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NMSK Exam 2: Neuro > Seizure and Syncope > Flashcards

Seizure and Syncope Flashcards

1
Q

Name 5 paroxysmal (episodic) disorders in Neurology

A
  1. Migraine
  2. Dizziness
  3. Syncope
  4. Seizure
  5. Transient global amnesia
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2
Q

Epilespsy is generally defined as?

A

2 or more unprovoked seizures

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3
Q

What continues to be a problem worldwide for patients with epilepsy based on longstanding stigma (ppl think their possessed by demons)?

Stricter laws when compared to?

A
  1. Unemployment and underemployment of these pt’s continues to be a problem (American with Disabilities Act in 1990 helped)
  2. Driving restrictions - in most states laws are more strict for ppl who had a seizure than ppl with DUIs
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4
Q

Does a NL single EEG rule out epilepsy/seizure?

A

No: only 40% of seizures are picked up on a SINGLE EEG.

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5
Q

Which type of seizure is nearly always picked up (90%) as a positive finding on a single EEG?

A

Petit mal (with hyperventilation)

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6
Q

How many sleep-deprived EEG’s are necessary for positive findings in 85% of all types of epilepsy?

A

3 sleep-deprived EEG’s

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7
Q

If you see minor abnormalities on an EEG, does this indicate a patient will have seizures?

A

No.

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8
Q

What is the single most important piece of information alongside EEG in the diagnosis of epilepsy? (this is going to be a test Q)

A

History of the event - preferably by witnesses.

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9
Q

What is the difference between partial and generalized seizures?

A
  1. Partial seizure = activity begins on ONE side of the brain
  2. Generalized seizure = activity begins on BOTH sides of the brain.
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10
Q

What are 3 types of Partial Seizures and how does each manifest?

A
  1. Simple partial: No LOC; lasts seconds, focal motor (twitching) activity; sensory activity; NO post-ictal-state.
  2. Complex partial: LOC; lasts 1-3 minutes; non-responsive staring and preceding aura, automatisms (lip smaking, chewing, picking at clothes), POST-ICTAL state.
  3. Secondarily generalized (partial onset): lasts 1-3 minutes; symptoms that are initially associated with no LOC => LOC, bilateral tonic-clonic activity; POST-ICTAL state.
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11
Q

Describe a simple partial seizure

A
  1. No LOC
  2. Lasts seconds
  3. Focal motor (twitching) activity
  4. Focal sensory activity;
  5. NO post-ictal-state.
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12
Q

Describe a complex partial seizure

A
  1. LOC
  2. 1-3 minutes
  3. Blank staring
  4. Preceding aura
  5. Automatisms (lip smaking, chewing, picking at clothes)
  6. POST-ICTAL state
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13
Q

Describe a secondary generalized seizure (begins as a partial)

A
  1. Symptoms that start out as no LOC => LOC
  2. Bilateral tonic-clonic activity
  3. 1 - 3 minutes
  4. Post-ictal state
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14
Q

What are the 7 types of generalized seizures?

A
    1. Absence (petit mal)
    1. Tonic-clonic (grand mal)
    1. Myoclonic
    1. Tonic
    1. Clonic
    1. Atonic
    1. Clonic-tonic-clonic
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15
Q

What is the difference between a tonic and a clonic seizure?

A
  1. Tonic = Muscle stiffness, rigidity (think increased tone)
  2. Clonic = Repetitive, jerking movements
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16
Q

What is seen with an Absence (petit mal) seizure, how long does it last, how does the patient feel after?

A
  1. Blank stare, rapid blinking, chewing, clonic hand motions
  2. LOC
  3. 10 - 30 seconds
  4. NO post-ictal state
  5. *Abrupt onset and abrupt end
17
Q

What is seen with a tonic-clonic seizure, how long does it last, and how does the patient feel afterwards?

A
  1. Bilateral extension (tonic) followed by symmetrical jerking of extremities
  2. LOC
  3. Lasts 1-3 mins
  4. Post-ictal state
18
Q

What is seen with an Atonic seizure, duration, and how does patient feel after?

