Seizure Flashcards
Seizure
Sudden change in behavior caused by electrical hyper synchronization of neuronal networks in the cerebral cortex
Unprovoked seizure
. Occurring in absence of precipitating factors and may be caused by static or progressive injury
Provoked seizure
. Seizures provoked by acute conditions
Acute symptomatic seizure
. In assoc. w/ transient CNS or systemic insult presumed to be an acute manifestation of the insult
Focal seizure
Originate w/in networks limited to one hemisphere
. Described according to whether or not consciousness and/or awareness are impaired
. Ictal onset consistent from one seizure to another
. Rarely does patient have more than 1 type of seizure
Generalized seizure
Initial activity is consistent w/ rapidly engaging networks distributing in bilateral cerebral hemispheres
. May begin w. Body movements, impaired consciousness, or both
. Onset of tonic-clonic seizures begins after the age of 30 suspect partial seizure that has become generalized or a provoked seizure
Aura
. Sensation perceived by a patient that precedes a condition affecting the brain
Ictal
Period during seizure
Postictal
State of consciousness following seizures
Automatism
. Unconscious movement that may resemble simple repetitive tics or may be a complex. Sequence of natural-looking movement
Epilepsy
. Chronic neurologic disorder
. 2+ unprovoked seizures separated by over 24 hrs
. One unprovoked seizure w/ underlying predisposition to seizures
. Diagnosis of an epilepsy syndrome
Provoked seizure from metabolic disturbance
. Cause: hyponatremia, hypo/hyperglycemia, hypo/hypercalcemia, uremia
. Confusion, lethargy, myoclonic jerks
Provoked seizure by drug intoxication
. CausE: cocaine, phencyclidine, methamphetmaines, ETOH
. Altered awareness, hyperactivity, incoordination
Provoked seizure from drug withdrawal
. Cause: alcohol withdrawal, Benzo withdrawal, barbiturate withdrawal, baclofen withdrawal
. Anxiety, agitation, sweating, hallucinations
Provoked seizure from medications
. Tricyclics antidepressants, clozapine,, cyclosporine
. Anything with low seizure threshold
Provoked seizure from infection
. Cause: meningitis, encephalitis
. Fever, headache, stiff neck
Provoked seizure from vasculopathy
. Cause: eclampsia, hypertensive encephalopathy
. Headache, blurred vision, edema
Febrile seizures
/ generalized, last less than 15 minutes
. Not recurring during 24 hr period
. Occur in children 6 mo-5 yrs
. Fever over 38 C
. Usually 24 hrs of febrile illness
. They are otherwise benign (recur in 1/3 children during early childhood)
. Risk of future epilepsy that is only slightly higher than general population
Causes of seizure disorder
. Genetic
. Structural: congenital or acquired through stoke or trauma
. Unknown
Jacksonian seizure
. Focal
. Tonic than clinic movements that start unilaterally in hand, foot, or face and spread to other parts of same side
. Post ictal: normal consciousness
Other motor focal seizures
. Turning head and eyes to one side
. Post ictal normal consciousness
Autonomic focal seizures
. Rare
. Funny feeling in epigastric, nausea, pallor, flushing, lightheaded
. Post ictal: normal consciousness
Subjective sensory of psychic phenomenon focal seizure
. Very rare
. Numbness, tingling, simple visual, olfactory, auditory hallucinations
. Anxiety or fear, deja vu, rage
. Post ictal: normal consciousness
Focal seizures w/ impairment of consciousness
. May start w/ autonomic or psychic symptoms
. Consciousness is impaired and patient appears confused
. Automatisms (chewing, smacking lips, walking about, unbuttoning cloths)
. Patient may recall psychic or autonomic symptoms
. Amnestic for rest of seizure
. Temporary confusion and headache may occur
Focal seizures that generalize
/ focal seizure evolving to bilateral tonic-clonic seizure
. May not recall local onset
. Recollection of aura and unilateral neurologic deficits during post-ictal period
Tonic clinic seizures
. May start w/ cry
. Body stiffs (tonic rigidity) and breathing stops
. Clonic phase: rhythmic muscular contractions
. Tongue biting and urinary incontinence
. Post-ictal: confusion, drowsiness, fatigue, headache, amenstic about seizure and aura
. May have temporary UMN signs (hyperactive reflexes)
Absence seizures
. Sudden brief lapse in consciousness,
. Blinking, or staring or movement of lips
. Post-ictal: confusion, no aura recalled
Myoclonic seizures
. Sudden brief lapse of consciousness
. Sudden brief rapid jerks involving trunk or limbs
. Post ictal: variable
Myoclonic atonic seizure
. Drop attack
. Sudden loss of consciousness w/ falling but no movements
. Post ictal: brief period of confusion
Psychogenic nonepileptic seizure
. Psuedoseizure
. Similar to epileptic seizures but do not have neurologic origin (somatic manifestation)
. Frequently are misdiagnosed and treated for epilepsy
. 5-10% of outpatient pilepsy patients and 20-40% innpatient have these
Seizure diagnostic evaluation
. Neuroimaging: CT first, MRI if needed . Labs: serum AED, CMP .lumbar puncture if suspect infection . ECG . EEG
Syncope vs seizure
. Syncope is sudden, may have prior palpitation or weakness (cardiogenic)
. Have prodrome (vasovagal lightheadedness, sweating, pallor)
. Occur soon after standing (orthostatic)
. Myoclonic jerking may occur but it is super brief
. Prompt recovery
. Non or minimal post-ictal confusion
.
Involuntary movement disorders
. Hyper kinetic: tumor, tic, chorea, athetosis, dystopia
. Hypokinetic: Parkinson’s
. Primary from basal ganglion
. Secondary from antipsychotics, dopamine receptor antagonists or postsynaptic blockade of brain dopamine D2 receptor
Basal ganglia
. Most often linked to initiation and execution of movements
. Act to facilitate desired movements and inhibit unwanted and/or competing movements
. Dopamine receptors
Tremors
. Rhythmic oscillatory movements
. Resting: most prominent at rest, dec./disappear w/ voluntary movement, Parkinsonism
. Postural: actively maintaining posture, hyperthyroidism, anxiety, essential tumor
. Intention: appears w/ movement
Tics
. Brief, repetitive, stereotyped, coordinated movements occurring at irregular intervals
. Repetitive winking, grimacing, shoulder shrugging
. May be temporarily suppressed
. Urge to perform tics
. Causes: Tourette syndrome, late effects of drugs (phenothiazines)
Chorea
. Choreiform movements are brief, rapid, jerky, irregular, and unpredictable
. Seldom repeat themselves
. Occur at rest or interrupt normal coordinated movements
. Faced head, lower arms, and hands are involved
. See in huintington’s disease
Athetosis
. Twisting and writhing than choreiform
. Commonly involves face and distal extremities
. Often assoc. w/ spasticity
. Cuases: cerebral palsy
Dystonia
. Similar to athetoid but involve larger parts of the body including trunk, grotesque, twisted postures
. Primary: primary torsion dystonia, spasmodic torticolllis
. Secondary: drugs (antipsychotics)
Facial dyskinesia
. Arrhythmic, repetitive, biz are movement that chiefly involve the face, mouth, jaw, and tongue
. Grimacing, pursing of lips, protrusions of tongue, opening and closing of mouth, and deviation of jaw
. Limbs and trunk involves less often
. Late complication of psychotropic drugs
. Occur in long standing psychoses, in some elderly individuals, or some edentulous person (tardive dyskinesia)
