Radiology Seizures

Question 1

Rasmussen’s encephalitis

Answer 1

dev from region of inflm localized to one cerebral hemisphere. due to either chronic viral infection or AI response against glutamate R. dev in children <10yo. pt suffer from simple or complex partial seizures. recurrent motor seizure termed epilepsy partials continua are common and often non-refactors to AED.
tx: glucocorticoid, IVIG, plasmapharesi to ctrl inflm. may need hemispherectomy

Question 2

seizure tx

Answer 2

20% refractory to medical. lesion –> intracranial electrode implanted + PET and SPECT to localize epileptogenic focus –> map brain of proposed resected area to prevent severe language or cog deficits –> surgical removal of temporal lobe-80% seizure free= most common surgical procedure in epilepsy.
corpus callosotomy- lesion made in CC- in pt with refractory epilepsy to prevent spreading of partial to generalized

Question 3

Wada test

Answer 3

inject sodium amobarbital- barbituate, into carotid artery to sedate single hemisphere for brain allowing for memory and language to be deterred in each hemisphere

Question 4

limbic encephalitis

Answer 4

inflm disorder of limbic system. memory loss, personality cages, psych sx, involuntary movements, seizures. acute or subacute. 2 times: infectious and AI

Question 5

infectious LE

Answer 5

viral. herpes simplex most common.

Question 6

AI LE

Answer 6

div into
1)paraneoplastic: make ab in association with tumor- most commonly lung ca-small cell tumor, thymus, breast, ovaries, testis, young female-often ovarian teratomas. most common ab is anti-Ma2, anti-amphiphysin, anti NMDA.

2) non-paraneoplastic: ab against V gated K ch. which are concentrated in hippocampus.
tx: immunosuppressive therapy + plasmapheresis and steroids. removal is often curative

Question 7

corpus callosotomy

Answer 7

lesion is made in corpus callosum to tx refractory secondarily generalized epilepsy to prevent parital seizures from spread across to pop hemisphere

Question 8

status epilepticus

Answer 8

seizure >5min without intricate return to baseline. emergency. MRI- cortical hyperintesity and diffusion restriction

Question 9

vagus nerve stimulation (VNS)

Answer 9

tx epilepsy. electrode implanted on midcervical portion of vagus N which sends intermittent electrical impulses though the N.

Question 10

seizure

Answer 10

abn excessive or synchronous neuronal activity in the brain. stereotypic.

Question 11

epilepsy

Answer 11

recurrent, unprovoked seizure due to inherent brain dysfunction. ex: metabolic derangement- hyponatremia, drug withdrawal, drug into

Question 12

epileptic personality

Answer 12

hypergraphia, hyposexuality, sticky personailty, hyper-regiiosity

Question 13

most focal epilepsies arise from

Answer 13

mesial temporal areas/ hippocampus

Question 14

causes of seizure kids

Answer 14

0-14 genetic, congenital malformation, trauma, neoplasm

Question 15

causes of seizure >60yo

Answer 15

vascular (>50%), neoplasm, trauma infection, neurodegen.

Question 16

absence seizure

Answer 16

kid stares~ daydream. no recollection. brought on by hyperventilation. EEG- 3cycle/s=3hz spike/wave pattern. if from complex partial seizure bc no post-octal state*

Question 17

juvenile myoclonic epilepsy

Answer 17

myoclonic jerks-typically upon wakening. trigger by sleep deprivation- teenager has seizure after all nighter. MRI and neuro exam are normal. EEG- 4-6hz polyspike. no not remit so need to tx: depakote= keppra = first choice

Question 18

jacksonian march

Answer 18

seizure progress up body bf generalizing

Question 19

aura

Answer 19

always a sign of a focal seizure

Question 20

primary generalized seizure

Answer 20

affect whole brain at once. lose consciousness. absence, atonic, tonic and tonic-clonic seizure.

Question 21

todd’s paralysis

Answer 21

focal neurologic deficit. usually weakness that persist for up to 24hr post seizure

Question 22

epilepsy syndrome

Answer 22

seizure classification scheme. include type of seizure, their localization, freq, seq of events, circadian distribution, precipitating factors, age at onset, mode of inheritance, physical or mental sx, signs, prog, response to tx

Question 23

landau kleffner syndrome

Answer 23

progressive aphasia in children. affect broker’s and wenches’ area. onset is seen btw 3-7yo. 80-85% kids show epileptiform activity during non-REM sleep- bilateral spike and wave discharges.

