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Seizures
Clinical Medicine II-Spring 2012
| Question | Answer |
|---|---|
| Epidosde of abnl neuro fxn caused by abnl electrical discharge of brain neurons | seizure |
| Condition of recurrent seizures d/t fixed condition | epilepsy |
| Mechanisms of seizures | nl inhibitory mechanisms like GABA fail which cause ↑ membrane excitability→intense, prolonged neuro discharge |
| Some causes of seizures | MANY idiopathic, degenerative, infectious, metabolic, neoplastic, perinatal (infx, metabolic) |
| Some exambles of degenerative seizures | MS, presenile dementia |
| Infectious causes of seizures | meningitis, abscess, neurosyphilis |
| Metabolic causes of seizures | hypoglycemia, hepatic failure, hyper/hypo-naturemia |
| Toxic causes of seizures | theophylline, lidocaine, tricyclic antidepressants, cocaine |
| When does pre-eclampsia become eclampsia | when seizures occur |
| Two major categories of seizures | Generalized and Partial (focal) seizures |
| Types of generalized sizures | grand mal, petit mal (absence), myoclonic, results in LOC |
| Two types of partial seizure | simple partial and complex seizure |
| Near-simultaneous activation of entire cerebral cortex, | Generalized seizure |
| What is a tonic-clonic seizure | Grand Mal seizure “convulsions” |
| Characteristics of a grand mal seizure | Abrupt LOC, falls down and fully extended (tonic phase)~30s, followed by rhythmic jerking of trunk and extremities (clonic phase), w/ apnea, cyanosis, tongue-biting, Urine incot, last <2m |
| What follows a grand mal sz? | post-ictal phase, pt remains unconscious, flaccid, confused, usually for many mins-1hr, Todd’s paralysis can also occur: transient postictal focal paresis |
| Characteristics of a petit mal (absence) seizure | Abrupt LOC, blank stare, eyelids may twitch, no response, lasts only seconds, frequent >100/day, usually in school-aged kids, unusual in adults |
| If adults look like they’re having a petit mal seizure what is it | most likely a partial seizure |
| What is a myoclonic seizures | LOC associated w/ isolated extremity jerking |
| Electrical discharges beginning in localized region of brain, can spread though | Partial (focal) Seizures, can lead to generalized |
| What is usually the cause of a partial seizure | focal structural brain lesion, tumor, AVM, scar tissue, CVA, head injury |
| Characteristics of a simple partial seizure | no alteration of consciousness, manifestations: motor:tonic/clonic movement but aware of it or sensory: weird taste, smell(hallucinations), numbness, paresthisia, |
| Characteristics of complex partial seizures | alteration of consciousness, visceral sx, hallucinations, memory distubances, dream-like states, automatisms, mood/affective disorders |
| AKA: psychomotor or temporal lobe sz | complex partial sz |
| What are some consequences of have the dx of sz | employment: driving, pilot, insurability, long-term meds |
| What need to be r/o as sz mimics | syncope, narcolepsy, movement disorders, hyperventilation syndrome, psychogenic seizures (faking) |
| How do we r/o b/w sz’s and syncope | syncope usually have signs prior to passing out, and will wake up right after it occurs, no post-ictal phase |
| How to r/o b/w psychogenic sz’s and real sz | response to emotional upset, only happen when other ppl are around, no incontinence, protect themselves from noxious stimuli, no post-ictal (not gradual), nl EEG during attack |
| If we r uncertain if it was a sz, do we put it on the chart? | no, don’t dx unless sure |
| What important hx ?’s should we ask post sz | HA, recent head trauma, DM: glucose, cancer, electrolyte disturbance: diuretic? Drug/etoh use, family hx |
| If sz disorder present, but pt is having a sz what ?’s do we ask them | compliance to meds, change in meds, sleep deprivation, recent illness, recent EtOH |
| What labs should we order on our sz pt’s | ALWAYS glucose, lytes, BUN/Cr, Ca, Mg, PO4, LP if meningitis suspected, Tox screen, anticonvulsant level w/ sz pt’s, 1st time: CT, or possibly MRI, EEG |
| Identifies and locates abnl electrical findings | EEG |
| Does a nl inter-ictal EEG r/o epilepsy | no, they can be nl when not having a sz |
| Tx of an acute sz | protect pt. from injury (away from a wall etc), pt on side reduce aspiration, assure airway w/ jaw thrust, >5m consider benzodiazepines |
| When do we start meds for 1st time sz | usually if a previous neuro illness or abnl PE is present, if everything nl post sz, usually monitor and watch: refer to neuro |
| Drugs for generalized, simple partial, and complex partial | phenytoin, carbamezapine, valproic acis, phenobarbital |
| Drugs for Petit mal sz’s | Valproic acid, ethosuximide |
| Tx for alcohol-withdrawl sz’s | benzodiazepines to manage all acute withdrawal sxs, no chronic anticonvulsants used |
| Limitations post first-time sz’s | no driving, operating dangerous machinery, heights, unsupervised swimming, in general 6m sz free |
| Status epilepticus | Continuous sz activity >30m or two or more sz’s w/o return of consciousness in b/w |
| Serious issue w/ status epilepticus | prolonged brain hypoxia >30-60mins neuro injury |
| Tx for status epilepticus | O2, via facemask, (intubation?) large-bore IV, GLUCOSE→give D50 if hypoglycemic,1: benzo’s, 2.phenytoin, then 3. phenobartibal, 4. Lidocaine, anesthesia? maximize each prior to moving on |
| Causes of status epilepticus | CNS infx, Trauma, Anoxia, noncompliance to meds, stroke, metabolic derangements |
| What should we check for post status epilepticus | Check serum CK for rhabodomylosis: caused by muscle breakdown results in renal failure |
Created by:
streetsmarts
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