

unpleasant sensation associated and in proportion with the injury and healing process

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8
Q

how is chronic pain diagnosed?

A

neuro exam, structural exam, electrodiagnostic examination

MRI and CT to rule out other injury

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9
Q

What are some complications to think about when treating chronic pain?

A

deepening mood disorders, tolerance to treatments and addition to treatments

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10
Q

How can you classify chronic pain?

A

By body region or by process involved

  • by neuropathic is neurogenic which is caused by a lesion in the nervous system
  • central is neurogenic which is caused by a lesion in the CNS
  • cancer which pain caused by the growth of cancer
  • inflammatory which is pain related to inflammatory events
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11
Q

what are the phases of migraine?

A

prodrome, aura (only in 20% of cases), headache and resolution

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12
Q

Who is more likely to get migraines?

A

women, 18% of women.

most common pediatric headache

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13
Q

What is the etiology of migraines?

A

activated primary afferent fibers of the trigeminovascular system
NO triggers release of CGRP from trigemovasc fibers-create neurogenic inflammatory response

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14
Q

what are some risk factors for migraines?

A

hormones, chronobiologic changes, vasodialators, diet, drugs, sensory input, stress, trauma

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15
Q

What are the 2 types of partial seizures?

A

simple (Jacksonian motor or Jacksonian sensory) or complex

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16
Q

What are the characteristics of a complex partial seizure?

A

psychomotor…seen as change a in behavior

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17
Q

Where does the complex partial seizure affect in the brain?

A

temporal lobe

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18
Q

What are some examples of generalized seizures?

A 
GAMCTA
gradmall(tonic clonic)
absence
myoclonic (isolated muscle)
Clonic (repetitive contract)
Tonic (rigid)
Atonic(no tone)
infantile seizure
febrile seizure
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19
Q

what are some side effects of anticonvulsants?

A

decreased neuronal activity
sleepiness (sedation)
inability to concentrate

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20
Q

What are some common etiologies of epilepsy?

A 
vascular stroke
cerebral tumor
inborn metabolism error
CNS infection
other: genetic predisposition
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21
Q

what is the difference between a simple and complex partial seizure?

A

in a simple awareness is maintained (jerky, muscle rigidity)

complex has automatisms, repetitive involuntary not coordinated movement

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22
Q

If a patient has involuntary movements and is conscious followed by a general loss of consciousness, what type of seizure is this?

A

partial seizure with secondary generalization

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23
Q

what is the difference between a partial and generalized seizure?

A

partial only involves part of the brain. General involves the entire brain

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24
Q

What is the DOC for treating absence seizure?

A

ethonosuximide

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25
Q

what population commonly has abscence seizures?

A

peds

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26
Q

what is the presentation of a grand mal or generalized tonic clonic seizure?

A

unconscious(abscence)
repetitive muscle contract
sustained muscle contract

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27
Q

what is the presentation of a myoclonic seizure?

A

sporadic, isolated jerky movement

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28
Q

What is the presentation of a tonic seizure?

A

muscle stiffness, rigidity

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29
Q

What is the presentation of an atonic seizure?

A

loss of muscle tone

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30
Q

What is the presentation of a simple partial seizure?

A

no altered consciousness
visions, smell, taste or memory disturbance
jerking
nausea, lightheaded, vertigo
*can be jacksonian sensory or jacksonian motor

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31
Q

what are some common causes of seizures?

A

drugs, alcohol, neoplasm

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32
Q

What is status epileptics?

A

tonic clonic beginning or begin as complex partial
last less than 2 minutes each
repetitive seizures-no conscious period between
Total seizure activity> 30 minutes or 2 consecutive seizures without consciousness between

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33
Q

What is the presentation of a complex partial seizure(psychomotor)?

A

unresponsive to stimuli

automatisms, repetitive involuntary not coordinated movement

34
Q

What is the treatment for status epileptics?

A

medical emergency. Assess immediately. mortality 10-50%

35
Q

What are some complications to consider with status epilepticus?

A

cardiac: HTN, tachycardia, arrythmia
pulmonary: apnea, resp fail, hypoxia
metabolic: hyperkalemia, volume depletion, hyperglycemia followed by hypoglycemia

36
Q

What is the etiology of status epileptics?

A

non compliance with meds, change of meds, alcohol withdrawal

recent cerebrovascular event or head trauma

37
Q

what population makes up 1/2 the patients affected with status epilepticus?

A

kids

2/3 of all patients have no seizure history

38
Q

what percentage of epileptics progress to Status epileptics?

A

1%

39
Q

What is the most common cause of hypoxic ischemic encephalopathy?

A

neonatal seizures

40
Q

What is the pathophys of neonatal seizures?

A

not as many mylinated axons as adult brain so electrical activity can’t be propogated same way

41
Q

what is the presentation of neonatal seizures?

A
  1. focal twitch of muscle groups=multifocal clonic
  2. tonic seizure: rigid posturing
  3. myoclonic: focal brief jerk
  4. subtle: chew, salivate, apnea, bicycle motion
42
Q

what is the presentation of a febrile seizure?

A
  1. core temperature increases to 39 degrees or greater
  2. tonic clonic seconds to minutes
  3. postictal fatigue follows
43
Q

What is the most common seizure disorder in children(after 9m-5 years)?

A

febrile (tonic clonic presentaiton with fever)

44
Q

What is the etiology of febrile seizures?

A

strong genetic component

45
Q

what is the treatment for febrile seizures?

