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neurology > TLOC > Flashcards

TLOC Flashcards

1
Q

What are the differentials for TLOC?

A

epilepsy, NEA, postural hypotension and syncope

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2
Q

What is the pathophysiology behind vasovagal syncope?

A

Vasovagal syncope is due to increased vagal tone. We collapse so we can redistribute the blood to brain.

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3
Q

What are the different types of reflex syncope?

A

vasovagal, situational and carotid sinus

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4
Q

What are the causes of vasovagal syncope?

A

caused by stress or pain or blood or standing

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5
Q

What are the causes of situational syncope?

A

caused by swallowing or cough or urination

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6
Q

What are the causes of carotid sinus syncope?

A

caused by pressure on the carotid sinus eg from massage

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7
Q

What is the prodrome for syncope?

A

hot, visual loss, faint, dizzy, palpitations, abdominal symptoms due to increased parasympathetic tone

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8
Q

Describe how loss of consciousness looks for syncope?

A

quick, short, convulsions are brief, pale, rarely incontinent or bite tongue

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9
Q

How is the recovery for syncope?

A

quick with little confusion

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10
Q

what do you check for in past medical history in syncope?

A

look for bradycardia (heart block), tachycardia (VT), AS- to check for cardiogenic syncope

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11
Q

What can trigger an epileptic fit?

A

tired, alcohol, flashing lights, menstruation

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12
Q

What can be the prodrome to epilpetic fits?

A

aura

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13
Q

Describe how the loss of consciousness for epilepsy looks

A

Lasts 2 to 3 minutes, TC seizures etc, bite side of tongue, incontinence

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14
Q

What is the recovery like for epilepsy?

A

are generally confused, amnesia, tired and have headache

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15
Q

What would you check for in past medical history for epilepsy?

A

perinatal illness, educational achievements, head injury, meningitis, is older than consider SOL or stroke

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16
Q

What are examples of focal epilepsies?

A

secondary generalised seizure (tonic clonic), temporal love: complex partial (automatisms eg lip smacking) and simple partial (aura)

17
Q

What are examples of generalised epilepsies?

A

myoclonic jerks, absence, primary tonic clonic- look same to witness but respond to different medication

18
Q

What is the difference between simple and complex partial?

A

simple have your consciousness intact don’t for complex

19
Q

Which epileptic medications are good for all types?

A

Keppra is good for both, lamotrigine (can cause rash as SE so just switch) good for all

20
Q

Which epilpetic medication is good for partial epilepsies?

A

carbamazepine

21
Q

Which epilpetic medication is good for generalised epilpesy?

A

sodium valproate (TERATOGENIC) good for generalized

22
Q

Which epilpetic medication is good for absence seizures?

A

Ethosuzomide

23
Q

Describe a classic non-epileptic seizure?

A

lasts up to 30 mins, waxing and waning, wild convulsions, arms flex and extend, eyes closed and resist opening, pelvis thrust. Arch back. Mouth closed

24
Q

What is the recovery like for NEA?

A

typically quick, can be very upset

25
Q

What do you look for in past medical history for NEA?

A

Other medically unexplained sx, childhoods trauma

26
Q

What investigations could you do for TLOC?

A

Heart sounds for aortic stenosis
ECG- look at QT interval
EEG- a sharp wave is an interictal marker
FBC
MRI- do if over 25 yrs or focal onset
In syncope consider 24 hour tape, tilt table and look at autonomic function
Prolactin - raised after epilpetic fit

27
Q

What is the management for vasovagal syncope?

A

In syncope you want to increase venous return by sitting on the floor and crossing legs or raise legs above head
Can prevent by exercising and increasing salt
Treatments include beta blockers, fluoxetine as preventatives

28
Q

Summarise GCS

A 
Best eye response (/15 - worst you can get is 3)
Spontaneously (+4)
To verbal command (+3)
To pain (+2)
No eye opening (+1)
Best verbal response
Oriented (+5)
Confused (+4)
Inappropriate words (+3)
Incomprehensible sounds (+2)
No verbal response (+1)
Best motor response
Obeys commands (+6)
Localizes pain (+5)
Withdrawal from pain (+4)
Flexion to pain (+3)
Extension to pain (+2)
No motor response (+1)

neurology (11 decks)

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