Seizures and Syncopes - Cohen Flashcards
syncope
LOC from lack of blood flow
faint
syncope - bradycardia and hypotension
seizure
sudden electrical discharge of brain
most common cause of LOC
syncope
often lack of blood flow to brain cells
vasovagal syncope
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
cardiovascular syncope
insufficient CO
with arrhythmia or structural abnormality of heart
cardiac causes of syncope
aortic stenosis - elderly
idiopathic subaortic hypertrophic cardiomyopathy - high school and college athletes
mitral valve prolapse - young women
cough syncope
repeated coughing - increased thoracic P - no blood to heart (decreased VR)
brief LOC
micturition syncope
men who stand to urinate at night - requires vagus nerve to pee
-patient passes out
epilepsy
2 or more spontaneous unprovoked seizures
bromide salts
prevent seizures
seizure disorder
aka epilepsy
preferred term is seizure disorder
provoked seizure
not epilepsy
2 MC causes
- hypoglycemia
- alcohol withdrawal - 2-3 days no drinks
check lytes
if have seizure
every patient with first seizure
full hx, PE, and neuro exam, MRI of brain, and full blood test
not every child needs MRI
diagnosis of seizure disorder
requires 2 or more unprovoked seizures
partial seizure
one hemisphere
generalized seizure
entire brain
tonic clonic
grand mal
clonic
muscle spasm
tonic
stiff muscle
convulsion
shaking
status epilepticus
one seizure after another
or prolonged seizure
grand mal seizure
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)
tonic clonic seizure changes
HR increased O2 sat drop BP increase pupils dilate metabolic acidosis - low serum bicarb
remain weak onse side for another day - todds paralysis
complex partial seizure
within one cerebral hemisphere
complex - LOC reduced
may gen an aura
deja vu and jamais vu
bad smell or taste, or dizziness
jamais vu
familiar surrounding looks unfamiliar
automatisms
repetitive blinking, chewing, simple motions, odd fumbling
with complex partial seizures
absence seizures
in children
brief - 10 seconds or less
quickly recover and normal LOC - don’t know they had seizure
absence epilepsy
100s of absence seizures/day
noticed by school teacher`
EEG with 3/second spike waves
absence seizure
tx of absence epilepsy
small dose of valproic acid
2/3 lose them at puberty
treat seizure patient
when have second unprovoked seizure
benzodiazepines
not give to seizure
-unless status epilepticus
chance of resp arrest
pseudoseizure
asynchronous limb movement, closed eyes, pelvic thrusting, more than 2 minutes, don’t respond to epileptic drugs
closed eyes***
real seizure - open eyes
weight gain, hair loss, platelet issues
depakote
status epilepticus
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
surgery for seizure
if know location
-can be very beneficial
