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Neurology > Seizures > Flashcards

Seizures Flashcards

1
Q

Recurrent , unprovoked seizures

A

Epilepsy

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2
Q

Abnormal electrical activity in the brain

A

Seizure

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3
Q

range from sensory symptoms, autonomic changes, psychic experiences
Confusion to full-blown convulsions

A

Semiology

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4
Q

Epilepsy

failure of 2+anti-eleptic Rx

A

Intractability –> Surgery Eval

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5
Q

Generalized Seizure

List

A
  • Absence Seizure
  • Myoclonic Seizures
  • Tonic-clonic seizures
  • Tonic
  • Atonic
  • Clonic
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6
Q

Absence Seizures

Types

A
  • Typical
  • Atypical
  • With Special Features
    • Myoclonic Absences
    • Abscences w/ Eyelid Myoclonia
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7
Q

Myoclonic Seizures

A
  • Myoclonic
  • Myoclonic-Atonic
  • Myoclonic-Tonic
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8
Q

Focal Seizures

Complex Partial

A

Focal discognitive WITH impaired awareness

  • aura
  • NO loss of consciousness
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9
Q

Focal Seizures

Simple Partial

A

Focal WITHOUT impairment of consciousness/awareness

*isolated motor s/s (tonic/clonic)

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10
Q
  • Childhood/teenage onset
  • Sudden onset, sudden offset
  • NO aura
  • Loss of consciousness
  • Eyelid flutter/minor automisms
  • 3-15 seconds duration
A

Absence Seizure

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11
Q

Absence Seizure

EEG:

A

3Hz Spike-Wave/HV Sensitive

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12
Q
  • Sudden siffening
  • Maximal extension in arms
  • A few seconds long
  • W/ Falls/Injury
A

Tonic Seizures

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13
Q

Tonic Seizures

Where in brain?

A

Extra-temporal

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14
Q

Tonic Seizures

EEG

A

Flattening/high frequency discharge

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15
Q
  • Abrupt onset
  • Sudden loss in tone
  • 1-2 seconds long
  • Head drop/Falls/Injuries
  • Poor prognosis
  • poor response to AEDs
A

Atonic Seizures

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16
Q

Atonic Seizure

EEG

A

Slow spike-wave/flattening

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17
Q
  • Sudden jerks
  • Bilateral, maximal in arms
  • 1 second long, multiple usually
  • possibly photic/sensory triggered
A

*Myoclonic Seizures

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18
Q

*Myoclonic Seizures

EEG

A

Generalized polyspike-wave burst

19
Q
  • Loss of Consciousness
  • Post seizure Mental status change
  • Focal/Generalized
  • Tonic limb extension 20-40 seconds
  • INTO Rhythmic Clonic Jerking of Extremities (30-50 secs)
  • STOP Breathing, tongue biting, incontinence
  • Post-ictal sleep
A

Tonic-Clonic

20
Q

Tonic Clonic

EEG

A

Variable,

*maybe Obscured

21
Q

Premature morality rate for Epilepsy sufferers

A

2-3x normal person

22
Q

Epilepsy

Dx

A

*Hx
-Auras
-Witness reports
-Post-ictal s/s /b
-Experiences following
seizure
*EEG
-Generalized vs. partial seizures
*MRI

23
Q

Epilepsy Foundation Goal of Treatment =

A

No Seizures + No Side Effects

24
Q

Epilepsy

Tx

A

*Anti-seizure Rx
*Epilepsy Surgery
*Neuromodulation
-Vagal N Stimuation
-Responsive Neurostim
*Diet
(keto, mod atkins)

25
Q
  • 30 or more minutes of continuous seizure/repetitive seizures with no intervening recovery of consciousness
  • generalized convulsive variant
A

Status Epilepticus (SE)

26
Q

Generalized Tonic-Clonic Seizures

  • Generalized Onset
  • Childhood/Juvenile Onset
  • Normal Brain
  • Generalized Ictal Discharge on EEG

*GOOD Prognosis

1ary/2ndary?

A

1ary Generalized Seizure

27
Q

Generalized Tonic-Clonic Seizures

  • Partial Onset/Aura
  • Any Age
  • MRI/Exam May Be Abnormal
  • Focal Sharp/Spikes

*VARIABLE Prognosis

A

2ndary Generalized

28
Q
  • NO Loss of Consciousness/Awareness
  • Focal Seizure s/s
  • Progress to Dyscognitive seizures/Tonic-Clonic Seizures
A

Focal Seizures without Impairment of Consciousness

29
Q

Focal Seizures w/o Impairment of Consciousness

EEG

A
  • Interictal-focal sharp/slow

* Ictal-rhythmic discharge = normal

30
Q
  • ALTERED Consciousness/Awareness
  • 30 sec - 3 minutes
  • Automatisms (Arms, Oral)
  • Amnesia
A

Focal Dyscognitive Seizures

31
Q

Focal Dyscognitive Seizures

EEG

A

Interictal-sharp waves or spikes; Ictal - focal or bilateral rhythmic sharp

32
Q

Seizure Workup

Hx

A

Ask witness:

  • act out/what look like
  • Duration
  • Fall? Hit body part?
  • Describe patient AFTER episode. Awake? Drowsy?
  • Urinate on self? Bite tongue?
  • ETOH/Drugs prior to seizure?
33
Q

Seizure Workup

PE

A
  • Current Mental Status
  • Full Body exam
    • injuries
    • Neuro exam
  • Urinate?
34
Q

Seizure Workup

Tests

A
  • EEG
  • Glucose
  • Infxn cause
  • ETOH/Drug screen
  • MRI - brain abnormalities/strokes/tumors
35
Q

Seizure Tx

Rx 1st line most seizures

A

Phenytoin
Valproic Acid
Carbemazepine

36
Q

Seizure Tx

Rx 1st line = Generalized, non-convulsive seizures

A

Ethosuximide

valproic acid

37
Q

Status Epilepticus

Tx

A

TREAT + ASSESS SAME TIME

1) Secure airway + High flow O2
2) Low glucose? Give glucose
3) Alcoholic? Thiamine + magnesium
4) Lorazepam
5) LORAZEPAM NO EFFECT? Phenytoin
6) PREVIOUS 2 NO EFFECT? Phenobarbitol / General anesth.

38
Q
  • only in front of others
  • w/ stress/emotion
  • rarely injured in seizure
  • often w/ psyc issues
  • SEIZURE RX NO EFFECT
A

Psychogenic Non-Epileptic Seizures (PNES)

S/s

39
Q

Fake seizure for attention/avoid responsibilities

A

Factitious Disorder

NOT PNES

40
Q

Syncope

Hx

A
  • Feel anything b/f event?
  • Other s/s of systemic illness?
  • hypoglycemia/dehydration risks?
  • FH Sudden Cardiac Death?
  • Witnesses around?
41
Q

Syncope

PE

A
  • Fully alert/oriented now?
  • Signs of injury (fall)?
  • Orthostatic?
  • Sinus rhythm?
  • O2%?
  • Systemic illness signs?
42
Q

Syncope

Tests

A
  • EKG
  • Glucose
  • Electrolyte
  • CBC
  • others….
43
Q

Syncope

Tx

A
  • Underlying cause
  • Glucose + Hydration
  • Rx dose decrease?
  • ->Follow-up

Neurology (20 decks)

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