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paroxysymal Flashcards

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1
Q

what is the presentation of tonic clonic seizure?

A

static muscle contractions (tonic) followed by intense muscle contraction punctuated by brief relaxations (clonic) for up to 1 minute
it can take 3-5 minutes to regain consciousness after this

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2
Q

what is the onset of tonic clonic seizures?

A

abrupt

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3
Q

What is the most important diagnostic if a child complains of a stiff neck, fever and headache?

A

lumbar puncture CSF to rule out meningitis

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4
Q

what defferentiates chronic pain from acute pain?

A

Pain with longer duration than the normal healing process (by 3 or 6 months)
Pain without a peripheral source or origin
serves no adaptive purpose
often refractory to treatment

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5
Q

what is the cause of chronic pain?

A

may be nociceptive or neuropathic (of peripheral origin) or both
may be idiopathic
may be from injury or malignancy

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6
Q

What is the pathogenesis of chronic pain?

A
  1. disruption of nociceptive pathways of peripheral nerve, spinal cord, brainstem or cerebrum
  2. plasticity of neuronal pathways= sprouting axons and loss of inhibitory interneurons
  3. strong psychosomatic and emotional components based on previous experience
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7
Q

what is the definition of acute pain?

A

unpleasant sensation associated and in proportion with the injury and healing process

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8
Q

how is chronic pain diagnosed?

A

neuro exam, structural exam, electrodiagnostic examination

MRI and CT to rule out other injury

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9
Q

What are some complications to think about when treating chronic pain?

A

deepening mood disorders, tolerance to treatments and addition to treatments

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10
Q

How can you classify chronic pain?

A

By body region or by process involved

  • by neuropathic is neurogenic which is caused by a lesion in the nervous system
  • central is neurogenic which is caused by a lesion in the CNS
  • cancer which pain caused by the growth of cancer
  • inflammatory which is pain related to inflammatory events
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11
Q

what are the phases of migraine?

A

prodrome, aura (only in 20% of cases), headache and resolution

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12
Q

Who is more likely to get migraines?

A

women, 18% of women.

most common pediatric headache

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13
Q

What is the etiology of migraines?

A

activated primary afferent fibers of the trigeminovascular system
NO triggers release of CGRP from trigemovasc fibers-create neurogenic inflammatory response

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14
Q

what are some risk factors for migraines?

A

hormones, chronobiologic changes, vasodialators, diet, drugs, sensory input, stress, trauma

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15
Q

What are the 2 types of partial seizures?

A

simple (Jacksonian motor or Jacksonian sensory) or complex

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16
Q

What are the characteristics of a complex partial seizure?

A

psychomotor…seen as change a in behavior

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17
Q

Where does the complex partial seizure affect in the brain?

A

temporal lobe

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18
Q

What are some examples of generalized seizures?

A 
GAMCTA
gradmall(tonic clonic)
absence
myoclonic (isolated muscle)
Clonic (repetitive contract)
Tonic (rigid)
Atonic(no tone)
infantile seizure
febrile seizure
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19
Q

what are some side effects of anticonvulsants?

A

decreased neuronal activity
sleepiness (sedation)
inability to concentrate

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20
Q

What are some common etiologies of epilepsy?

A 
vascular stroke
cerebral tumor
inborn metabolism error
CNS infection
other: genetic predisposition
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21
Q

what is the difference between a simple and complex partial seizure?

A

in a simple awareness is maintained (jerky, muscle rigidity)

complex has automatisms, repetitive involuntary not coordinated movement

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22
Q

If a patient has involuntary movements and is conscious followed by a general loss of consciousness, what type of seizure is this?

A

partial seizure with secondary generalization

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23
Q

what is the difference between a partial and generalized seizure?

A

partial only involves part of the brain. General involves the entire brain

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24
Q

What is the DOC for treating absence seizure?