A
  1. -“Drop seizure”: fall to the floor; confused for fainting
    • LOC
    • Variable duration
    • Post-ictal state
19
Q

What is seen with a Myoclonic Seizure, duration, and how does patient feel after?

A
  1. Quick, repetitive, symmetrical jerksof extremities and/or torso
  2. LOC
  3. Lasts < few seconds
  4. Minimal post-ictal state
20
Q

MANY PTS WILL NOT BE AWARE OF HOW SIMPLE OR COMPLEX PORTION ; WITNESSS MAY REPORT (PT TURNED HEAD TO RIGHT, EYES DEVIATED TO RIGHT, RIGHT ARM LIFTED UP, STARTED JERKING AND WHERE DOWN ON THE GROUND STIFF AND SHAKING. THIS ICALLED ______. COMING FROM _____ side of BRAIN.

A

Version

Left

21
Q

Which drug is used to treat absence (petit mal) seizures, if this is the only type of seizure the person has experienced?

A

Ethosuxamide (absence only)

22
Q

Which combination of AED’s has been shown to be synergistic in treatment of epilepsy (especially for primary generalized seizures)?

A

Valproic acid and Lamotrigine

23
Q

What drugs can be used for partial and generalized drugs?

A
  1. Valproic acid
  2. Lamotrigine
  3. Topiramate
  4. Leviteracetam
  5. Zonisamide
  6. Perampanel
24
Q

What is Status Epilepticus?

A

Seizure >10 minutes or repeated seizures w/o recovery in between

25
Q

What is the general treatment for Status Epilepticus?

A
  1. ABC’s; establish IV
  2. Try to get hx: seizure previously, allergies to seizure meds
  3. Labs: accucheck, CBC, chemistry panel, drug levels
  4. Non-contrast CT head
  5. Give benzodiazepine (buys time), but must give a longer-lasting anti-epileptic drug (AED)
26
Q

What type of imaging should be taken with Status Epilepticus?

A

Non-contrast CT head

27
Q

Which drug should be given for initial treatment of Status Epilepticus?

What is the purpose?

A
  1. Benzodiazepine (i.e., lorazepam 2-4 mg IV)
  2. This buys time, but must give longer lasting AED
    1. ​*Fosphenytoin
    2. Phenobarbital
    3. Valproic acid
    4. Lacosamide
28
Q

What is the last resort AED to give a patient with status epilepticus?

A

Pentobarbital coma

29
Q

What are 3 general principles/considerations in the treatment of patients with epilepsy?

A
    1. Try to use monotherapy
    1. Consider drug interactions, i.e., OC’s w/ carbamazepine
    1. Consider long-term side effects, i.e., bone loss with carbamazepine or phenytoin
30
Q

All woman of child-bearing age with epilepsy should be on what?

Which drug should be avoided?

A
  1. Multivitamin + 1mg Folic acid: many of the AED’s are folate-depleting
  2. Valproic acid
31
Q

What is the drug of choice for a woman with epilepsy?

A

Newer ones are probably safer (lamotrigine, leviteraetam), BUT

Whichever drug BEST controls her seizures (no one size fits all)

32
Q

What are common associated signs with Syncope?

A
    • Slow onset
    • Pallor
    • Sweating
    • Lightheadedness
    • Positionally related
    • Abnormal head sensation
    • Brief unconsciousness
33
Q

What are 4 common signs/symptoms seen with a seizure that are distinct from syncope?

A
  1. Urinary or bowel incontinence
  2. Tongue injury
  3. Tonic/clonic movements
  4. Post-ictal state
34
Q

What is Transient Global Amnesia?

Typical patient presentation and how long do they episodes last?

Recurrence?

A
    • Sudden, temporary, isolated episode of memory loss (amnesia); pt asks the same q over and over
  2. - No other symptoms or signs
    • Patient knows self and close family friends, but may not recognize others
    • Usually lasts a few hours, then resolves
    • Usually doesn’t recur
35
Q

MC reason for breathrough seizure in a pt who had it controlled

A

med non-compliance

NMSK Exam 2: Neuro (15 decks)

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