Seizure Semiology

Question 1

Hemisphere localization:
Dystonic limb posturing

Answer 1

Contralateral (mesial temporal)

Question 2

Hemisphere localization:
Head turning

Answer 2

Ipsilateral (Early) - lateral temporal
Contralateral (late and versive / transition to generalization)

Question 3

Hemisphere localization:
Figure of 4 sign

Answer 3

Contralateral

Question 4

Hemisphere localization:
Todd’s Paralysis

Answer 4

Contralateral

Question 5

Hemisphere localization:
Focal clonic activity

Answer 5

Contralateral (lateral temporal)

Question 6

Hemisphere localization:
Unilateral eye blinking

Answer 6

Ipsilateral

Question 7

Hemisphere localization:
Unilateral limb motor automatisms

Answer 7

Ipsilateral (temporal)

Question 8

Postictal Nose wiping

Answer 8

Ipsilateral (temporal)

Question 9

Localization clues:
Preservation of Ictal speech

Answer 9

Nondominant temporal lobe

Question 10

Localization Clues:
Ictal speech arrest

Answer 10

Dominant temporal lobe

Question 11

Localization Clues:
Postictal aphasia

Answer 11

Dominant Hemisphere

Question 12

Localization Clues:
Ictal vomiting

Answer 12

Right temporal lobe

Question 13

Localization Clues:
Hypermotor (3)

Answer 13

Frontal lobe (less commonly insular or temporal)

Question 14

Localization Clues:
Ictal urinary urge

Answer 14

Right temporal lobe

Question 15

Localization Clues:
Limb Paresthesia

Answer 15

Contralateral parietal lobe

Question 16

Localization Clues:
Simple visual Hallucination

Answer 16

Contralateral occipital lobe

Question 17

Localization Clues:
Complex visual hallucination

Answer 17

Contralateral temporo-occipital lobe

Question 18

Features associated with supplementary motor seizures

Answer 18

• prominent tonic posturing (usually of contralateral upper extremity)
• Contraversive head and eye deviation
• Preservation of consciousness

Question 19

Orbitofrontal versus anterior cingulate seizures
Features common to both (5)
Unique to Anterior cingulate (2)
Unique to Orbitofrontal (3)

Answer 19

Common to both:
- Hypermotor motor movements
- Elaborate Gestures
- Autonomic Features
- Fear
- Chepeau de Gendarme
Unique to AC
- Sudden mood changes
- Tonic / Dystonic Posturing
Unique to OF
- Olfactory sensations
- Hallucinations
- Prominent facial expression

Question 20

Features associated with Dorsolateral frontal seizures (4)

Answer 20

• Unilateral clonic activity of face, spreading to arm / leg
• Preserved Consciousness
• Forced head turning (contralateral)
• Aphasia (if dominant)

Question 21

Features associated wit parietal lobe seizures
- Generic (4)
- Less Generic, but potentially confused with others (2)
- Unique (2)

Answer 21

Generic:
- Tonic posturing / clonic activity (contralateral)
- Todd’s Paralysis (contralateral)
- Head deviation
- Postictal aphasia (if dominant)
Less Generic, but potentially confused w/ others
- Oral automatisms
- Complex gestural automatisms
Unique
- painful / thermal sensation
- sexual / groin paresthesia

Question 22

Features associated with occipital lobe seizures (3)

Answer 22

Elementary visual hallucinations:
- flashing or steady spots, simple geometric forms
- Repeated eye blinking
- tonic eye / head deviation (IL or CL)

Question 23

Features associated with Insular epilepsy (4)

Answer 23

• Laryngeal discomfort / constriction
• thoracoabdominal constriction or dyspnea
• hypersalivation
• unpleasant parasthesias or warmth in perioral region

Question 24

Helpful treatment for olfactory seizures

Answer 24

Selective amygdalectomy

Question 25

Clinical differences between:
- “normal” myoclonia during typical absence seizure
- Epilepsy with myoclonic absences (2)
- Eyelid myoclonia with absence seizure (3)

Answer 25

Eye blinking in typical absence:
- mild eye blinking or mouth movements
EMA
- severe, repetitive myoclonic jerks of shoulders, arms, and legs
- with concomitant tonic contraction
EEM
- prominent jerking of eyelids, often associated with upward devation of eyeballs and retropulsion of the head
- FOLLOWED by mild impairment of consciuosness
- can be photosensitive or triggered by eye closure in brightly lit room

Question 26

Head turning in frontal lobe seizures, significance of:
early head/eye turning
late head/eye turning

Answer 26

• Early head turning, no consistently laterlizing
• late head turning: consistent to contralateral side

Question 27

In frontal lobe seizures, early asymmetric tonic posturing suggests:

Answer 27

contralateral hemisphere