Blackouts Flashcards
(27 cards)
What are the distinguishing features of a seizure arising from the temporal lobe? (4)
May begin with limbic symptoms such as altered memory/smell, a difficult to describe ‘rising’ sensation in the abdomen, altered language function (if in dominant side temporal lobe).
What are the distinguishing features of a seizure arising from the frontal lobe? (3)
Can have a motor onset, with symptoms including forced head turn (where head is pushed away from the side of the epileptic focus), occurrence at night, and violent hyperkinetic movements.
What are the distinguishing features of a seizure arising from the parietal lobe? (2)
May begin with odd sensations or complex visual hallucinations.
What are the distinguishing features of a seizure arising from the occipital lobe? (4)
Likely to present with elementary visual symptoms such as eye pain, nystagmus, decreased vision and palinopsia (the persistence of an image even after the stimulus has been removed).
What is involved in the acute phase of epilepsy investigations?
Basic investigations to look for obvious triggers - this means checking for infections, significant metabolic derangements, performing an ECG (to check for cardiogenic syncope), etc.
How do we categorise first seizures based on their onset? (2)
Focal in onset OR generalised in onset.
How does the type of seizure onset impact differential diagnoses?
Focal onset seizures are more likely to be caused by structural lesions, whilst generalised attacks are more likely to be genetically mediated.
What is the imaging modality of choice in seizure investigation?
MRI scanning (unless it is an emergency situation)
When is EEG most useful in seizure investigation?
In characterisation of primary generalised syndrome seen in children and young adults (not very helpful in most cases of adult onset focal seizures).
When are anti-epileptic drugs given following a first seizure? (2)
-If there have been numerous prior attacks
-If there has only been one identified seizure but investigations identify a high risk of further seizures.
What is a seizure?
The transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain.
What is epilepsy?
The tendency to multiple unprovoked seizure attacks.
Describe normal neuronal activity on an EEG.
The hallmark of a normally functioning brain is an alpha rhythm on EEG, which appears as a wiggly line which waxes and wanes.
What is meant by ‘spike and wave discharges’ on an EEG?
Abnormally synchronised activity between neuron assemblies, characteristic of a seizure.
Which types of seizures are considered to be focal seizures? (3)
-Focal aware seizure
-Focal unaware seizure
-Focal to bilateral tonic clonic seizure
Which types of seizures are considered to be generalised seizures? (3)
-Primary generalised tonic clonic seizure
-Absence seizure
-Generalised myoclonic seizure
What are functional seizures?
Paroxysmal time-limited motor, sensory, autonomic and/or cognitive signs or symptoms, which are not caused by ictal epileptiform activity.
What other names are functional seizures known by? (3)
-Psychogenic non-epileptic seizures (PNES)
-Non-epileptic attack disorder (NEAD)
-Dissociative seizures
What are the four most common presentations of functional seizures?
-Rhythmic motor tremor or rigor-like movements (rapid twitching of limbs)
-Subjective sensations (“funny feeling”)
-Unresponsiveness without motor manifestations (‘swoon’)
-Complex movements (i.e back arching, pelvic thrusting)
What is Lamotrigine?
An anti-epileptic drug (in the triazine anticonvulsant class) used to treat epilepsy and also sometimes to treat bipolar disorder.
What is syncope?
A transient loss of consciousness due to a temporary reduction in cerebral blood flow.
What is encephalitis?
Inflammation of the brain parenchyma (as opposed to the meninges as in meningitis).
Describe the presentation encephalitis is associated with.
Various combinations of headache and neurological dysfunction, such as altered state of consciousness, seizures, behaviour change, and focal neurological (motor and sensory) deficits.
What is the most common identifiable cause of encephalitis?
Viruses, most commonly Herpes Simplex Virus (HSV)
