coma/delirium/ and epilepsies

Question 1

is delirium caused by a structural or non-structiural dysfunction?

Answer 1

non

Question 2

is the differential for delirium a broad or narrow etiology>

Answer 2

broad, look for more than once cause happening at same time.

Question 3

what is the delirium acronym?

Answer 3

drugs
emotional
low O2
infection
retition of urine
ictal states
undernutrition (wernicke's)
metabolic
subdural cns process
sensory, pain

Question 4

what is the chief characteristic of delirium?

Answer 4

waxing and waning with agitation

Question 5

iscoma caused by structural or nonstructural causes? what are the 2 exceptions

Answer 5

structural

drug induced and status ellipticus

Question 6

review the most common causes of coma in order?

Answer 6

vascular
trauma
endocrine problem
medications, drugs, ETOH
Infection CNS or non--shock
organ failure
seizure
temperatur disturbance
tumor

Question 7

what is the order of levels of arousal?

Answer 7

1. alert- eyes open, maintain awake
2. somnolent- sleepy, maintain awake from arousal
3. obtunded- sleepy awaken from verbal but can’t stay awake
4. obtunded- sleep awaken to pain, but can’t stay awake
5. stupours- cannot arouse to verbal or negative stimulus- grimace
   6comatose- no arousal

Question 8

what is cushing’s triad?

Answer 8

hypertension, bradycardia and respiratory change- seen in acute ICP elevation

Question 9

where is coma damage with pinpoint pupils?

Answer 9

pons

Question 10

cheyne stokes respirations comes from damage where?

Answer 10

deep hemisphere or diencephalon

Question 11

rhythmic hyperventialtion is from damage where?

Answer 11

pulmonary or metabolic

central midbrai or uppe pons

Question 12

apneusis is from damage where?

Answer 12

dorsolateral pontine tegmentum

Question 13

where is cluster breathing damage?

Answer 13

low pons or high medulla

Question 14

where is ataxic breathing damage?

Answer 14

dorsomedial medulla

Question 15

what is the order from best to worse in arousal of a patients movement?>

Answer 15

spontaneous, localizes, withrdrawals, decerebrate ro decorticate posturing, no response

Question 16

how do we treat elevated ICP?

Answer 16

head of bed up
hyperventialte
hyperosmotic use (mannitol)
neuroanesthetics
ventricular drain (NOT LP)
craniectomy

Question 17

when do seizures often occur

Answer 17

after awakening

Question 18

what can often provok generalized seizures?

Answer 18

sleep deprivation and alcohol

Question 19

do focal seizures have an alteration of awareness?

Answer 19

may not

Question 20

where do the majority of seizures in adults arise?

Answer 20

in the temporal lobe- over 65%

deep mesial structures

Question 21

what is the most physiologic mimmicker of seizure?

Answer 21

syncope

Question 22

To determine if a seizure is provoked or non-provoked, what does emergency room generally test for?

Answer 22

WBC, metabolic profile, drug scree

head CT if damage suspected

Question 23

does normal neuroimaging exclude seizures?

Answer 23

no

Question 24

Epileptiform discharges are often depicted as what?

Answer 24

sharp waves or spikes interictally

Question 25

What is the sensitivity of a routine EEG?

Answer 25

about 30%

Question 26

what increases the sensitivity of a routine EEG?

Answer 26

within 1st 24 hours of seizure or sleep deprived EEG

Question 27

drug of choice for abscence seizures?

Answer 27

ethosuzimide

Question 28

what anti-convulsants may worsen generalized seizures?

Answer 28

carbamazepine, gabapentin, pregabalin, gabatril

Question 29

how many patients can control seizures with meds?

Answer 29

2/3

Question 30

valproic acid has what 2 side effects?

Answer 30

weight gain and teratogen

Question 31

does topiramate and zonisamide cause weight gain?

Answer 31

no weight loss

Question 32

what drugs have fewest effects on newborn infants when mom is taking

Answer 32

levitiracetam and lamotrigine

Question 33

if we use surgery for epilepsy, where is the surgery most likely found?

Answer 33

mesial temporal, brain for movement or language cannot be removed, neither can both mesial temporal lobes

Question 34

how long must someone go without a seizure in order to drive?

Answer 34

3 months- acadamy | 6months in iowa- no madatory reporting

Question 35

what type of seizure do we se sudden unexpected death in epilepsy most?

Answer 35

generalized tonic-clonic seizures

Question 36

what needs to be excluded when making a diagnosis of epilepsy?

Answer 36

physiologic and psychologic mimickers

Question 37

patients failing 2-3 seizure meds should be?

Answer 37

referred to an epilepsy center

Question 38

when is epilepsy surgery typically an option?

Answer 38

intractable focal seizures

Question 39

does >10 seconds of electrographic change not associated with a clinical event constitute a seizure?

Answer 39

yes

Question 40

what is two uprovoked seizures

Answer 40

epilepsy if >24hrs apart

Question 41

auromatisms associated with seizures are most commonly found in what 2 places?

Answer 41

oral or hand

Question 42

what 3 characteristics of movements are concerning for seizures?

Answer 42

symmetry, synchronicity, rhythmicity

Question 43

what are small focal seizures that proceed or predict the onset of a patient's typical more robust seizures?

Answer 43

aura- frequently autonomic or sensory in nature

Question 44

somatosensory auras are frequently what lobe location?

Answer 44

parietal

Question 45

psychlogical aura are frquently what lobe related?

Answer 45

frontal

Question 46

deja-vu is freq what lobe associated?

Answer 46

temporal

Question 47

what are partial seizures without alteration of conciousness?

Answer 47

simple partia

Question 48

what are partial seizures with associated alteration of consciousness

Answer 48

complex partial

Question 49

what has an onset 3-12 months, with trunk and extremity flexion or extension after waking?

Answer 49

infantile spasm

Question 50

what is hypsarrhythmia?

Answer 50

high amplitude chaotic background on EEG associated with infantile spasm

Question 51

when are febrile seizures most comon

Answer 51

6 mo to 5 y

Question 52

a febrile seizure lasting longer than 15 min is termed?

Answer 52

complex- also multiple in 24 hours , small increase in future risk of epilepsy

Question 53

besides ethosuximide, what can we treat absence seizures with?

Answer 53

lamotrigine, or valproic acid

Question 54

what is a partial epilepsy characterized by facial clonic seizures and generalized TC seizures freq at night? what does EEG show

Answer 54

benign rolandic bilateral independent centro temporal sharp waves with horizontal dipol FREQUENTLY UNTREATED

Question 55

when is the onset of mesial temporal lobe epilepsy

Answer 55

partial epilepsy usually in teens

Question 56

what increases risk of mesial temporal lobe epilepsy? what is eeg?

Answer 56

prolonged febrile seizures | - temporal sharps and temporal intermittent rhythmic delta activity

Question 57

Rx for mesial temporal seizures?

Answer 57

medications but frequently surgical resection

Question 58

when does REM parasomnias often occur?

Answer 58

last third of the night whereas non-REM occur in first third

Question 59

what is an acute event which frightens caretaker and caracterized by apnea, color change, limpness or rigidity and apparent choking?

Answer 59

Apparent life threatening events- not associated with SIDS risk, usually in young children

Question 60

what is described by cyanosis, pallor, and syncope with agitation and frustration in children?

Answer 60

breath holding spells

Question 61

what are spells of movement or alteration of consciousness without an EEG correlate?

Answer 61

psudoseizure- non-epileptic seizures, conversion disorder.