Seizures and Syncopes - Cohen

Question 1

syncope

Answer 1

LOC from lack of blood flow

Question 2

faint

Answer 2

syncope - bradycardia and hypotension

Question 3

seizure

Answer 3

sudden electrical discharge of brain

Question 4

most common cause of LOC

Answer 4

syncope

often lack of blood flow to brain cells

Question 5

vasovagal syncope

Answer 5

faint
-sympathetic withdrawal - vasodilation

-increased PS activity - bradycardia

with crowding, ETOH, fatigue, severe pain, hunger, emotion or stress, needles, dental work

lasts less than 1 minute

often feel cold and sweaty

Question 6

cardiovascular syncope

Answer 6

insufficient CO

with arrhythmia or structural abnormality of heart

Question 7

cardiac causes of syncope

Answer 7

aortic stenosis - elderly

idiopathic subaortic hypertrophic cardiomyopathy - high school and college athletes

mitral valve prolapse - young women

Question 8

cough syncope

Answer 8

repeated coughing - increased thoracic P - no blood to heart (decreased VR)

brief LOC

Question 9

micturition syncope

Answer 9

men who stand to urinate at night - requires vagus nerve to pee
-patient passes out

Question 10

epilepsy

Answer 10

2 or more spontaneous unprovoked seizures

Question 11

bromide salts

Answer 11

prevent seizures

Question 12

seizure disorder

Answer 12

aka epilepsy

preferred term is seizure disorder

Question 13

provoked seizure

Answer 13

not epilepsy

2 MC causes

• hypoglycemia
• alcohol withdrawal - 2-3 days no drinks

Question 14

check lytes

Answer 14

if have seizure

Question 15

every patient with first seizure

Answer 15

full hx, PE, and neuro exam, MRI of brain, and full blood test

not every child needs MRI

Question 16

diagnosis of seizure disorder

Answer 16

requires 2 or more unprovoked seizures

Question 17

partial seizure

Answer 17

one hemisphere

Question 18

generalized seizure

Answer 18

entire brain

Question 19

tonic clonic

Answer 19

grand mal

Question 20

clonic

Answer 20

muscle spasm

Question 21

tonic

Answer 21

stiff muscle

Question 22

convulsion

Answer 22

shaking

Question 23

status epilepticus

Answer 23

one seizure after another

or prolonged seizure

Question 24

grand mal seizure

Answer 24

generalized tonic-clonic

aura - brief warning

tonic phase first
-eyes open and roll up**

clonic phase - repetitive movements

end 2 minutes - remain unresponsive 5 minutes

• no memory of seizure
• confused for hours or days (post-ictal period)

Question 25

tonic clonic seizure changes

Answer 25

``` HR increased O2 sat drop BP increase pupils dilate metabolic acidosis - low serum bicarb ``` remain weak onse side for another day - todds paralysis

Question 26

complex partial seizure

Answer 26

within one cerebral hemisphere complex - LOC reduced may gen an aura deja vu and jamais vu bad smell or taste, or dizziness

Question 27

jamais vu

Answer 27

familiar surrounding looks unfamiliar

Question 28

automatisms

Answer 28

repetitive blinking, chewing, simple motions, odd fumbling with complex partial seizures

Question 29

absence seizures

Answer 29

in children brief - 10 seconds or less quickly recover and normal LOC - don't know they had seizure

Question 30

absence epilepsy

Answer 30

100s of absence seizures/day noticed by school teacher`

Question 31

EEG with 3/second spike waves

Answer 31

absence seizure

Question 32

tx of absence epilepsy

Answer 32

small dose of valproic acid 2/3 lose them at puberty

Question 33

treat seizure patient

Answer 33

when have second unprovoked seizure

Question 34

benzodiazepines

Answer 34

not give to seizure -unless status epilepticus chance of resp arrest

Question 35

pseudoseizure

Answer 35

asynchronous limb movement, closed eyes, pelvic thrusting, more than 2 minutes, don't respond to epileptic drugs closed eyes*** real seizure - open eyes

Question 36

weight gain, hair loss, platelet issues

Answer 36

depakote

Question 37

status epilepticus

Answer 37

multiple seizures without regaining normal fxn or 30 minute seizure medical emergency tx - ABCs, glucose, O2 levels, urine toxicology give small dose of lorazepam/diazepam - ONLY for status epilepticus loading dose of phenytoin IV glucose and O2 - if chance of hypoglycemia or hypoxia

Question 38

surgery for seizure

Answer 38

if know location | -can be very beneficial