Seizures Flashcards
Generalized tonic-clonic seizure
Pathophysiology:
- Loss of consciousness
- tonic contraction 10-30 sec +/- loss of respiratory effort and cyanosis
- alternating contraction/relaxation + ventilatory efforts
- post ictal state
Clinical:
- transient unilateral weakness in post-ictal period = Todd’s paralysis (investigate for further focal cause)
Dx/Rx:
- status = GTC > 30 mins
- valproic acid for GTC
- ativan (lorazepam) for status
Absence seizure
Pathophysiology:
- genetically inherited
- brief spells of loss of consciousness +/- subtle motor manifestations
Clinical:
- inducible by hyperventilation
- 3/s spike and wave forms on EEG
Dx/Rx:
- valproic acid
- ethosuximide
Simple partial seizures
Pathophysiology:
- begins with motor, sensory, autonomic phenomena
- consciousness preserved unless secondarily generalized
Clinical:
Dx/Rx:
- phenytoin
- carbamazepine
Complex partial seizures
Pathophysiology:
- partial seizure in which consciousness, memory, or responsiveness is impaired
Clinical:
- begins with aura (epigastric, deja vu, sensory)
- loss of consciousness
- automatisms
Dx/Rx:
- phenytoin
- carbamazepine
Vasovagal syncope
Pathophysiology:
- prolonged standing
- 2/2 blood, pain, emotional stimuli, etc.
Clinical:
- prodrome: lightheadedness, pallor, diaphoresis, hypersalivation
- loss of consiousness +/- incontinence
Dx/Rx:
- propanolol
- volume expansion
Cardiovascular syncope
Pathophysiology:
- occurs when recumbent, s/p exertion
- 2/2 abrupt decrease in cardiac output after brady or tachyarrhythmia
Clinical:
- SVT, Vtach, mitral valve prolapse, long QT, aortic stenosis, cardiomyopathy, etc.
Dx/Rx:
Basilar artery insufficiency
Cerebrovascular syncope
Pathophysiology:
- occurs s/p 50
- brief attack with prolonged LOC
Clinical:
Dx/Rx:
Subclavian steal syndrome
Cerebrovascular syncope
Pathophysiology:
- retrograde flow in vertebral artery with subsequent hypoperfusion
- change in BP between arms
due to a proximal stenosis (narrowing) and/or occlusion of the subclavian artery. The arm may be supplied by blood flowing in a retrograde direction down the vertebral artery at the expense of the vertebrobasilar circulation
Clinical:
Dx/Rx:
Migraine, Takayasu’s arteritis (pulseless disease), carotid sinus syncope
Cerebrovascular syncope
Types of cerebrobasilar insufficiency
Lennox-Gastaut Syndrome
Pathophysiology:
- age of onset in childhood
Clinical:
- tonic, atonic, generalized tonic clonic, or absence seizures
- a/w mental retardation
- EEG: slow 1-2 Hz spike and wave
Dx/Rx:
- valproic acid
- lamotrigine
- felbamate
Benign Rolandic Epilepsy
Pathophysiology:
- age of onset in childhood
Clinical:
- simple partial seizures involves mouth and face or are GTC
- nocturnal preponderance of seizures
- EEG: centrotemporal spikes
Dx/Rx:
- carbamazepine
Juvenile Myoclonic Epilepsy
Pathophysiology:
- onset in adolescence, young adulthood
Clinical:
- myoclonic, absence, or GTC seizures
- early morning preponderance
- EEg: 4-6 Hz polyspike and wave
Dx/Rx:
- valproic acid
- lamotrigine
