Status Epilepticus / acute seizure management Flashcards
Conditions commonly associated with NCSE:
- Neonatal / Infantile (3)
- Childhood ONLY (3)
Conditions commonly associated with NCSE:
- Neonatal / Infantile
- Otahara syndrome
- West syndrome
- Severe myoclonic epileptic encephalopathy of infancy (SMEI) / Dravet
- Childhood
- (occipital) Early-onset Panayiotopoulos syndrome
- Other childhood EI’s
- ESES / Landau-Kleffner
Epilepsy Conditions commonly associated with NCSE:
- Childhood OR Adult (8)
- LGS (atypical absence)
- LGS (tonic SE)
- Complex partial SE: Limbic
- Complex partial: nonlimbic
- Typical absence SE
- Postictal phase from GTC
- Subtle SE (i.e. myoclonic SE)
- Aura continua
Top 5 causes of Status Epilepticus: Adult
CVA (25%)
Changes in ASM (19%)
EtOH/Drugs (12%)
Anoxia (11%)
Metabolic (9%)
Top 5 causes of Status epilepticus: Pediatric
Fever / infection (35%)
Changes in ASM (20%)
Crytpogenic (9%)
Metabolic (8%)
Congenital (7%)
Medications known to cause SE
Non-ASM (8)
ASM (3)
LIIT FACTs about TV
Non-ASM
- Lithium
- Isoniazid
- Ifosfamide
- Tacrolimus
- Flumazenil
- Amoxapine
- Cyclosporine
- Theophylline
ASM
- Tiagabine
- Vigabatrin
- Valproate
Paraneoplastic Cancers commonly associated with SE (3) (and associated Antibodies)
Hu (small Cell lung Ca)
Ma2 (sslc, testicular germ-cell carcinoma)
CRMP5 (sslc / thymoma)
Autoimmune CONDITIONS associated with Status epilepticus (3)
- Hashimoto’s Thyroiditis
- Systempic Lupus (SLE)
- Rasmussen’s encephalitis
Autoimmune RECEPTORS associated with status epilepticus (3)
- Thyroid microsomal antibodies
- Voltage gated K channels
NMDA receptor - Anti-NR2A
Stages of Status Epilepticus (5)
Stage 1 (early)
- Incipient: 5 minutes
- Early: 5-10 minute
Stage 2 (established)
- 30-60 minutes
Stage 3 (refractory)
- 60 minutes
Complications of Tonic-clonic Status epilepticus:
Cerebral (6)
- Hypoxic / metabolic damage
- Excitatoxic Damage
- Edema / Increased ICP
- Venous thrombosis
- Infarction
- hemorrhage
Complications of Tonic-clonic Status epilepticus:
Cardiac (3)
Hypo/Hypertension
Cardiac Failure / shock
Tachy-Brady-arrhythmia / arrest
Complications of Tonic-clonic Status epilepticus: Respiratory (5)
- Apnea / Respiratory failure
- Hypertension
- Aspiration
- Pneumonia
- Pulmonary Embolus
Complications of Tonic-clonic Status epilepticus:
Autonomic
- Sweating
- Hyperthermia
Complications of Tonic-clonic Status Epilepticus: labs (2)
Leukocytois
CSF pleocytosis
Complications of Tonic-clonic Status epilepticus:
Metabolic / systemic (10)
HA, Da FIR
- Hypoglycemia
- Hyponatremia
- Hypokalemia
- Acidosis
- Acute renal Failure
- Acute Hepatic Failure
- DIC
- Rhabdomyolysis
- Infections
- Fractures
Peri-Ictal MRI imaging changes for Status Epilepticus
- Ipsi/Bilateral thalamic lesions (mass effect)
- Contralateral Cerebellar diaschisis (hippocampal swelling)
- Splenium abnormalities (focal cortical lesion)
- PRES (migratory focal cortical lesions
This patient is in status, what are we seeing and what kind of seizures is he having?
Increased T2 signal in R hemisphere (Epilepsia partialis continua
This patient is in status, what are we seeing and what kind of seizures is he having?
Hippocampal swelling (bitemporal status)
This patient is in status, what are we seeing and what kind of seizures is he having?
Axial DWI showing expanded and hyperintense splenium (bi-temporal status epilepticus)