Collapse and Seizures

Question 1

What is this a presentation of?

Loss of consciousness, emotional upset during vigorous crying, involuntary holding of breath at the end of expiration.

Answer 1

Breath holding attack

Question 2

What is this a presentation of?
Loss of consciousness, paroxysmal, self-limiting, brief asystole, bye pain fear or anxiety. Hail and hypotonic, rigid, clonic movements, upwards eye deviation, urinary incontinence.

Answer 2

Reflex anoxic seizure

Question 3

What is this a presentation of?

Loss of consciousness, dizziness, nausea, sweating, feeling hot before a fall to the ground, some jerking.

Answer 3

Syncope (vasovagal, orthostatic, carotid, situational)

Question 4

What is this a presentation of?

Variable loss of consciousness, sudden collapse, may occur during exercise, may show long QT complex.

Answer 4

Cardiac syncope

Question 5

What are the red flags for collapse and seizures?

Answer 5

1. known congenital disease
2. during exercise or supine
3. preceded by palpitations
4. family history of long QT complex, HOCM, SUDEP
5. heart murmur present

Question 6

How are collapses and seizures generally investigated?

Answer 6

1. Bloods
2. ECG, Echo if there is a murmur
3. Lying-standing BP

Question 7

What is a febrile convulsion and in what age groups does it occur?

Answer 7

1. seizure associated with fever caused by an infection outside of the CNS.
2. 6-months to 7 years old

Question 8

What is the aetiology of febrile convulsions?

Answer 8

1. polygenic
2. 25% Risk if siblings have had one
3. occur in 4% of children up to 5 years in western Europe

Question 9

What is this a presentation of?

A single, tonic clonic, symmetrical generalised seizure lasting under 15 minutes, underlying illness, eye rolling.

Answer 9

Febrile convulsions

Question 10

What type of febrile convulsion is described?

Isolated, generalised tonic-clonic seizure, under 15 minutes, do not recur within 24-hours.

Answer 10

Simple febrile seizure

Question 11

What type of febrile convulsion is described?

Focal onset or focal CNS signs, over 15 minutes, incomplete recovery within one hour, recurrence within 24-hours.

Answer 11

Complex febrile seizure

Question 12

What are the possible differentials in a complex febrile seizure?

Answer 12

Meningitis, encephalitis, epilepsy, hypoglycaemia, CNS lesion, electrolyte imbalance.

Question 13

How is a febrile convulsion investigated?

Answer 13

1. identify infection
2. FBC, U&Es, calcium, glucose
3. MSU for MCS, blood cultures, CXR, ENT swabs
4. focal signs - MRI brain

Question 14

What is the management for febrile convulsions?

Answer 14

1. recovery position
2. over 5-minutes - lorazepam IV/buccal midazolam/PR diazepam
3. antipyretic - paracetamol syrup

Question 15

How should you educate parents after a febrile convulsion?

Answer 15

1. protect child from injury during a seizure
2. when to seek medical help (> 5mins)
3. all fevers should prompt antipyretic use