seizures, Cohen I

Question 1

% population that will lose consciousness at least once in lifetime

Answer 1

50%

Question 2

found down

Answer 2

slang loss of consciousness

Question 3

syncope

Answer 3

loss of consciousness from lack of blood flow to brain

Question 4

faint

Answer 4

syncope likely vaso vagal

due to bradycardia and hypotension via vagus nerve

Question 5

seizure

Answer 5

neurological changes due to a sudden electrical discharge in brain

Question 6

important questions for someone who lost consciousness

Answer 6

light headedness, dizziness, loss of vision, nausea, sweating, pallor or gray color, shaking or convulsion, open or closed eyes, standing or lying or sitting positions, unprotected fall or gradual
duration of unconsciousness
speed of recovery to normal consciousness
previous LOC?

Question 7

consciousness requires

Answer 7

functioning brain stem and one cerebral hemisphere

Question 8

brain is absolutely dependent on

Answer 8

minimum blood pressure
glucose concentration
partial P of O2

Question 9

what to make sure to measure in patient who suffers syncope

Answer 9

EKG

Question 10

Vaso vagal syncope is caused by combination of

Answer 10

sympathetic withdrawal (vasodilation)
increased PAN activity (bradycardia)

Question 11

vaso vagal syncope precipitated by

Answer 11

• hot or crowded environment, ETOH, extreme fatigue, severe pain, hunger, prolonged standing, emotional or stressful situation
• church services, funerals, athletic activities
• blood drawing, insertion of IV line, dental work

Question 12

period unconsciousness in vaso vagal syncope

Answer 12

less than a minute

full recovery within 5 minutes

Question 13

patient Sx vaso vagal syncope

Answer 13

cold and sweaty
light and woozy dizzy
vision dims
voice muffled
ears ring
palpitations
difficulty breathing
nausea
increased perspiration
numbness in hands

Question 14

do vaso vagal syncope patients bite tongue or have urinary incontinence

Answer 14

no

Question 15

CV syncope

Answer 15

decreased/insufficient CO caused by arrhythmias or structural cardiac abnormality

Question 16

cardiac arrhythmias that can lead to CV syncope

Answer 16

bradyarrhythmias

tachyarrhythmias

Question 17

structural cardiac abnormality that can cause CV syncope

Answer 17

L ventricular myocardial path of various causes caused dec motility
flow obstruction

Question 18

stroke volume impairments causing CV syncope

Answer 18

aortic stenosis
idiopathic subaortic hypertrophic cardiomyopathy
mitral valve prolapse

Question 19

common cause syncope and sudden death in high school and college athletes

Answer 19

idiopathic subaortic hypertrophic cardiomyopathy

Question 20

very common cause CV syncope in young women

Answer 20

mitral valve prolapse

Question 21

cough syncope

Answer 21

repeated coughing

may increase thoracic P and lower venous return to right atrium

Question 22

micturition syncope

Answer 22

elderly patients
almost always men who stand to urinate late at night
LOC due to vagal response needed to urinate in patients who are sleepy

Question 23

other disorders that may resemble syncope

Answer 23

hypoglycemia
anemia
hypoxia
diminished CO2 d/t  hyperventilation
anxiety attacks
hysterical fainting
seizure

Question 24

seizure

Answer 24

widespread electrical discharge originating in neurons in cerebral Cx causing abrupt loss or decline in consciousness, new movements, altered bodily sensation or unusual psychic feeling

Question 25

what mediates seizures

Answer 25

ion channels Na K Ca and NT glutamate, GABA

Question 26

Epilepsy

Answer 26

2+ spontaneous seziures | unprovoked!!

Question 27

Lunatic definition

Answer 27

patient with seizure once a mo

Question 28

preferred term to epileptics

Answer 28

seizure disorder

Question 29

2 most common causes of provoked seizures

Answer 29

1 hypoglycemia | 2 alcohol withdrawal (less than 48 hours after stopped drinking)

Question 30

common causes provoked seizures

Answer 30

``` hypoNa, hypoMg, hypoCa hypoxia fever benzo withdrawal illicit drugs prescription drugs head trauma brain tumors brain hemorrhages strokes ```

Question 31

idiopathic epilepsies

Answer 31

have seizures for unknown reasons

Question 32

patient with first seizures should be evaluated for

Answer 32

full Hx physical exam neuro exam MRI of brain and full blood tests

Question 33

Dx seizure disorder

Answer 33

unless strong evidence from Hx, due to reliable witnesses of 2+ unprovoked seizures

Question 34

can seizure patient have normal EEG

Answer 34

yes

Question 35

partial seizure

Answer 35

1 cerebral hemisphere "focal"

Question 36

generalized tonic clonic seizure

Answer 36

grand mal

Question 37

status epilepticus

Answer 37

1 seizure after another

Question 38

when do generalized tonic clonic seizures begin

Answer 38

adolescence and in 20s | never in infants <5 mo

Question 39

before tonic clonic seizure

Answer 39

aura

Question 40

tonic phase of generalized seizure

Answer 40

clenching or tightening of mm in fixed position arms flexed, legs extended breathing mm can lock mouth can close quickly causing biting of tongue or lip loss of urinary and rarely bowel continence

Question 41

eyes roll up and open at start of seizure

Answer 41

tonic clonic seizure

Question 42

clonic phase generalized seizure

Answer 42

repetitive synchronous movements of the arms and or legs

Question 43

tonic clonic seizure time duration

Answer 43

``` lasts 2 minutes with gradual slowing of movements respiration resumes unresponsive for 5+ minutes slowly gain orientation after no memory of seizure may be combative or agitated at time ```

Question 44

post ictal seizure

Answer 44

confusion for hours after tonic clonic seizure

Question 45

vitals for tonic clonic seizures

Answer 45

``` HR increase O2 saturated BP increase pupils dilate no reaction to light metabolic acidosis with decline in HCO3 ```

Question 46

Todds paralysis

Answer 46

patients remain weak on one side for another day due to seizures focus itself