SEIZURES/MENINGITIS Flashcards by Brylee Blair

What is a seizure?

brief episode of abnormal electrical activity in the nerve cells of the brain cortex

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etiology of seizures

primary (idiopathic)
secondary (something was not quite right)
brain injury

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secondary etiology: children

birth trauma
infection (meningitis)
congenital abnormalities
high fevers that have rapid onset

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secondary etiology: middle age

head trauma
infection (meningitis)
alcohol
stimulants/medications

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secondary etiology: elderly

brain tumors
stroke

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What is epilepsy?

recurrent unprovoked seizure activity
EEG changes
unorganized electrical activity
affects 0.5% of US

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seizures: pathogenesis

seizure focus
group of abnormal neurons that spontaneously fire
emits excessive paroxysmal electrical discharges

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common factors lowering seizure threshold

sleep deprivation, alcohol withdrawal, television flicker, epileptogenic drugs, systemic infection, head trauma, recreational drugs, AED non-compliance menstruation

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occasional factors lowering seizure threshold

barbiturate withdrawal, dehydration, benzodiazepines withdrawal, hyperventilation, flashing lights, diet and missed meals, reflex triggers, stress, intense exercise

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clinical manifestations of seizures

sensations and perceptions, muscle movements, altered consciousness

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What is a focal/partial seizures

caused by focal irritations, unilateral, may stay focal or become generalized

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What does a generalized seizure involve?

both sides of the brain
person is unconscious

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What is a generalized tonic clonic seizure?

“grand mal”
salvation, tongue biting, incontinence
no recollection
stiffening of body, jerking of extremities

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What is the tonic phase?

prolonged skeletal muscle contraction

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What is the clonic phase?

alternating skeletal muscle contraction and relaxation
arms and legs jerk

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What is the postictal phase?

becomes calm, nearly unresponsive

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What is an absence seizure?

“petit mal”
occurs mostly in children and are outgrown by adolescence
characterized by brief staring spells

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What is a simple partial seizure?

no loss of consciousness
lasts less than 1 min
may involve simple motor, sensory, or other phenomena

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What is a complex partial seizures?

usually begins in temporal lobe
characterized by alteration in consciousness, 45-90 seconds

What occurs during complex partial seizures?

beginning = motionless, fixed gaze
followed by automatism = repetitive, purposeless movements
followed by brief period of confusion

Phases of a seizure

prodromal (precedes)
aural (sensory warning)
ictal (actual seizure)
post ictal (recovery)

What is an aura?

subjective sense of impending seizure
simple partial seizure
anxiety, mood change, confusion

What are the characteristics of an aura?

jerking, headache, fatigue, alterations in mood, odors, tastes, sounds.

What happens during the post-ictal phase?

time varies per person, can last seconds to days
depends on severity of seizure, area of brain, and frequency
muscle fatigue, lethargy

What is status epilepticus?

continuous seizure activity >15 min must be treated immediately hyperthermia may occur

How do AEDs work?

suppress the seizure focus and spread of seizure activity

What are the four basic mechanisms of AEDs?

1. suppression of sodium influx 2. suppression of calcium influx 3. blocking receptors for glutamate 4. potentiation of GABA

examples of drugs used for sodium/calcium reflux

phenytoin (Dilantin) carbamazepine (Tegretol) valproic acid (Depacon)

examples of drugs that block glutamate receptors

felbamate (Felbatol) topirmtate (Topamax)

example of drug that potentiates GABA

gabapentin (Neurontin)

traditional AEDs

phenytoin (Dilantin) levetiracetam (Tegretol) phenobarbital (Solfoton) valproic acid (Depacon) ethosuximide (Zarontin) primadone (Mysilone)

new AEDs

gabapentin (Neurontin) pregabalin (Lyrica) felbamate (Felbatol) topiramate (Topamax)

problems with AEDs

monitor plasma levels compliance withdrawal can occur suicide risk

AE of AEDs

CNS depression, GI disturbances, motor disturbances

What is meningitis?

acute inflammation of the meningeal tissues of the brain and spinal cord

What is the cause of meningitis?

infection (lung or bloodstream) or penetrating wounds

What is the major bacteria responsible for meningitis?

streptococcus pneumoniae and neisseria meningitidis (bacterial) enteroviruses (viral)

risk factors for meningitis

older adults, college students, prisoners, post-op, alcoholism, diabetes, splenectomy

classic triad of meningitis symptoms

fever, stiff neck, headache

pathogenesis of meningitis

infection of arachnoid mater and CSF, inflammatory response and pus secretion, increase in CSF production, increase in ICP

cm of meningitis

kernig sign, brudzinski sign

antibiotics for meningitis

ceftriazone (rocephin) vancomycin acyclovir

What is drug therapy other than antibiotics for meningitis?

steroid therapy, prophylaxis vaccines

cm for encephalitis (inflammation of brain)

day 2 or 3 of infection range from mild changes in mentation to coma

drugs for encephalitis

acyclovir for HSV, reduces mortality, does not reduce neuro complications

What is a brain abscess and what causes it?

pus within brain tissue local or systemic infection