A

ethonosuximide

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25
what population commonly has abscence seizures?
peds
26
what is the presentation of a grand mal or generalized tonic clonic seizure?
unconscious(abscence) repetitive muscle contract sustained muscle contract
27
what is the presentation of a myoclonic seizure?
sporadic, isolated jerky movement
28
What is the presentation of a tonic seizure?
muscle stiffness, rigidity
29
What is the presentation of an atonic seizure?
loss of muscle tone
30
What is the presentation of a simple partial seizure?
no altered consciousness visions, smell, taste or memory disturbance jerking nausea, lightheaded, vertigo *can be jacksonian sensory or jacksonian motor
31
what are some common causes of seizures?
drugs, alcohol, neoplasm
32
What is status epileptics?
tonic clonic beginning or begin as complex partial last less than 2 minutes each repetitive seizures-no conscious period between Total seizure activity> 30 minutes or 2 consecutive seizures without consciousness between
33
What is the presentation of a complex partial seizure(psychomotor)?
unresponsive to stimuli | automatisms, repetitive involuntary not coordinated movement
34
What is the treatment for status epileptics?
medical emergency. Assess immediately. mortality 10-50%
35
What are some complications to consider with status epilepticus?
cardiac: HTN, tachycardia, arrythmia pulmonary: apnea, resp fail, hypoxia metabolic: hyperkalemia, volume depletion, hyperglycemia followed by hypoglycemia
36
What is the etiology of status epileptics?
non compliance with meds, change of meds, alcohol withdrawal | recent cerebrovascular event or head trauma
37
what population makes up 1/2 the patients affected with status epilepticus?
kids | 2/3 of all patients have no seizure history
38
what percentage of epileptics progress to Status epileptics?
1%
39
What is the most common cause of hypoxic ischemic encephalopathy?
neonatal seizures
40
What is the pathophys of neonatal seizures?
not as many mylinated axons as adult brain so electrical activity can't be propogated same way
41
what is the presentation of neonatal seizures?
1. focal twitch of muscle groups=multifocal clonic 2. tonic seizure: rigid posturing 3. myoclonic: focal brief jerk 4. subtle: chew, salivate, apnea, bicycle motion
42
what is the presentation of a febrile seizure?
1. core temperature increases to 39 degrees or greater 2. tonic clonic seconds to minutes 3. postictal fatigue follows
43
What is the most common seizure disorder in children(after 9m-5 years)?
febrile (tonic clonic presentaiton with fever)
44
What is the etiology of febrile seizures?
strong genetic component
45
what is the treatment for febrile seizures?
many pharm complications (have used oral diazepam before)
46
What are the categories for classifying epilespy?
Idiopathic, crytogenic/symptomatic, mixed classification (not focal or not sure)
47
What is the etiology of epilepsy?
genetic predisposition congenital abnormality-inborn metab error vascular stroke cerebral tumor CNS infection (drugs, toxin, trauma, withdrawal, triggers)
48
What are some triggers for epileptics?
fever, menstrual period, stress, flashing light, strong emotions, exercise, loud music
49
What is the treatment for epilepsy?
carbamazepine, valproic acid, levetiracetam, phenytonin (toxic) surgical resection possible
50
What is the diagnostic test for epilepsy?
blood glucose, calcium, urea N, Na electroencephalogram, CT Scan, MRI -in this order look for interictal spike, interictal period, slow silent,seizure tonic, seizure clonic, postictal depression
51
What is the presentation of epilepsy?
disorder of recurrent unprovoked seizure
52
What is the pathophy of epilepsy?
uncontrolled neuronal firing
53
What is the pregnancy protocol for epileptics?
1.have a planned pregnancy 2.withdrawl from meds if no seizure activity 3.monitor for breakthrough seizure 4.if necessary monotherapy with lowest dose 5.watch for change in drug metabolism-blood levels may change up to 50% change in pharmokinetics (most drugs are category C or D) Magnesium sulfate is only category B
54
What seizures does carbamezepine treat?
tonic clonic, partial simple and complex | NOT absence
55
What are some types of generalized seizures?
grand mal (tonic clonic), absence, myoclonic, clonic, tonic, atonic
56
What are some types of partial seizures?
Simple, complex, partial with secondary generalization
57
What types of seizures does Levetriacetam treat?
Tonic clonic, partial simple and complex
58
an afebrile neonate from normal pregnancy and birth who starts to seize intermittently is probably because of...
hypoglycemia
59
What is the most common adult headache?
tension type headache
60
what is the etiology of the tension type headache?
unknown, thought to be due to sensitization of the trigeminal pathways
61
What is the best treatment for tension type headaches?
1. go off any offending analgesics that can cause rebound effect 2. give tapering dose predisone 3. NSAIDS long acting 4. aspirin 5. isometheptene 6. Butalbital
62
what is the presentation of a tension type headache?
``` episodic 30 minutes to 7 day duration B/L mild to moderate pain pressing band no aggravation by physical activity, no nausea, no vomit ``` Chronic (30min-7 day duration) 5+Days per month 180days per year (for 6 months) same symptoms
63
What are some ways to prevent tension type headaches?
``` methysergide prophylactic B-blockers Divalproex sodium TCA Trizanidine ```
64
what is the requirement for a chronic tension type headache?
B/L, mild to moderate, pressing | 5 days per month or 180 per year for 6 months
65
what can be taken to treat partial seizuress and treat migraines?
topiramate
66
what is the only beta blocker FDA approved for migraine prophylaxis?
timolol
67
what are the etiology of a migraine headache?
NO from trigeminal blood vessels can cause primary afferent neurons to release CGRP which causes and inflammatory reponse
68
what are the phases of a migraine headache?
prodrome aura 10-20% of cases headache resolution
69
what is the requirements to be considered a chronic migraine?
15 days per month for 3 months
70
what are some options for migraine prophylaxis?
1. timolol | 2. antieleptics (50% of patients experience headache reduction)
71
What are some treatments for migraines?
1. OTC aspirin, NSAIDs (GI, renal toxicity, antiinflam action), 2. Fioriat 3. Ergotamine, dihydroergotamine, 4. tritans
72
What are the drugs within Fiorat?
Butalbital, caffeine, acetaminophen
73
What are some examples of Tritans used to treat migraines?
sumatriptan-nasal spray available frocatriptan (longest elimination T1/2) rizatriptan -requires dose adjust if pt on Beta blocker
74
what drug can be used after the onset of a migraine?
metoclopramide: | actions are to decrease nausea, increase GI motility, enhance the actions of the oral analgesic
75
What type of headache can be transformed into a migraine?
tension type headache
76
What is the presentation of a migraine?
``` U/L 60% of time neck pain in 75% photophobia 90% throbbing 85% nausea 80% last 4-72 hours ```
77
A migraine lasting longer than 72 hours is known as..
status migranous
78
what is the presentation of a cluster headache?
``` temporal sequence at certain time of day moderate to severe pain U/L infraorbital, retroorbital, temporal stabbing, boring (pressure is constant) can be burning Rapid onset 5-15 minutes duration 30-40 minutes to 3 hours can have remission for 6 months to 2 years ```
79
Autonomic symptoms can be seen in what 2 types of headache?
cluster and migraine
80
what are some drugs that are taken to prevent cluster headaches?
methysergide, topiramate, verapmil, divalproex sodium, Baclofen
81
What is the etiology of cluster headaches?
activated trigeminovascular systems then activated sphenopalatine ganglion

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