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FINALS > seizures > Flashcards

seizures Flashcards

1
Q

what is syncope?

A

reflex bradycardia with or without peripheral vasodilation

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2
Q

what are pre syncope symptoms?

A

light headedness, dizziness, sweating, nausea, pallor, tachycardia

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3
Q

what can cause syncope?

A

vasovagal - can only occur when standing up

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4
Q

what can provoke vasovagal syncope?

A

emotion
fear
pain
standing too long

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5
Q

what are strokes Adams attacks?

A

transient arrhythmias causing reduced cardiac output and loss of consciousness

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6
Q

what occurs pre attack in a stroke Adams?

A

palpitations

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7
Q

what happens during an attack in stroke Adams?

A

fall to ground with LOC
pallor
slow or absent pulses

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8
Q

what is the recovery like in stroke adams?

A

within seconds

associated with flushing

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9
Q

what can cause a drop attack?

A

cataplexy - associated with narcolepsy

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10
Q

what is the attack like in a drop attack?

A

sudden weakness in legs with no warning symptoms

LOC

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11
Q

what is epilepsy?

A

recurrent tendency to spontaneous, intermittent, abnormal electrical activity in brain that manifests as convulsions or abnormal behaviour

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12
Q

what causes epilepsy?

A

too much excitation - glutamate
OR
not enough inhibition - GABA

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13
Q

how many events needs to have taken place for a diagnosis of epilepsy?

A

2

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14
Q

what can cause epilepsy?

A

idiopathic

structural abnormalities - SOL, stroke

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15
Q

what is aura? what are examples of it?

A

individualised symptoms that proceed the seizure by minutes

  • deja vu
  • flashing lights
  • funny tastes or smells
  • strange feeling in gut
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16
Q

what happens during an epilepsy seizure?

A

period when patient losses awareness and becomes unresponsive
lasts less than 5 mins
associated with tongue biting and urinary incontinence

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17
Q

what happens post ictal epilepsy seizure?

A

slow recovery that is often associated with confusion, headache, muscle ache, temporary weakness

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18
Q

what is the temporary weakness after an epileptic seizure called?

A

Todd’s palsy

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19
Q

what are focal epileptic seizures?

A

increased activity in only one hemisphere

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20
Q

what are simple focal epileptic seizures?

A

localised symptoms
no loss of awareness
no post ictal symptoms

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21
Q

what are complex focal epileptic seizures?

A

localised symptoms with
aura
LOC
post ictal symptoms

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22
Q

what are focal epileptic seizures with secondary generalisation?

A

localised symptoms that

proceed to generalised seizures

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23
Q

in focal seizures in the temporal lobe, what symptoms would you experience?

A 
dysphasia 
deja vu
flashback 
odd tastes or smells 
visual and auditory hallucinations 
lip smacking
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24
Q

in focal seizures in the frontal lobe, what symptoms would you experience?

A

posturing movements
head and leg movements
Jacksonian seizure

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25
Q

what is Jacksonian seizure? what is it associated with?

A

twitching movement of the upper limbs that spread to face and lower limbs
Todd’s palsy

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26
Q

in focal seizures in the parietal lobe, what symptoms would you experience?

A

numbness (sensory disturbance)

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27
Q

in focal seizures, in the occipital lobe, what symptoms would you experience?

A

lines and flashes (visual disturbance)

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28
Q

what are generalised seizures?

A

epileptic seizures that occur due to simultaneous abnormal activity in multiple parts of the brain

29
Q

is there LOC in generalised seizures?

A

LOC occurs immediately

30
Q

what can trigger generalised seizures?

A

flashing lights

sleep deprivation

31
Q

what happens during the tonic phase of tonic colonic seizures?

A

patients falls to the ground and becomes rigid and cyanosed as they stop breathing

32
Q

during which phase would tongue biting and incontinence occur in a tonic-colonic seizure?

A

tonic phase

33
Q

what it the colonic phase in a tonic-colonic seizure?

