Headache, Seizures

Question 1

Most common type of headache

Answer 1

Tension

Question 2

Headache predicated by stress, hunger, sleep deprivation, eye strain.

Heightened neuronal sensitivity.

Answer 2

Tension

Question 3

Clinical features of tension headache

Answer 3

Band-like pain around head

Steady, aching (non pulsatile)

Bilateral, without photophobia, phono phobia, nausea, or vom

Question 4

Tx Tension HA

Answer 4

NSAIDs

Muscle relaxants

Antidepressants / psychotherapy

Question 5

Headache more common w females, unilateral pulsating, n/v, photophobia, phonophobia

Answer 5

Migraine

Question 6

Migraine Tx

Answer 6

abortive triptan, antiemetic, NSAIDs

Question 7

Headache more common w males, one sided, tearing, red eye, nasal congestion, same time every day

Answer 7

Cluster

Question 8

Cluster HA Tx

Answer 8

abortive: oxygen, triptan;

preventative CCB of choice: VERAPAMIL

Question 9

Types of generalized seizures

Answer 9

Absence - staring

Atonic - loss of muscle tone, falls

Tonic Clonic - convulsions

Myoclonic - quick, involuntary muscle twitch

Question 10

Types of partial seizures

Answer 10

Simple - intact awareness

Intact - loss of consciousness

Question 11

Seizure lasting more than 5 mins

Answer 11

Status epilepticus

Question 12

Post ictal state

Answer 12

time after seizure occurs, before pt returns to normal

Question 13

Diagnosis criteria of epilepsy

Answer 13

At least 2 unprovoked seizures occurring > 24 hr apart

Question 14

Isolated tonic or clonic activity of a limb or transient altered sensory perception - may spread to include the entire side of the body in a “jacksonian march”

Answer 14

Simple partial seizure

Question 15

Characterized by an aura, followed by impaired consciousness. N/V, focal sensory or tonic clonic activity may be present.

Answer 15

Complex partial seizure

Question 16

When might anticonvulsant therapy not be indicated for a seizure?

Answer 16

Single, unprovoked seizure

Normal neuro exam, normal brain imaging and EEG

risk of recurrence < 50%

Question 17

Possible complications of status epileptics

Answer 17

Permanent brain damage from hyperthermia

circulator collapse

excitotoxic neuronal damage

Question 18

Management of status epilepticus

Answer 18

Emergency

1. Airway

Cooling blanket or induction of motor paralysis w neuro block for hyperthermia

Diazepam or Lorazepam, IV until seizure stops
+ Phenytoin or Phosphenytoin

Question 19

Some causes of seizures in neonates

Answer 19

Drug withdrawal

Perinatal hypoxia

Metabolic / electrolyte imbalance

Genetic
CNS infecition
Trauma

Question 20

Some causes of seizures in infants and children

(1 month - 12 yrs)

Answer 20

FEBRILE

Genetic
Developmental
CNS infection
Trauma

Question 21

Some causes of seizures in adolescents

Answer 21

Illicit drug use

Brain Tumor

Genetic
CNS Infection
Trauma

Question 22

Some causes of seizures in young adults

Answer 22

Autoantibodies

Alcohol withdrawal

Illicit drug use

Brain Tumor

Trauma

Question 23

Some causes of seizures in older adults (>35yrs)

Answer 23

Metabolic disorders
(uremic, liver failure, glucose, electrolytes)

Cerebrovascular Disease

Alzheimers / Neurodegenerative

Autoantibodies
Alcohol
Tumor

Question 24

Tx in first 5-30 mins of GTC Status Ep.

Answer 24

IV Benzodiazepine (Loraz, Midaz, Clonazepam)

or IV Antiepileptic (Phenytoin or VPA or Leva)

Question 25

Tx of Established and Early Refractory SE | 30 mins - 48 hrs

Answer 25

IF GTC >> IV Midazolam or IV Propofol + Phenobarb If FOCAL >> Continue IV Antiepileptic (VPA, Phen, Leva)

Question 26

Tx of Late Refractory SE (>48 hrs)

Answer 26

Phenobarbital THEN IV Midazolam or Propofol