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WI18 Neuro > Seizures > Flashcards

Seizures Flashcards

1
Q

seizure

A

transient disturbance of cerebral function due to abnormal paroxysmal neuronal discharge

excessive amount of excitatory activity

pts can’t remember them, can’t control themselves

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2
Q

dz w/ recurrent, unprovoked seizures

A

epilepsy

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3
Q

what would provoke a seizure

A

hypoglycemia
febrile seizures
alcohol/drug withdrawal

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4
Q

etiologies of epilepsy (8)

A
  1. Tumor
  2. Trauma
  3. Idiopathic
  4. Infection
  5. Congenital/perinatal
  6. genetics
  7. CNS vascular dz (stroke)
  8. CNS degenerative dz (Alzheimers)
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5
Q

CNS vascular dz and epilepsy

A

secondary to stroke

mc cause of seizures with onset above 60 yrs

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6
Q

trauma anf epilepsy

A

particularly a cause in young adults, but terms must be met

more likely if dura mater is present, occurs after first couple of weeks following event

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7
Q

tumors and epilepsy

A

must be exclude

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8
Q

what must be excluded when any patient presents with new onset seizures?

A

tumors/space occupying lesions of the CNS

rare in childhood (bc tumors of childhood go to cerebellum)

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9
Q

ILAE classifies seizures based on which criteria? (3)

A
  1. Where?
  2. Aware?
  3. Other
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10
Q

types of seizures

A

General

Partial

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11
Q

Partial Seizure

A

only restricted portion of one cerebral atmosphere

may become generalized

typically less obvious (auditory or olfactory)

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12
Q

types of partial seizures

A

simple partial seizures (aware)

complex partial seizures (LOC, post ictal)

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13
Q

simple partial seizures (def + manifestation)

A

focal aware seizure with no LOC

PT is able to respond

motor, sensory, psychic, autonomic

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14
Q

complex partial seizures

A

starts focally and causes impairment of conciousness

last 30-120 seconds

pt is unresponsive and does not recall event

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15
Q

where do complex partial seizures typically originate?

A

temporal lobe

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16
Q

aura

A

simple partial seizure that lasts only a few seconds

typically precedes temporal lobe complex partial seizure

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17
Q

automatisms

A

non purposeful stereotyped and repetitive behaviors that occur during the seizure

pt doesn’t recall

mc oral or manual (lip smacking, fumbling hands)

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18
Q

types of general seizures

A

absent
atypical absent
myoclonic
tonic clonic

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19
Q

pt population most likely to have complex partial seizure

A

older adults >60

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20
Q

absence seizures

A

impairment of consciousness without loss of posture (pt. is unware of this loss)

no warning, no post ictal state

typically described as “daydreaming”

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21
Q

pt population most likely to get absence seizures

A

begins in childhood (4-8) or early teens

occurs in children with above average intelligence

freq., brief seizures thru our day, older children and adults have less, more time

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22
Q

atypical absence seizures

A

similar to absence seizure but obvious changes in muscle tone and more gradual onset and termination

do not respond well to medication

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23
Q

tonic clonic seizures

A

generalized seizure with two phases

associated with post ictal state

mc found in adults >60 with brain lesion, rare in neonates and infants

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24
Q

tonic phase

A

entire body is rigid

apnea occurs, pt falls to ground, increased HR/BP, 10-20 seconds

25
Q

clonic phase

A

jerking of body for 2-3 minutes

periods of atone followed by episodes of violent flexion

pupils dilate and contract, tongue bites/urinary incontinence

26
Q

post ictal phase

A

HA, disorientation, nausea, drowsiness and muscle soreness

increased lactic acid

gradually returns to awareness 10-15 min later

27
Q

post epileptic automatisms

A

follows tonic clonic seizure

may display abnormal behavior and have no memory

28
Q

pt convulsions continue without recovery of consciousness > 30 minutes

A

status epilepticus

medical emergency due to apnea, acid/base abnormalities

29
Q

second tonic clonic seizure after regaining consciousness

A

serial seizures

30
Q

prodrome

A

occurs hours before a generalized seizures

HA, jerking motions, lethargy, irritability, mood alteration

31
Q

provocation?

