Questions

Question 1

What risk factor(s) or cause(s) presumably instigated RS’s seizures?

Answer 1

Football injury (head trauma)
Subdural hematoma (due to injury)
Brain surgery (this is what appears to be the actual cause itself, though either of the above two can lead to seizures on their own)

Question 2

Name some other risk factors/causes that may lead to seizures

Answer 2

Family history of seizures
Stroke
Tumors
Illicit drug use
CNS degrading diseases
Alcohol withdrawal
Many cases are simply idiopathic!... no known cause

Question 3

What does the acronym DRESS stand for?

Answer 3

Drug Reaction with Eosinophilic and Systemic Symptoms

Question 4

What are some signs and symptoms of DRESS that RS presented with?

Answer 4

Maculopapular scaly red rash (skin reaction)
Fever
Lympadenopathy
Symptoms of hepatic impairment (hepatitis)
Generally feeling “Lousy” (various organ system damage)

Question 5

What drug was RS initially taking? What is its presumed mechanism of action?

Answer 5

Phenytoin. It blocks sodium channels to stabilize neural firing and inhibiting the occurrence of seizures

Question 6

Name 3 anticonvulsant drugs.

Answer 6

phenytoin
carbamazepine
phenobarbital

Question 7

What is another name for tonic-clonic seizure?

Answer 7

Grand Mal

Question 8

List the two phases of tonic-clonic seizures. What happens at each phase?

Answer 8

in tonic, the body becomes rigid

in clonic, there is uncontrolled jerking

Question 9

Name 2 complications of subdural hematoma

Answer 9

Brain herniation
Seizures
Permanent muscle weakness or numbness

Question 10

Hematomas cause __________ and __________. It is often these 2 consequences that cause irritation of adjacent organs and tissues and cause the symptoms and complications of a hematoma.

Answer 10

Swelling and inflammation

Question 11

What metabolite is formed from aromatic anticonvulsants that is thought to be responsible for DRESS?

Answer 11

Arene oxide intermediates

Question 12

One of the theories regarding the pathophysiology of DRESS involves the metabolic intermediate forming a covalent complex with what?

Answer 12

CYP3A1

Question 13

In relation to our patient, why was Gabapentin considered a favorable option?

Answer 13

It is renally excreted, which is preferred due to our patient’s severe liver damage

Question 14

Briefly describe differences of each: Craniotomy, Craniectomy, and Burr-Hole.

Answer 14

Craniotomy: part of the skull is removed to access the brain injury and then replaced
Craniectomy: part of the skull is permanently removed
Burr-Hole: drill into the skull and place a small tube to drain the excess blood

Question 15

What is status epilepticus?

Answer 15

A seizure that lasts for more than 5 minutes, or repeated seizures without a recovery time between them

Question 16

What is the MOA of Gabapentin?

Answer 16

Binds with high affinity to a protein with an amino acid sequence identical to that of the Calcium channel subunit α2δ-1 (alpha 2 delta - 1)

Question 17

One of the biggest causes for concerns when dealing with subdural hematomas is the rise in __________ ___________ , so it is imperative that they be rapidly identified by ___ _____ or _____.

Answer 17

intracranial pressure; CT Scan or MRI

Question 18

What are the two disease-related precautions for the use of Valproic Acid?

Answer 18

Acute head trauma and hepatic impairement

Question 19

Eosinophilia is a common sign in DRESS Syndrome. What lab value would indicate eosinophilia?

Answer 19

> 1.5 X 10^9 per liter

Question 20

The liver is affected by DRESS syndrome and the patient may present with cholestasis. What are two signs that can identify this abnormality?

Answer 20

Dark urine and clay colored/white stools

Question 21

Lorazepam belongs to which class of drugs?

Answer 21

Benzodiazepines

Question 22

Elevated AST and ALT levels indicate damage or cellular death in which organ?

Answer 22

Liver

Question 23

Benzodiazepines enhance the neuronal inhibitory effect of which neurotransmitter?

Answer 23

GABA

Question 24

What term describes fibrosis or scarring of the liver?

Answer 24

Cirrhosis

Question 25

RS’s seizures began following a surgery to correct a _____________?

Answer 25

Subdural hematoma

Question 26

What are 3 signs and symptoms typically seen in DRESS syndrome?

Answer 26

``` Maculopapuplar pustular rash High fever Eosinophilia Lymphocytosis Lymphadenopathy Organ involvement ```

Question 27

What is the disease concern typically seen with Valproic Acid that made it not a good choice for our patient?

Answer 27

It was not recommended for post-traumatic seizure prophylaxis patients with acute head trauma

Question 28

What is the typically treatment for a patient who is experiencing DRESS syndrome?

Answer 28

Stop the causative agent Start oral prednisone Possibly start topical corticosteroids for rash

Question 29

What is the problem with knowing the MOA for anti-convulsant/anti-epileptic drugs?

Answer 29

The MOA is typically unknown. Usually it has to do with increasing the GABA activity which is a neuroinhibitor.

Question 30

___________________ typically causes dark urine and pale stool.

Answer 30

Biliary obstruction