A

many pharm complications (have used oral diazepam before)

46
Q

What are the categories for classifying epilespy?

A

Idiopathic, crytogenic/symptomatic, mixed classification (not focal or not sure)

47
Q

What is the etiology of epilepsy?

A

genetic predisposition
congenital abnormality-inborn metab error
vascular stroke
cerebral tumor
CNS infection
(drugs, toxin, trauma, withdrawal, triggers)

48
Q

What are some triggers for epileptics?

A

fever, menstrual period, stress, flashing light, strong emotions, exercise, loud music

49
Q

What is the treatment for epilepsy?

A

carbamazepine,
valproic acid,
levetiracetam, phenytonin (toxic)
surgical resection possible

50
Q

What is the diagnostic test for epilepsy?

A

blood glucose, calcium, urea N, Na
electroencephalogram, CT Scan, MRI
-in this order look for interictal spike, interictal period, slow silent,seizure tonic, seizure clonic, postictal depression

51
Q

What is the presentation of epilepsy?

A

disorder of recurrent unprovoked seizure

52
Q

What is the pathophy of epilepsy?

A

uncontrolled neuronal firing

53
Q

What is the pregnancy protocol for epileptics?

A

1.have a planned pregnancy
2.withdrawl from meds if no seizure activity
3.monitor for breakthrough seizure
4.if necessary monotherapy with lowest dose
5.watch for change in drug metabolism-blood levels may change up to 50%
change in pharmokinetics
(most drugs are category C or D)
Magnesium sulfate is only category B

54
Q

What seizures does carbamezepine treat?

A

tonic clonic, partial simple and complex

NOT absence

55
Q

What are some types of generalized seizures?

A

grand mal (tonic clonic), absence, myoclonic, clonic, tonic, atonic

56
Q

What are some types of partial seizures?

A

Simple, complex, partial with secondary generalization

57
Q

What types of seizures does Levetriacetam treat?

A

Tonic clonic, partial simple and complex

58
Q

an afebrile neonate from normal pregnancy and birth who starts to seize intermittently is probably because of…

A

hypoglycemia

59
Q

What is the most common adult headache?

A

tension type headache

60
Q

what is the etiology of the tension type headache?

A

unknown, thought to be due to sensitization of the trigeminal pathways

61
Q

What is the best treatment for tension type headaches?

A
  1. go off any offending analgesics that can cause rebound effect
  2. give tapering dose predisone
  3. NSAIDS long acting
  4. aspirin
  5. isometheptene
  6. Butalbital
62
Q

what is the presentation of a tension type headache?

A 
episodic 30 minutes to 7 day duration
B/L
mild to moderate pain 
pressing band
no aggravation by physical activity, no nausea, no vomit

Chronic (30min-7 day duration) 5+Days per month
180days per year (for 6 months)
same symptoms

63
Q

What are some ways to prevent tension type headaches?

A 
methysergide prophylactic
B-blockers
Divalproex sodium
TCA
Trizanidine
64
Q

what is the requirement for a chronic tension type headache?

A

B/L, mild to moderate, pressing

5 days per month or 180 per year for 6 months

65
Q

what can be taken to treat partial seizuress and treat migraines?

A

topiramate

66
Q

what is the only beta blocker FDA approved for migraine prophylaxis?

A

timolol

67
Q

what are the etiology of a migraine headache?

A

NO from trigeminal blood vessels can cause primary afferent neurons to release CGRP which causes and inflammatory reponse

68
Q

what are the phases of a migraine headache?

A

prodrome
aura 10-20% of cases
headache
resolution

69
Q

what is the requirements to be considered a chronic migraine?

A

15 days per month for 3 months

70
Q

what are some options for migraine prophylaxis?

A
  1. timolol

2. antieleptics (50% of patients experience headache reduction)

71
Q

What are some treatments for migraines?

A
  1. OTC aspirin, NSAIDs (GI, renal toxicity, antiinflam action),
  2. Fioriat
  3. Ergotamine, dihydroergotamine,
  4. tritans
72
Q

What are the drugs within Fiorat?

A

Butalbital, caffeine, acetaminophen

73
Q

What are some examples of Tritans used to treat migraines?

A

sumatriptan-nasal spray available
frocatriptan (longest elimination T1/2)
rizatriptan -requires dose adjust if pt on Beta blocker

74
Q

what drug can be used after the onset of a migraine?

A

metoclopramide:

actions are to decrease nausea, increase GI motility, enhance the actions of the oral analgesic

75
Q

What type of headache can be transformed into a migraine?

A

tension type headache

76
Q

What is the presentation of a migraine?

A 
U/L 60% of time
neck pain in 75%
photophobia 90%
throbbing 85%
nausea 80%
last 4-72 hours
77
Q

A migraine lasting longer than 72 hours is known as..

A

status migranous

78
Q

what is the presentation of a cluster headache?

A 
temporal sequence at certain time of day
moderate to severe pain
U/L
infraorbital, retroorbital, temporal
stabbing, boring (pressure is constant)
    can be burning
Rapid onset 5-15 minutes
duration 30-40 minutes to 3 hours
     can have remission for 6 months to 2 years
79
Q

Autonomic symptoms can be seen in what 2 types of headache?

A

cluster and migraine

80
Q

what are some drugs that are taken to prevent cluster headaches?

A

methysergide, topiramate, verapmil, divalproex sodium, Baclofen

81
Q

What is the etiology of cluster headaches?

A

activated trigeminovascular systems then activated sphenopalatine ganglion

Cns (12 decks)

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