A

seizures that result from external precipitators

I.e. menstruation, photo sensitivity, caffeine

32
Q

clinical evolution of seizures

A
  1. neuroimaging
  2. EEG
  3. LP
  4. Drug levels
33
Q

neuroimaging done in seizures

A

done to rule out mass lesions

MRI of brain w/ and w/o contrast

CAN do CT (Pacemaker or metal in body)

34
Q

lab tests done in seizure work up

A

CBC + glucose + LFT/Renal FT

+/- VRDR, prolactin levels

35
Q

study of choice for seizure evaluation

A

EEG

will be normal until pt seizes

36
Q

LP in seizure work up

A

evaluation of pts with possible meningitis/encephalitis
obtunded
SAH

37
Q

DDX seizures

A
  1. Syncope
  2. TIA
  3. Cardiac Dysrhythmia
  4. brainstem ischemia
38
Q

syncope v seizures

A

preceded by pallor, sweating, nausea

recovery occurs rapidly (no post ictal)

39
Q

when is AED used in tx

A

is NOT given after single seizure, bc recurrence is high

report to public health dpt

encouraged to avoid dangerous situations

admitted to ICU

40
Q

mc cause of status epilepticus

A

non compliance with seizure meds

41
Q

tx of status epilepticus

A

high mortality rate, risk of neurological sequel

  1. Benzo (diazepam or Ativan IV over 2 min, repeat if needed, monitor for respiratory depression)
  2. intubation + D50 IV
  3. Fosphenytoin (Cerebyx) loading for cartiac arrhythmia and HoTN
42
Q

drug levels are monitored

A
  1. after treatment is initiated
  2. after dosage is changed or another drug added
  3. when seizures are poorly controlled
43
Q

mc cause of lower than expected AED serum levels

A

non compliance

44
Q

when are meds DC

A

seizure free for at least 3 yrs

taper off and see if they reoccur

45
Q

SUDEP

A

sudden unexpected death not due to drowning or trauma

thought to have a seizure over night that causes terminal apnea and asystole

46
Q

SUDEP risk factors

A 
UNCONTROLLED EPILEPSY**/non compliance 
>3 tonic clonic sz/yr
young (<40) 
polypharmacy 
nocturnal seizure
47
Q

management of SUDEP

A

effective seizure control

caregiver/nocturnal supervision

48
Q

solitary sz

A

pt without history of seizure has 1 and sent to ER

MRI and EEG done

49
Q

risk/recurrence of solitary sz

  • MRI, - EEG
A

one tonic-clonic but no abnormalities and evidence of focal onset

risk is low, no AED

50
Q

who is started on AED after one seizure

A

abnormal MRI (I.e. CA metastasis on brain) or abnormal EEG

51
Q

risk/recurrence of solitary sz

+ MRI, + EEG

A

high recurrence risk

AED begun

52
Q

risk/recurrence of solitary sz

either + MRI/-EEG or -MRI/+EEG

A

unsure

risk is 30-50%, consult and decide

53
Q

metabolic causes of provoked seizure

A

uremia
hypoglycemia
withdrawal from alcohol/drugs

54
Q

delirium tremens

A

occurs in alcohol withdrawal (lack of inhibition = over excitation)

highest risk > 48hrs after drink

must ask if history, monitor q 4 hrs

55
Q

tx of delirium tremens

A

benson to manage if bad enough

seizures are typically self limiting and don’t req. AED

56
Q

types of fever provoked seizure

A

simple febrile seizure, complex febrile seizure

occurs in children 3mo-5 yrs (18-24), typically during acute phase (OM, URI)

57
Q

simple febrile seizure

A

symmetric seizure
brief
no future risk of epilepsy

58
Q

complex febrile seizure

A

focal, repeated. prolonged

associated with risk of epilepsy

WI18 Neuro (16 decks)

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