A

asymmetrical convulsive jerks
eyes roll into back of head
start breathing again

34
Q

what are absence seizures?

A

brief lapses in awareness

patient stops what they are doing and stares blankly

35
Q

are people aware they are having an absence seizure?

A

no but they recover quickly

36
Q

what is seen on an EEG in an absence seizure?

A

spike and wave at 3Hz

37
Q

what are myoclonic seizures?

A

colonic like jerks without the tonic contraction

38
Q

what are atonic seizures?

A

sudden loss of all muscle tone with maintenance of consciousness

39
Q

how do you diagnose epilepsy?

A

clinical diagnosis

40
Q

what other investigation can be done for epilepsy?

A

CT/MRI - rule out structural abnormality

EEG - confirm non epileptic attacks

41
Q

when would you start an anti-epileptic?

A

after 2nd seizure

42
Q

what is first line treatment in absence seizures?

A

valproate

ethosuximide

43
Q

what is first line treatment in myoclonic seizures?

A

valproate

44
Q

what is second line treatment in myoclonic seizures?

A

lamotrigine

clonazepam

45
Q

what is first line treatment in atonic/tonic colonic seizures?

A

valproate

46
Q

what is second line treatment in atonic/tonic colonic seizures?

A

lamotrigine

carbamazepine

47
Q

what is first line treatment in focal seizures?

A

carbamazepine

48
Q

how does sodium valproate work?

A

increases GABA activity

49
Q

who is sodium valproate not suitable for?

A

young woman - teratogenic

50
Q

what are the side effects of sodium valproate?

A 
teratogenicity 
nausea
vomiting
tremor 
weight gain 
liver failure
51
Q

what is the main issue with lamotrigine?

A

taken several months to titrate to effect

52
Q

what are the side effects of lamotrigine?

A

steven johnson syndrome
maculo-papular rash
disseminated intravascular coagulation (DIC)

53
Q

is topiramate well tolerated?

A

no

causes mediation, dysphasia, weight loss

54
Q

can carbamazepine be used in generalised epilepsy?

A

no

will make seizures worse

55
Q

what are the side effects of carbamazepine?

A 
leucopenia
drowsiness 
double or blurred vision 
impaired balance 
P450 inducer
56
Q

what is SUDEP?

A

sudden unexplained death in epilepsy

57
Q

what increases your risk of SUDEP?

A

poorly controlled

patient smokes, drinks, uses illicit drugs

58
Q

how long after your first seizure are people not allowed to drive for?

A

car - 6 months

HGV - 5 years

59
Q

with a diagnosis of epilepsy with seizures, how long can you not drive for?

A

12 months

60
Q

with a diagnosis of epilepsy, if you have changed medication how long can you not drive for?

A

6 months

61
Q

what affect does valproate have on contraception?

A

reduces efficacy
avoid progesterone only
COCP reduced
larger dose of morning after pill

62
Q

how can risk of congenital abnormalities from anti-convulsants be reduced?

A

folate 5mg daily during first trimester

63
Q

are anti-convulsants safe during breast feeding?

A

they pass into the breast milk and advice needs to be given

usually all safe to use

64
Q

what is status epileptics?

A

seizures lasting more than 5 mins
multiple seizures in 30 mins
second seizure before recovery from first

65
Q

what are triggers for status epileptics?

A 
infection
head injury
eclampsia
abrupt withdrawal of anti-convulsants 
metabolic upset - hypoglycemic/natremic
66
Q

what is the management for status epileptics?

A

ABCDE
1st line IV lorazepam
2nd line phenytoin
3rd line general anaesthetic

67
Q

what is non-epileptic attack disorder?

A

functional seizures at a subconscious level

strong association with past trauma - childhood sexual absue

68
Q

what is the presentation of non-epileptic attack disorder?

A

long lasting 10-20 mins
coordinated, symmetrical, large movements
maintain normal breathing and awareness
no tongue biting or incontinence

69
Q

what makes non-epileptic attack disorder worse?

A

anti-convulsants

FINALS (25 decks)

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