Loss of consciousness

Question 1

Differential for loss of consciousness

Answer 1

1. Epileptic seizure
2. Syncope (vasovagal, postural, cardiogenic)
3. Other physiological (hypoglycaemia, sleep disorder, TIA)
4. Psychological (panic attacks, non epileptic attacks)

Question 2

What are the two types of epileptic seizures

Answer 2

generalized

focal

Question 3

Risk factors for seizures?

Answer 3

family history
early life risk factors
brain injury- stroke, neurosurgery

Question 4

List two early life risk factors for seizures

Answer 4

birth injury
febrile convulsions
meningitis
encephalitis

Question 5

List two symptoms of focal seizures-aura

Answer 5

strange taste, smell
deja-vu, jamais-vu
fear
ascending unusual feeling
sensory changes

Question 6

List two preceding symptoms of syncope

Answer 6

negative neurological symptoms: darkening of vision, ringing in ears
hot flush
dizzy/lightheaded

Question 7

Patient has seizure that lasts 10 seconds. Which lobe is likely associated? (focal)

Answer 7

frontal lobe

Question 8

Patient has seizure that lasts 3 minutes and is focal. Which lobe is affected?

Answer 8

temporal lobe

Question 9

List three characteristics of generalised seizures

Answer 9

body stiff
loud scream
rigid to jerking
colour purple/blue
eyes rolled back
heavy breathing, snoring afterwards

Question 10

How might a patient feel after a seizure?

Answer 10

headache
myalgia
need to sleep
amnesia
tongue pain

Question 11

Patient loses consiousness and awakes with tongue bite to tip of tongue. Is this a seizure?

Answer 11

unlikely, seizure would be laceration to side of tongue

Question 12

What are the types of generalised sezirues

Answer 12

tonice
clonic
tonic-clonic
atonic
myoclonic
absence

Question 13

What are the features of non-epileptic attack?

Answer 13

waxing and waning
tremor, no jerking
confused, rapid recovery, emotional

Question 14

What is the most important investigation for LOC

Answer 14

ECG

Question 15

What are the investigations for LOC

Answer 15

bloods: glucose, FBC
ECG
if seizure: MRI, EEG, video monitoring

Question 16

History of febrile convlusions make you more prone to which type of epilepsy?

Answer 16

mediotemporal lobe and hippocampal epilepsy

Question 17

What is the risk of recurrence of first time seizure?

Answer 17

Risk of recurrence of seizure= if no risk factors normal EEG then 20%. If risk factors and abnormal EEG then 60%.

(10% should always be the answer if you don’t know= top tip)