Neurology - blackout and fits Flashcards
(25 cards)
What about a blackout would make you think it is epilepsy or a non-epileptic attack?
Epilepsy - lateral tongue bites, symmetrical jerking with extended arms, open eyes, slow and confusion post-ictal
NEA - tip of tongue bites, assymetrical jerking, closed eyes, fast recovery
Name 3 causes of status epilepticus
Epilepsy - non-adherence or more severe disease
NEA - alcohol, brain infections, hypoglycaemia
What is the pathway to treat status epilepticus?
Benzodiazepine - wait 10 mins - benzo again - 10 min - 2nd line antiepileptic - ICU and anaesthesia
Name some benzodiazepines
lorazepam, diazepam, midazolam, chlordiazepam
Name some 2nd line antiepileptic
carbamazepine, phenytoin, lamotrigine, valporate, phenobarbitol
What are 3 timings for diagnosing tonic-clonic status epilepticus?
Time seizure starts
time seizure is beyond the point of being self-limting - 5 min, digagnose
Time damage occurs - 30 mins
What is status epilepticus?
30 minutes of seizures or 2 successive seizures without regaining consiousness
How would you treat status epilepticus?
benzodiazepium within 30 minutes or IV lorazepam and pheytoin infusion
How long does jerking last in each of the causes of blackout and think of other determining factors
syncope - a few secs, quick recovery, triggers to it, pale
epilepsy - < 2 minutes, lateral tongue bites, red/cyanosis, slow recovery
NEA - 10-15 mins, multiple, quick recovery, eye closed, tired after
What are the 3 main causes of transient loss of consciousness?
syncope
epilepsy
psycogenic non-epileptic attack
What are the 3 main causes of transient loss of consciousness?
syncope
epilepsy
psycogenic non-epileptic attack
What would you do in a blackout workup?
ECG, urinalysis, glucose, FBC, U&E, LFT, CRP, CT, MRI
What would you suspect if someone presented with blackout and focal signs?
stroke, space occupying lesion, injury, meningitis, encephalitis, subarachnoid haem
What is syncope?
transient global cerebral hypoperfusion to 1/2 normal blood flow which results in loss of postural tone and consiousness
What are the three types of syncope?
Cardiac
Postural/orthostatic - vasovagal, autonomic failure (e.g. DM, PD, D&V)
Reflex - micturition, defacation, swallowing/coughing
What is epilepsy?
paroxysmal event involving hypersyndronus uncoordinated neuronal discharge in brain resulting in abnormal movements, sensations or cognition
What is a psychogenic non-epileptic attack?
physiollogicala manifestation or psychlogical stress
What are some causes of loss of consiousness without focal seizures?
TOMES
toxins, organ failure, metabolic, endocrine, seizures
Metabolic - COATPEGS: CO2, O2, ammonia, temperature, pH, electrolytes, glucose, serum osmolality
How would you treat partial seizures?
Carbamazepine - 70% effective
What would you see in a frontal-temporal parital seizure?
deja vu, confusion, difficulty speaking and understanding speech
abnormalities on MRI on fronto-temporal dominant lobe
What are the 3 Ps of syncope?
posture, provocation, prodrome
What is first line treatment in focal seizures?
carbamezpine, lamotrigine
What is first line treatment in tonic clonic seizures?
sodium valporate
What is first line treatment in absence seizures?
sodium valporate, ethosuximide