Question 24

tuberous sclerosis

Answer 24

cortical tubers, ash leaf macules (hypo pig lesions- more apparent in UV light), gerd. tx with ACTH - prevent infantile spasms associated with TS by decr CRH made which causes excess excitability.
seizures here are called infantile spasms.
infant cry in pain and bend forward at trunk.

Question 25

west syndrome

Answer 25

in infants. triad- infantile spasm, pathognomonic EEG (high amp wave and background of irreg spikes) called hypsarrhythmia, mental retardation.
tx: adrenocorticotropic hormone

Question 26

lennox-gastraut syndrome

Answer 26

2-6yo. hard to ctrl. multiple seizure types- tonic (stiffen body, upward deviation of eyes), atonic (brief loss of M tone and consciousness), atypical absence, myoclonic.

Question 27

benign rolandic epilepsy/ epilepsy with centrotemporal spikes

Answer 27

most common epilepsy syndrome in kids. characterize by nocturnal seizures. centrotemporal spikes. rarely need tx. kids have few seizures and always remit by age 16.

Question 28

gelastic seizures

Answer 28

lesion of hypothalamus cause laughing fits

Question 29

vasovagal syncope

Answer 29

recurrent epic of loss of consciousness in absence of emotional cue suggest cardiac etiology. many pt have convulsive mvt during syncope.

Question 30

non epileptic seizure

Answer 30

aka pseudoseizure. dif mvt, lasting if amounts of time. suggested by conclusion in doctor’s office or waiting room

Question 31

seizure dd

Answer 31

syncope, TIA, migraines, mvt disorder, narcolepsy/ cataplexy, pseychiatric pathology/ non-epileptic seizure (NES), malingering. EEG can dd NES v epileptic event, focal v generalized. get vEEG

Question 32

depakote SE

Answer 32

incr liver function test, pacreatitis, hirusitism, leukopenia, alopecia. wt gain- cause most discontinuation. most associated with neural tube defect in preg woman

Question 33

topiramate

Answer 33

anti seizure. CI: hx of kidney stones

Question 34

oxcarbazepine, carbamazepine

Answer 34

anti-seizure med.

SE- hyponatremia

Question 35

phenytoin

Answer 35

anti-seizure. chronic use cause atrophy of cerebellum, swollen gum, weird teeth

Question 36

lamotrigine

Answer 36

anti-seizure. associated with steven johnson syndrome- life-threatening HS reaction affecting skin and mucous membrane. rash. to decr risk, titrate slowly to therapeutic dosase

Question 37

simple febrile seizure

Answer 37

GTC that lasts for <1min and no seizure in 24hr

Question 38

complex febrile seizure

Answer 38

seizure with focal features that lasts longer than 15min or recur in 24hr

Question 39

febrile seizure

Answer 39

3% will dev epilepsy. tx if complex, <15min, focal features, structural abn on imaging. strong family hx is not RF

Question 40

SUDEP

Answer 40

sudden unexpected death in epilepsy pt. the sudden, unexpected, witness or unwitnessed, non-traumatic, non-drowning death of pt with epilepsy or w/wo evidence of seizure, excluding documented status epileptics and no structural air to cause of death. to prevent, if pt lose consciousness TC mvt, urinary incontinence and tongue biting, give lorazepam.

Question 41

status epilepticus (SE)

Answer 41

life threatening condition. seizure >5-10min or recurrent without regaining consciousness btw seizure for >30min. bento = preferred initial management bc of rapid onset of action. IV phenytoin can’t be given quickly due to risk for cardiac arrhythmia.

Question 42

epilepsia partialis continua

Answer 42

persistent focal motor seizure. usually in hand and foot

Question 43

SE chart

Answer 43

ABC (airway/ O2, IV catheter with NS, blood sampling -glu, A-B eq, electrolytes), establish dx by clinical observation –> 5- 15min (IV lorazapem) –> 15-35min (phenytoin or fosphenytoin–> 35-45min (transfer to PICU, rapid seq intubation and ventilation, pentobarbital, EEG)

Question 44

AED

Answer 44

lowest dose. 33% need >1. if fail 1, success on 2nd is 10%.

Question 45

severe head trauma

Answer 45

use of prophylactic anticonvulsant decr initial seizure rate but no impact on long term seizure rate.