Flashcards in Radiology Seizures Deck (45):
dev from region of inflm localized to one cerebral hemisphere. due to either chronic viral infection or AI response against glutamate R. dev in children <10yo. pt suffer from simple or complex partial seizures. recurrent motor seizure termed epilepsy partials continua are common and often non-refactors to AED.
tx: glucocorticoid, IVIG, plasmapharesi to ctrl inflm. may need hemispherectomy
20% refractory to medical. lesion --> intracranial electrode implanted + PET and SPECT to localize epileptogenic focus --> map brain of proposed resected area to prevent severe language or cog deficits --> surgical removal of temporal lobe-80% seizure free= most common surgical procedure in epilepsy.
corpus callosotomy- lesion made in CC- in pt with refractory epilepsy to prevent spreading of partial to generalized
inject sodium amobarbital- barbituate, into carotid artery to sedate single hemisphere for brain allowing for memory and language to be deterred in each hemisphere
inflm disorder of limbic system. memory loss, personality cages, psych sx, involuntary movements, seizures. acute or subacute. 2 times: infectious and AI
viral. herpes simplex most common.
1)paraneoplastic: make ab in association with tumor- most commonly lung ca-small cell tumor, thymus, breast, ovaries, testis, young female-often ovarian teratomas. most common ab is anti-Ma2, anti-amphiphysin, anti NMDA.
2)non-paraneoplastic: ab against V gated K ch. which are concentrated in hippocampus.
tx: immunosuppressive therapy + plasmapheresis and steroids. removal is often curative
lesion is made in corpus callosum to tx refractory secondarily generalized epilepsy to prevent parital seizures from spread across to pop hemisphere
seizure >5min without intricate return to baseline. emergency. MRI- cortical hyperintesity and diffusion restriction
vagus nerve stimulation (VNS)
tx epilepsy. electrode implanted on midcervical portion of vagus N which sends intermittent electrical impulses though the N.
abn excessive or synchronous neuronal activity in the brain. stereotypic.
recurrent, unprovoked seizure due to inherent brain dysfunction. ex: metabolic derangement- hyponatremia, drug withdrawal, drug into
hypergraphia, hyposexuality, sticky personailty, hyper-regiiosity
most focal epilepsies arise from
mesial temporal areas/ hippocampus
causes of seizure kids
0-14 genetic, congenital malformation, trauma, neoplasm
causes of seizure >60yo
vascular (>50%), neoplasm, trauma infection, neurodegen.
kid stares~ daydream. no recollection. brought on by hyperventilation. EEG- 3cycle/s=3hz spike/wave pattern. if from complex partial seizure bc no post-octal state*
juvenile myoclonic epilepsy
myoclonic jerks-typically upon wakening. trigger by sleep deprivation- teenager has seizure after all nighter. MRI and neuro exam are normal. EEG- 4-6hz polyspike. no not remit so need to tx: depakote= keppra = first choice
seizure progress up body bf generalizing
always a sign of a focal seizure
primary generalized seizure
affect whole brain at once. lose consciousness. absence, atonic, tonic and tonic-clonic seizure.
focal neurologic deficit. usually weakness that persist for up to 24hr post seizure
seizure classification scheme. include type of seizure, their localization, freq, seq of events, circadian distribution, precipitating factors, age at onset, mode of inheritance, physical or mental sx, signs, prog, response to tx
landau kleffner syndrome
progressive aphasia in children. affect broker's and wenches' area. onset is seen btw 3-7yo. 80-85% kids show epileptiform activity during non-REM sleep- bilateral spike and wave discharges.
cortical tubers, ash leaf macules (hypo pig lesions- more apparent in UV light), gerd. tx with ACTH - prevent infantile spasms associated with TS by decr CRH made which causes excess excitability.
seizures here are called infantile spasms.
infant cry in pain and bend forward at trunk.
in infants. triad- infantile spasm, pathognomonic EEG (high amp wave and background of irreg spikes) called hypsarrhythmia, mental retardation.
tx: adrenocorticotropic hormone
2-6yo. hard to ctrl. multiple seizure types- tonic (stiffen body, upward deviation of eyes), atonic (brief loss of M tone and consciousness), atypical absence, myoclonic.
benign rolandic epilepsy/ epilepsy with centrotemporal spikes
most common epilepsy syndrome in kids. characterize by nocturnal seizures. centrotemporal spikes. rarely need tx. kids have few seizures and always remit by age 16.
lesion of hypothalamus cause laughing fits
recurrent epic of loss of consciousness in absence of emotional cue suggest cardiac etiology. many pt have convulsive mvt during syncope.
non epileptic seizure
aka pseudoseizure. dif mvt, lasting if amounts of time. suggested by conclusion in doctor's office or waiting room
syncope, TIA, migraines, mvt disorder, narcolepsy/ cataplexy, pseychiatric pathology/ non-epileptic seizure (NES), malingering. EEG can dd NES v epileptic event, focal v generalized. get vEEG
incr liver function test, pacreatitis, hirusitism, leukopenia, alopecia. wt gain- cause most discontinuation. most associated with neural tube defect in preg woman
anti seizure. CI: hx of kidney stones
anti-seizure. chronic use cause atrophy of cerebellum, swollen gum, weird teeth
anti-seizure. associated with steven johnson syndrome- life-threatening HS reaction affecting skin and mucous membrane. rash. to decr risk, titrate slowly to therapeutic dosase
simple febrile seizure
GTC that lasts for <1min and no seizure in 24hr
complex febrile seizure
seizure with focal features that lasts longer than 15min or recur in 24hr
3% will dev epilepsy. tx if complex, <15min, focal features, structural abn on imaging. strong family hx is not RF
sudden unexpected death in epilepsy pt. the sudden, unexpected, witness or unwitnessed, non-traumatic, non-drowning death of pt with epilepsy or w/wo evidence of seizure, excluding documented status epileptics and no structural air to cause of death. to prevent, if pt lose consciousness TC mvt, urinary incontinence and tongue biting, give lorazepam.
status epilepticus (SE)
life threatening condition. seizure >5-10min or recurrent without regaining consciousness btw seizure for >30min. bento = preferred initial management bc of rapid onset of action. IV phenytoin can't be given quickly due to risk for cardiac arrhythmia.
epilepsia partialis continua
persistent focal motor seizure. usually in hand and foot
ABC (airway/ O2, IV catheter with NS, blood sampling -glu, A-B eq, electrolytes), establish dx by clinical observation --> 5- 15min (IV lorazapem) --> 15-35min (phenytoin or fosphenytoin--> 35-45min (transfer to PICU, rapid seq intubation and ventilation, pentobarbital, EEG)
lowest dose. 33% need >1. if fail 1, success on 2nd is 10%.