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Neuroanatomy 2 > Seizures - Atia > Flashcards

Seizures - Atia Flashcards

1
Q

4 “s”s of Seizure - define

A

Abnormal SYNCHRONOUS discharge of neurons in the CORTEXXX that produces STEREOTYPED behaviours, they are SELF-LIMITED (seconds to minutes)

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2
Q

What is epilepsy

A

2 or more unprovoked seizures

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3
Q

What characterizes post-ictal seizure

A

Disorientation

Confusion

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4
Q

What is the difference between location of onset for generalized and Psimple and Pcomplex seizures

A

Generalized - BOTH hemispheres simultaneously

PS and PC - FOCAL lesion within one hemisphere

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5
Q

Which type of seizure has an aura associated?

A

Partial seizure

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6
Q

Which types of seizures involve altered LOC

A
  1. Generalized

2. Partial complex

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7
Q

Which types of seizures have post-ictal confusion associated?

A
  1. Generalized (except absence)

2. Partial complex

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8
Q

4 types of generalized seizures

A
  1. Atonic
  2. Myoclonic
  3. Absence (maybe just thalamus, brief fade out and back in)
  4. Tonic-clonic
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9
Q

If you have a partial seizure what must you do?

A

Search for a FOCAL lesion - tumor, stroke, abscess

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10
Q

The tonic phase of a seizure is …

A

Stiffness

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11
Q

Characteristic of a complex partial seizure

A

Should be asymmetrical

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12
Q

If a partial seizure generalizes then

A

it is mostly tonic clonic (NOT absence)

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13
Q

Key differences between Absence and complex partial seizures?

A
  1. Age group (A- paediatric, CP - adult)
  2. Aura (A - absent, CP - sometimes)
  3. Frequency (A - 100s/day, CP - less frequent)
  4. Duration (A - 10-15s, CP - 1-2 min)
  5. Tonic clonic changes (A - NEVER, CP - Sometimes)
  6. Post-ictal confusion (A - absent, CP - +)
  7. EEF (A - GENERALIZE3Hz spike and wave, CP - Focal discharges)
  8. CT/MRI lesion (A - thalamic?, CP - FOCAL lesion)
  9. Treatment ( A - Ethosuximide, CP - various)
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14
Q

What % of the population has epilepsy and what is the risk of having one seizure in lifetime

A

1%
5%
M=F

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15
Q

DDx seizure vs syncope - awake or asleep?

A

Can be asleep in seizure, often awake in syncope

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16
Q

DDx seizure vs syncope - trigger

A

Seizure - Sleep loss

Syncope - heat/injury/emotion

17
Q

DDx seizure vs syncope - ONSET

A

Seizure - SUDDEN

Syncope - Gradual

18
Q

DDx seizure vs syncope - Motor - Vocalization

A

Seizure - can be present

Syncope - ABSENT

19
Q

DDx seizure vs syncope - Motor - Tonic-clonic

A

Seizure - Pronounced

Syncope - brief can occur

20
Q

DDx seizure vs syncope - Motor - Tongue biting

A

Seizure - bite sides not tip

Syncope - ABSENT

21
Q

DDx seizure vs syncope - Autonomic - incontinence

A

Seizure - can have incontinence

Syncope - NOne

22
Q

DDx seizure vs syncope - Autonomic - Colour

A

Seizure - Normal/blue

Syncope - PALE

23
Q

DDx seizure vs syncope - Injury

A

seizure - Common

Syncope - absent

24
Q

DDx seizure vs syncope - POST event

A

Seizure - Confused/somnolent

Syncope - ALERT but tired

25
Q

What are the causes of secondary seizure

A
  1. Structural - Tumor, pus, blood, stroke
  2. Metabolic - non-adherence to meds,
    HYPO-glycemia
    HYPO-Na, Ca, Mg
    EtOH withdrawal
    Drugs - cocaine, amphetamines
26
Q

Which kind of strokes cause seizures?

A

NOT SUBCORTICAL STROKES - REMEMBER CORTEX - only cortical strokes

27
Q

List work-up for a seizure

A
  1. cbc
  2. Glucose
  3. Electrolytes esp… Na
  4. Mg Ca
  5. Albumin/creatinine
  6. fox screen
  7. Check anti-epileptic drug levels
    IMAGE - MRI
28
Q

what would you see on an MRI for seizure

A

Abnormal fray matter around ventricles - CT not useful

29
Q

What can EEG do and can’t it do?

A
  1. captures inter-ictal epileptiform discharges
30
Q

FIRST EEG is…

A

50% SENSITIVE

31
Q

Three EEGs are

A

80% SENSITIVE

32
Q

Length of time a patint can’t drive if they have a seizure?

A

6 months minimum

33
Q

How do the anti-epileptic drugs work?

A

Decrease neuronal activity by
1) Increase GABA - benzos, clobazem, lorazepam, diazepam
2) DECREASE glutamate (excitatory)
3) alter ion channels (Na, Ca), phenytoin, carbamazepine, lamotrigine, ethosuximide
4) Combination (valproic acid, topiramate)
Unknown - Keppra

34
Q

what percent of patients will become seizure-free?

A

75%

35
Q

what is the risk of having a second seizure after first unprovoked seizure?

A

50% within 2 years (only treat if Physical/imaging or EEG is abnormal)

36
Q

when do you give treatment for a seizure?

A
  1. unprovoked seizure - but pt wants
  2. Provoked with an irreversible cause (stroke)
  3. 2 Unprovoked
37
Q

What is status epilepticus?

A
  1. Ongoing seizure lasting >5 min
  2. Repeated seizure without returning to baseline
    (> 2 min is BAD)
38
Q

What is the first thing you do if you have a status epilepticus?

A
  1. ORDER CAP GLUCOSE

If glucose 2 ativan and phenytoin IV

Neuroanatomy 2 (25 decks)

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