radiology/seizure Flashcards
Neuroimaging that measures neuronal glucose metabolism (2x)
PET SCAN
Pt in ED with sudden HA and collapsing, some lethargy. Exam shows rigid neck, no papilledema, no focal CN or motor signs. The initial test should be?
CT HEAD
Which is an advantage for CT head vs MRI?
DIAGNOSING ACUTE EPIDURAL HEMORRHAGE
Gadolinium contrast in MRI scans is most specifically useful for diagnosing patients with diseases affecting which of the following structures?
BLOOD BRAIN BARRIER
CT is preferable over MRI in which situation?
70 Y/O FEMALE WHO FELL AT HOME AND NOW HAS DEPRESSED LEVEL OF CONSCIOUSNESS
CT scan is better than MRI for what?
DIFFERENTIATING HEMORRHAGING FROM EDEMA
65 y/o has first generalized tonic-clonic Sz seen by spouse and they have been confused and lethargic since. Episode began w/ repetitive shaking of right arm. Blood tests unremarkable and no hx of other recent symptoms, trauma, or metabolic disorders. What study will likely reveal cause?
BRAIN MRI
What does functional MRI measure?
DETECTS BLOOD FLOW
Purpose of CT scan when patient suspected of having stroke?
EXCLUDE HEMORRHAGE
Which MRI technique most likely reveals early signs of ischemic stroke?
DIFFUSION WEIGHTED MRI
16 y/o pt brought to psychiatrist’s attn after having single grand mal sz. Pt’s parents have noted on occasion pt has sudden jerks of entire body, resulting in dropping objects. EEG: rare 4-6 HZ irregular polyspike/wave bursts. Diagnosis? (9x)
JUVENILE MYOCLONIC EPILEPSY
Fever, HA, seizures, confusion, stupor, and coma, evolving over several days. EEG with lateralized high-voltage sharp waves arising in the L temporal region w slow wave repeating at 2-3 sec intervals. CT low-density lesion in L temporal lobe. (8x)
HERPES SIMPLEX ENCEPHALITIS
8y/o has episodes of staring into space and then blinking for a few seconds. EEG will show? (7x)
3 CYCLES PER SECOND SPIKE AND WAVE ACTIVITY
40y/o has episodes of flailing of the arms and tonic postures described as “fencing.” EEG confirms seizure. Which seizure type? (4x)
FRONTAL LOBE
10 y/o child freq episodes brief lapses of consciousness without premonitory sxs. Lasts 2-10 seconds, followed by immediate and full resumption of consciousness without awareness of what has happened. These ictal episodes most likely caused by what kind szs? (4x)
ABSENCE
EEG that reveals posterior alpha and anterior beta activity is most likely to have been obtained from whom? (4x)
A RELAXED ADULT WITH EYES CLOSED
What is the diagnostic value of transient paresis or aphasia after a seizure? (3x)
LOCALIZES THE FOCUS OF SEIZURE
28 y/o female referred to psych d/t recent onset episodes of altered behavior lasting 1 to 2 minutes. Husband notes if occurs when cooking pt will place the clean silverware back in dishwasher. Also notes she does drawing movements he is unable to interrupt. Pt has no recollection of the events. MRI scan is normal. Diagnosis? (x2)
COMPLEX PARTIAL SEIZURES
1st seizure with focal onset and secondary generalization in a 58 y/o pt is likely the consequence of what? (2x)
GLIOBLASTOMA MULTIFORME
The EEG finding of 4-6 hz irregular polyspike activity in a patient with generalized seizures is characteristic of which of the following forms of epilepsy? (2x)
JUVENILE MYOCLONIC
Which of the following surgical procedures can be used in the treatment of epilepsy refractory to meds? (2x)
ELECTRICAL STIMULATION OF THE VAGUS NERVE
What EEG findings are expected in a comatose pt with hepatic encephalopathy? (2x)
TRIPHASIC WAVES
3 days s/p cardiac arrest and CPR, 73 y/o man is comatose. His eyes are open but he does not fix and follow with his eyes. Doll’s eyes elicits full horizontal eye movements. His spontaneous limb movements are symmetrical. Reflexes: mildly hyperactive. The EEG shows? (2x)
BURST SUPPRESSION PATTERN
Pt with seizure has flailing arms and tonic postures of “fencing.” What seizure type?
FRONTAL LOBE
Absence seizure EEG?
THREE CYCLE PER SECOND SPIKE-AND- WAVE
Seizures get controlled, then has paranoid delusions, what type of seizure
COMPLEX PARTIAL
Dx for pt w/ new-onset sz, multiple subQ nodules, freckling of axilla?
NF TYPE I
40 yo new-onset sz b/l thrashing movement. What suggests non-epileptic cause?
FOLLOWING COMMANDS
Which of the following best describes the characteristics of the normal adult alpha rhythm seen on an EEG recording?
INTERMITTENT AND POSTERIOR DOMINANT
EEG-biofeedback training is efficacious for what d/o?
