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SBM neurology > Quiz 2 epilepsy > Flashcards

Quiz 2 epilepsy Flashcards

1
Q

most susceptible areas of the brain to epileptic activity

A

frontal (particularly limbic) and temporal lobes

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2
Q

in a generalized seizure, the trigger is outside the cortex in the……

A

reticular formation or thalamus

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3
Q

general seizure presentation

A
  • initial tonic rigidity with extensors overpowering flexors
  • stop breathing, air expelled through closed glottis
  • clonic phase - contraction relaxation
  • postictal phase - relaxation
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4
Q

autonomic overflow can occur during seizure causing

A

emptying of bladder and to a lesser extent bowels

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5
Q

vitals during ictal phase of generalized seizure

A
  • pupils dilated

- HR and pulse elevated

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6
Q

what is seen on the EEG during the clonic phase?

A
  • spike-wave
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7
Q

what do the spikes and waves represent in spike-wave EEG?

A
  • spike - massive depolarization and muscle contraction

- wave - relaxation and massive neuronal inhibition

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8
Q

how can we distinguish between a primary generalized seizure and one coming from a focal seizure?

A
  • when coming from focal seizure, there can be an aura or unusual motor events before seizure
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9
Q

discuss progression of juvenile myoclonic epilepsy (JME)

A
  • starts in childhood with absence seizures
  • late childhood/adolescence - involuntary jerking in the morning
  • eventually has generalized seizure which leads to diagnosis
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10
Q

underlying cause of JME

A
  • genetic mutations that affect ion channels

- at least six variations

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11
Q

a generalized seizure is also known as a

A

grand mal seizure

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12
Q

treatment of JME

A
  • respond well to specific anticonvulsants
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13
Q

examples of metabolic grand mal seizures

A
  • ionic
  • sedative withdrawal
  • hypoglycemia
  • hypoxia
  • hyperthermia
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14
Q

when do absence seizures occur?

A

mostly childhood

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15
Q

an absence seizure is also known as a

A

petit mal seizure

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16
Q

absence seizure presentation

A
  • blank staring
  • does not remember
  • may be eyelid fluttering or chewing movements
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17
Q

petit mal diagnosis markers

A
  • spike wave of 3 per second

- can almost always be brought on by hyperventilation

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18
Q

when focal seizure involves sensory cortex it usually presents as…

A
  • positive symptom (presence of sensation)
19
Q

hallmark of “complex partial seizures”

A
  • more complicated emotions, feelings or perceptions

- clouding of consciousness

20
Q

what is Todd Paralysis?

A
  • focal paralysis due to post-ictal depression of function in area affected by seizure
  • can be difficult to distinguish from a stroke
21
Q

explain characteristics of focal seizure in motor area

A
  • contralateral clonic jerks
  • if it spreads, jerks spread to adjacent areas
  • jacksonian march
22
Q

presentation if focal seizure in somatosensory cortex

A
  • contralateral paresthesia

- can also “march”

23
Q

what is on the differential for simple partial seizure of the somatosensory cortex?

A
  • TIA

- migraine transient dysfunction

24
Q

giveaways of TIA over simple partial seizure

A
  • old age
  • artery stenosis
  • no “march”
  • history of cardiovascular disease
25
Q

giveaways for migraine over simple partial seizure

A
  • followed by unilateral headache (but headache CAN come after seizure on rare occasions)
26
Q

“march” of migraine vs simple partial seizure

A
  • migraine - minutes

- seizure - seconds

27
Q

presentation of auditory-vestibular partial seizure

A
  • tinnitus (hallucination of sound)

- vertigo

28
Q

auditory-vestibular seizure can be mistake for…. if no convulsion occurs

A
  • inner ear disease (Meniere syndrome)
29
Q

audiometric tests in AV-seizure

A
  • normal in seizure

- abnormal in Meniere syndrome

30
Q

presentation of visual partial seizure

A
  • hallucination in contralateral visual field
31
Q

foci in primary vs association visual cortexes

A

primary - unformed flashes

association - more formed shapes, people talking etc.

32
Q

where do complex partial seizures start?

A
  • frontal or temporal lobes

- to a lesser extent parietal association

33
Q

explain possible presentation of seizure isolated to limbic system

A
  • leaves reticular formation and neocortex intact so can carry out complex activities and not remember them
34
Q

the behavior of unremembered complex activities associated with limbic complex partial seizure is more often explained by

A

ischemia
trauma
migraine

35
Q

most common cause of status epilepticus

A

withdrawal of medication

36
Q

what is the mechanism of danger with status epilepticus?

A
  • hyperthermia from muscle contraction causes irreversible damage to neurons
  • hypoxia from inadequate ventilation
  • severe lactic acidosis
  • death ultimately results from overtaxation of cardiorespiratory reserve
37
Q

focal counterpart to status epilepticus

A

epilepsia partialis continua

  • not as life threatening
  • can generalize to status epilepticus
38
Q

most common causes of epilepsia partialis continua

A
  • neoplasm

- ischemia/infarction

39
Q

treatment of seizures from underlying systemic metabolic disorders

A

treat underlying condition

40
Q

qualities of an ideal anti-convulsant

A
  • decreases abnormal excitability
  • minimal sedating effect
  • minimal other deleterious effects
41
Q

emergent treatment of status epilepticus

A
  • intravenous benzos

- phenytoin, phenobarbital

42
Q

percent of epileptic patients who see results with medication

A

80%
50% with negligible symptoms
30% complete resolution of symptoms

43
Q

preferred imagine technique for looking for tumors that are epileptic foci

A

MRI, with and without contrast, due to bone obfuscation in CTs

SBM neurology (22 decks)

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