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Epilepsy Board Study > Secondary Epilepsies > Flashcards

Secondary Epilepsies Flashcards

1
Q

VGKC Complex

A

Symptoms = personality or behavioral changes, myoclonus, neuropathy, and hyponatremia.

Associated: SCLC, thymoma

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2
Q

NMDA Receptor

A

Psychosis, extrapyramidal d/o, choreoathetosis, dysautonomia

Associated: Ovarian teratoma

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3
Q

GAD

A

Stiff person syndrome, ataxia, brainstem encephalitis, parkinsonism, and diabetes (T1DM)

Asosciated: Thymoma, Breast adenocarcinoma

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4
Q

Ma1, Ma2

A

Brainstem encephalitis

Associated: testicular

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5
Q

ANNA-1 (Hu)

A

Brainstem encephalitis, autonomic or sensory neuropathy

Associated: SCLC

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6
Q

CRMP-5

A

Dementia, personality change, chorea, ataxia, and neuropathy

SCLC Thymoma

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7
Q

Amphiphysin

A

Dementia myelopathy, and neuropathy

Associated: SCLC breast adenocarcinoma

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8
Q

If Antibody target is GABAreceptor, symptoms would be:

A

Encephalopathy
Associated with Cancer
SCLC, thymoma

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9
Q

If antibody target ANNA -2 (Ri), symptoms would be

A

Brainstem encephalitis, cerebellar ataxia,

Associated cancers SCLC, breast, gynecological

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10
Q

If antibody target AMPA, symptoms would be

A

Psychiatric
Associated cancer
Multiple solid cancers

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11
Q

Epileptogenic tumors:

A

DNETs > gangliogliomas > low grade astrocytomas

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12
Q

Cortical Malformations (MCD)

A

-Hemimeg
-Lissencephaly
-Double cortex syndrome/subcortical band heterotopia
-Polymicrogyria
Perisylvian polymicrogyria sydnrome
Schizencephaly
Porencephalic cyst
-Periventricular nodular heterotopia

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13
Q

Periventricular Lesions between TSC vs PVNH

A 
Subependymal Nodules (TSC)
Smaller
Less in number
Heterogeneous
Calcified
WM hyperintensity on MRI
PVNH
Larger
More in number, often bilateral
Homgenous 
Not calcified
Gray matter intensity on MRI
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14
Q

Focal Cortical Dysplasia

Neuroimaging findings

A

Typical MRI findings: None or blurred gray-white junction, thickened cortex, transmantle sign (T2 hyperintensity extending radially from ventricle to cortex)
May found on functional imaging (PET, interictal SPECT)

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15
Q

Focal Cortical Dysplasia (FCDs)

Severity classficiation

A

Classified pathological severity

  • Mild - microdysgenesis
  • Type I - intermediate, may not be seen on MRI
  • Type II - most severe type, balloon cells IIb on pathology
  • Type III - dual pathology (FCD + other lesions)
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16
Q

Post traumatic seizure

A

Single late unprovoked post-traumatic seizures is nearly synonymous with epilepsy
Seizure recurrence after single late was 86% within two years.

Therefore: one late seizure is necessary to diagnose epilepsy after trauma and should consider AED

17
Q

PNES

Diagnosis tool

A

video EEG gold standard for post-traumatic seizure-like events

18
Q

Posttraumatic Seizure prophylaxis

A

Strongest evidence for prevention of early seizures in adults, data is insufficient

Tx phenytoin after severe head injury x 1 week, treatment does not reduce mortality, disability or late seizures.

19
Q

Head trauma classification

A

Mild: <30 min LOC, no structural brain injury
Moderate: 30min-24hr LOC, skull fx w/ contusion, ICH
Severe: >24hr, brain contusion, ICH, dural penetration

20
Q

Seizure presenting as stroke:

Percentages

A

80% neonates
30% children
rare adults

21
Q

Epilepsy-risk after pediatric stroke

A

Up to 40% in pediatric stroke

<5% in adults

22
Q

Post stroke seizures

A 
Early = within first week
Late = after 1st week

Risk of further seizures after single late seizure >50% –> AED strongly considered

23
Q

Predictors of post stroke epilepsy

A

Cortical location
Presence of hemorrage
Stroke severity (exam and NIHSS)

24
Q

EEG findings in stroke

A

Focal slowing or generalized slowing

LPDs- rare, may predict early seizures, but not necessarily later epilepsy

25
Q

Mesial temporal sclerosis

A

One of the most common causes of adult onset epilepsy
Also found ~14% without epilepsy

Semiology: abdominal auras (nausea, pressure, butterflies, epigastric rising), fear, unpleasant taste or smell, oroalimentary or ipsilateral automatisms, and autonomic phenomena

26
Q

MTS Findings:
EEG
MRI

A

Ictal EEG: anterior temporal rhythmic theta or alpha actvitiy >5Hz within 30 seconds of seizure onset

MRI - hippocampal atrophy*** on T1, hippocampal hyperintesnsity on T2,

PET: temporal hypometabolism

27
Q

Histopathology of MTS

A

Neuronal loss and gliosis in CA1, CA3, CA4 hippocampal regions with relative sparing of CA2

28
Q

Predictors of good surgical outcomes in MTS

A 
Later age at onset
Shorter duration of epilepsy
Presence of febrile seizures
Positive MRI (or PET w/ neg MRI)
Unilateral findings on PET
Concordant data - matching localization of semiology, EEG, functional imaging, anatomical imaging)
Lack of need for intracranial monitoring
29
Q

Chance of seizure freedom after resection in MTS

A

60-70%

30
Q

Surgical options with MTS

A

selective amygdalohippocampectomy
Tailored temporal lobectomy (sparing eloquet function)
Hippocampal laser ablation
Standard anterior temporal lobectomy

31
Q

Tumors are more epileptogenic

General features

A

Adult onset
Lower grade `
Cortical tumors
Tumors closer to sensitive networks - hippocampus, motor cortex (*parietal tumors)

32
Q

Less likely to cause tumors

A

High grade, fast growing tumors (ex GBM, primary CNS lymphoma)

33
Q

Risk of having recurrent/refractory seizures from tumor

A

If seizures is the initall presenting symptoms of tumor increases risk of refractory seizures and recurrent seizures

34
Q

AAN recommendations for AED prophylaxis

A

Strongly AGAINST AED ppx in tumors without hx of seizures

-Can by used peri- or post-operatively x 1 week

35
Q

Vascular malformations associated with epilepsy

A

AVMs
Cavernous malformations
(Developmental venous anomalies usually incidental findings are not epileptogenic)

36
Q

Mechanism of epilepsy in vascular malformations

A

Surrounding hemorrhage, gliosis, encephalomalacia are the epileptogenic tissues

37
Q

Surgical management goals for vascular malformations

A
  1. Seizure freedom
  2. Hemorrage prevention

ECOG better outcomes especially in temporal cavernous malformation.

38
Q

AVM

A

Direct connection between arteries and veins without capillaries in between
MRI: = small collection of signal void

39
Q

Cavernous Malformations

aka cavernous angiomas or cavernomas

A

small bundles of brittle vascular endothelium (not true blood vessels) that lead to recurrent bleeding
MRI = heterogeneous, with core mixed signal intensity surrounded by T2 or GRE hypointense rim

Epilepsy Board Study (8 decks)

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