GAD
49 y/o pt develops seizure disorder that is difficult to control. CSF shows lymphocytic pleocytosis and many RBC’s. MRI: T2 hyperintensity in the Left temporal lobe, with gadolinium enhancement in this area in T1 weighted image. EEG: periodic discharges. Dx?
HERPES SIMPLEX ENCEPHALITIS
Typical feature of epileptic activity in alcoholic pt with seizure 12h after EtOH cessation
MULTIPLE EPISODES
Distinguishing absence seizures from partial complex seizures:
LACK OF POSTICTAL MANIFESTATIONS
Which procedure confirms the diagnosis of non-epileptic seizures? Video telemetry or EEG between episodes?
EEG VIDEO TELEMETRY
Antiepileptic for juvenile myoclonic epilepsy:
VALPROIC ACID
Complex partial seizures are differentiated from simple partial seizures by:
SIMPLE SEIZURES HAVE NO LOSS OF CONSCIOUSNESS BUT HAVE ALTERED RESPONSIVENESS TO OUTSIDE STIMULI.
24 y/o pt w/ hx of epilepsy since childhood has several seizures in rapid succession. Following Szs, pt developed paranoia and hallucination, but resolved over a matter of days. Dx:
INTERICTAL PSYCHOSIS
Convulsive episode with leftward eye deviation, tonic contracture of left side. Postictally, eyes deviate to right w/ hemiparesis of left side
SEIZURE FOCUS RIGHT FRONTAL REGION
28 y/o F w/ HA, hyperventilates, asynchronous tonic-clonic sz, no LOC during Sz:
PSYCHOGENIC SEIZURE
In young pt w/ epilepsy, Tx depression w/:
PROZAC
Why is there a relatively high rate of suicide in epileptics?
COMORBID PSYCHIATRIC DISORDERS
Lack of prolactin elevation after szs suggests what kind of szs:
NON-EPILEPTIC
Drug-addicted healthcare professional experiences seizure that is not a withdrawal phenomenon. Cause?
MEPERIDINE
Complex partial epilepsy aura has what symptom?
LIP SMACKING
Head & eyes deviate to right and right arm extends immediately before a generalized tonic- clonic seizure. Seizure focus:
LEFT CEREBRAL HEMISPHERE
Gustatory special sensory seizures (auras) localize where?
INSULAR CORTEX
Pt w/ episodes of altered behavior lasting 1-2 minutes. During episodes pt makes chewing movements. Pt has no recollection. MRI is normal. Dx?
COMPLEX PARTIAL SEIZURES
32 Pt reports AH of someone not present, then stops moving, stares blankly, repetitively picks clothing, and does not respond for several minutes. Symptoms resolve after 15min but pt has no recollection of events. This represents what type of seizure?
COMPLEX PARTIAL
16 y/o pt w/ new onset tonic clonic seizures. Pt reports having jerky movements which cause him to drop objects. EEG shows polyspike pattern. Which antiepileptic medication?
VALPROIC ACID
15 y/o has hx of seizures beginning at the age of 9years, followed by prolonged motor or sensory deficits lasting days to weeks. The pattern of the seizures and the focal deficits has changed over time. The pt also has hemicranial headaches. No family hx of similar symptoms. Most likely diagnosis?
MITOCHONDRIAL ENCEPHALOMYOPATHY, LACTIC ACIDOSIS AND STROKE.
What is the medication for adequate initial treatment of absence seizures in children?
VALPROIC ACID
Gelastic seizures are a/w which brain foci?
HYPOTHALAMUS
An increase in beta frequency during an awake EEG is caused by what type of medication?
SEDATIVES
Most common EEG finding in metabolic encephalopathy? (question requires assigning diagnosis to EEG)
GENERALIZED SLOWING
15 y/o pt w/ partial complex seizures w/ secondary generalization, mental retardation, and adenoma sebaceum. Dx?
TUBEROUS SCLEROSIS
Pt w/ h/o Depression and well–controlled epilepsy responded to bupropion after failing on several antidepressants. Pt had not tried imipramine, nortriptyline, duloxetine, and selegiline. No Sz have occurred on bupropion 100mg BID. Insurance recommends changing med due to reduced sz threshold with bupropion. What is appropriate response from psychiatrist?
CONTINUE BUPROPION
54 y/o pt with gastric ulcer undergoes emergent surgery and 30 hrs post-op becomes confused, agitated and responds to internal stimuli and suffers a generalized tonic-clonic seizure: Dx:
DELIRIUM TREMENS
A child with intellectual disability is free of seizures but develops epilepsy in adolescence. Pattern of onset is often seen with?
AUTISM SPECTRUM DISORDER
Test for psychogenic tremor by:
TLL PATIENT TO TAP HAND AND SEE IF TREMOR CHANGES
Pt p/w limb-shaking episodes lasting >3min. Pt is conscious, talking, and is briefly able to suppress movements during these episodes. Which is a risk factor for poor prognosis?
INSIDIOUS ONSET OF SYMPTOMS
