Syncope/Seizures Flashcards
What are the types of reflex syncopes?
Vasovagal (fainting):
Triggered by emotion, pain or stress
Preceded by feeling light headed, pale, sweaty, blurred vision
LoC lasts 2 mins, no post-ictal state
Situational:
Triggered by cough or micturition
Carotid sinus:
Triggered by turning head or shaving
What are causes for postural hypotension?
Primary autonomic failure:
Parkinsons
Lewy body dementia
Secondary autonomic failure:
Diabetes
Uraemia
amyloidosis
Drug-induced:
Diuretics
Vasodilators
Alcohol
Volume depletion:
Haemorrhage
Diarrhoea
What are causes of cardiac syncope?
Arrhythmias
Structural abnormalities
PE
What investigations can be carried out in seizures?
Neurological exam
General observations, O2, blood sugars
Routine bloods: FBCs, U&Es (acute metabolic disturbances e.g. hyponatraemia, hypocalcaemia), LFTs
CT/MRI scan – to exclude acute pathology
ECG – seizure could be secondary to arrythmia, due to secondary cerebral hypoxia
EEG - to identify different forms of seizures
What are the features of generalised tonic-clonic seizures (GTCS)?
Involves both sides of the brain
Symptoms: Immediate LoC Tonic phase (muscle tensing), then clonic phase (muscle jerking) after Tongue biting Incontinence Groaning Irregular breathing
Post-ictal period: Drowsy Confused Irritable Depressed
What is the treatment for GTCS?
1st line = sodium valproate
2nd line = lamotrigine or carbamazepine
What are the features of focal (partial) seizures?
Starts in a specific area, on one side of the brain
Symptoms: Hallucinations Memory flashbacks Déjà vu Doing strange things on autopilot
What are the different types of focal seizures?
Focal aware seizures (simple partial):
Only affects a lobe or small structure in brain
Patient remains fully aware
Can develop into secondary GTCS
Focal unaware seizures (complex partial):
Affects unilateral cerebral hemisphere
Patient awareness and responsiveness is impaired during event but may not lose consciousness completely
What is the treatment for focal seizures?
1st line = lamotrigine or carbamazepine
2nd line = sodium valproate or levetiracetam
What are the features of temporal lobe seizure?
Most common type of focal seizure
Symptoms: Déjà vu Olfactory and auditory hallucinations Feeling of rising epigastric sensation Derealisation or depersonalisation Automatism Lip smacking Mumbling
What are the feature of absence seizures?
Typically being in 3-10 year olds
More common in girls
Begins on both sides of brain, therefore it is a type of generalised seizure
Symptoms:
Lasting a few seconds and quick recovery
Brief lapses in muscle tone
Patient ‘blanks out’ or ‘stares into space’
May indicate Lennox-Gastaut syndrome
What is the treatment for absence seizures?
1st line = sodium valproate
2nd line = lamotrigine
What are the features of myoclonic seizures?
Typically occurs in children with Juvenile myoclonic epilepsy
Symptoms:
Sudden brief muscle contraction, like a ‘jump’
Remains awake
What is the treatment for myoclonic seizures?
1st line = sodium valproate
2nd line = lamotrigine, levetiracetam or topiramate
What are the features of infantile spasms?
In infants age 6 months Rare Flexion of head, trunk, limbs and extension of arms Last 1-2 secs Repeated up to 50 times Progressive mental handicap
