DDx: Seizures and Epilepsy Flashcards Preview

08 NEUROLOGY > DDx: Seizures and Epilepsy > Flashcards

Flashcards in DDx: Seizures and Epilepsy Deck (11):
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Differential Diagnosis of New-Onset Seizures in Adults

Focal seizures -  in which the patient maintains full awareness are termed focal seizures without dyscognitive features (simple partial seizures), whereas those involving an alteration of consciousness, are classified as focal seizures with dyscognitive features (complex partial seizures).  Absence seizures are characterized by brief periods of staring and unresponsiveness, typically lasting seconds, with an immediate return to normal awareness. Generalized tonic-clonic (grand mal) seizures are characterized by stiffening of the trunk and extremities followed by generalized symmetric jerking.  Myoclonic seizures consist of brief, shock-like muscle jerks without loss of awareness.

Syncope

Migraine

Pseudoseizure

Movement disorders

Sleep disorders

Seizures provoked by metabolic abnormalities and transient causes

Acute structural lesion-related seizures

CNS infection-related seizures

Chronic lesion-related seizures

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Syncope

Prodromal autonomic symptoms or palpitations followed by sudden loss of consciousness with rapid return to normal; clonic or tonic movements during syncope can be identical to generalized seizures

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Migraine

Visual or sensory alterations associated with headache; can be problematic when not accompanied by headache

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Pseudoseizure

Bizarre spells of altered or lost consciousness of prolonged duration (10-30 min); frequent pelvic thrusting; lack of response to antiepileptic drugs; only truly distinguishable from epileptic seizures by video-EEG monitoring

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Movement disorders

Tics, nonepileptic myoclonus

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Sleep disorders

Narcolepsy/cataplexy, sleep myoclonus

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Seizures provoked by metabolic abnormalities and transient causes

Generalized tonic-clonic (not partial-onset) seizures associated with alcohol withdrawal, hypocalcemia, hyponatremia, hypoglycemia, drug overdose, recent head trauma; this diagnosis is dependent on identifying one of these conditions

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Acute structural lesion-related seizures

Stroke: seizures are usually accompanied by neurologic deficits but seizure may be first manifestation

Subarachnoid hemorrhage: usually associated with severe headache, nausea, and syncope

Intracerebral hemorrhage: associated with headache, focal deficits

A consideration only for new-onset seizures

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CNS infection-related seizures

Meningitis is almost always associated with fever and meningeal signs. Encephalitis can have an insidious onset but is usually associated with altered mental status; a consideration only for new-onset seizures. CSF examination is always required if CNS infection is considered in the differential diagnosis

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Chronic lesion-related seizures

Tumor: slowly growing masses may not cause neurologic deficits or the deficit may go unnoticed because of the gradual onset

Developmental malformation: may not manifest with seizures until adulthood.

Previous brain injury: history of any brain abnormality, especially stroke or head trauma, increases the risk of seizures

A consideration in new-onset and chronic seizures. MRI is always necessary to exclude these diagnoses if partial-onset seizures are present

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