Seizure Semiology

Question 1

Common viscero sensory aura associated with temporal lobe epilepsy

Answer 1

Rising epigastric sensation

Question 2

Common cognitive phenomena associated with temporal lobe epilepsy

Answer 2

Fear, déjà vu, jamais vu, visceral and auditory illusions, complex auditory or visual hallucinations

Question 3

An abrupt, explosive seizure onset is likely attributable to which lobe of the brain?

Answer 3

Frontal

Question 4

Postictal dysphasia in temporal lobe epilepsylateralizes to which hemisphere?

Answer 4

dominant hemisphere

Question 5

Post-ictal amnesia is a sign of

Answer 5

bilateral hippocampal impairment

Question 6

Dacrystic seizure localization

Answer 6

Temporal, hypothalamic

Question 7

Ictal/postictal speech impairments can be lateralized to

Answer 7

Language-dominant hemisphere

Question 8

Postictal nose wipe can be lateralized and localized to

Answer 8

tends to lateralize to the ipsilateral hemisphere in patients with temporal lobe epilepsy

Question 9

Where do complex visual hallucinations localize to?

Answer 9

Visual association cortex

Question 10

Cognitive features such as Déjà vu, and jamais vu, and emotional features such as panic and fear are common in what type of focal seizures?

Answer 10

common mesial temporal lobe seizures, formerly “psychic”

Question 11

Where does the “figure of 4” or “fencing” posture lateralize to?

Answer 11

hemisphere contralateral to the extended arm

Question 12

Where in the brain do somatosensory auras originate?

Answer 12

primary somatosensory area(unilateral) or supplementary sensorimotor (bilateral)

Question 13

What are three features that are indicative of lateral temporal lobe onset rather than mesial temporal lobe onset?

Answer 13

Vertigo, clonic movements, or simple auditory features such as buzzing or ringing early in a temporal lobe seizure and three features that suggest a lateral temporal onset

Question 14

Animated and sometimes violent organized complex motor behaviors such as thrashing or kicking localize to the _____ Cortex

Answer 14

Orbital frontal cortex

Question 15

Ictal spitting, vomiting, and coughing lateralize to which hemisphere?

Answer 15

right hemisphere

Question 16

Unilateral dystonic limp posturing in temporal lobe seizures lateralizes to which hemisphere?

Answer 16

contralateral hemisphere

Question 17

Where in the brain do simple auditory hallucinations such as ringing and buzzing originate?

Answer 17

for nondescript noise ,Heschel’s gyrus, within the superior temporal lobe. If more complex, temporal auditory association cortex

Question 18

Olfactory symptoms such as unpleasant burning smell originate in what area of the brain?

Answer 18

medial temporal

Question 19

Wherein the brain do gustatory sensations such as a bitter or bad taste originate?

Answer 19

Insula

Question 20

Localization for myoclonic seizures

Answer 20

Primary motor cortex, premotor cortex

Question 21

Localization for tonic seizures

Answer 21

primary motor cortex, premotor cortex, supplementary motor cortex

Question 22

Localization for clonic seizures

Answer 22

primary motor cortex, premotor cortex, supplementary motor cortex

Question 23

Localization for unilateral tonic-clonic seizures

Answer 23

primary motor cortex, premotor cortex, supplementary motor cortex-contralateral pre-motor and primary motor cortices

Question 24

Version is seen when a seizure spreads to what area of the brain

Answer 24

Frontal eye fields

Question 25

What is the duration of an epileptic spasm?

Answer 25

1-2 seconds

Question 26

What is the most common manifestation of the supplementary sensorimotor area (SSMA) seizures

Answer 26

bilateral, asymmetric tonic posturing with preserved awareness, especially “fencer’s posture” also known asM2e

Question 27

Unilateral ictal eye blinking lateralizes to which hemisphere?

Answer 27

ipsilateral hemisphere

Question 28

A focal impaired awareness seizure with mirthless laughter (gelastic) or crying (dacrystic) is highly suggestive of_______

Answer 28

hypothalamic hamartoma

Question 29

What is piloerection and where does it localize to?

Answer 29

errection of the hairs ofthe skin resulting in “goosebumps”. Strongly associated with temporal lobe epilepsiesincluding the insula and amygdala.

Question 30

Automatisms that typically involve the hands and mouth, such as lip smacking, chewing, and picking motions, tend to originate from which lobe of the brain?

Answer 30

Mesial temporal

Question 31

Which of the following sets of features suggest onset in the frontoparietal operculum? A)chewing, swallowing, salivation B) clonic jerking of the lower extremities C) auditory hallucinations like buzzing

Answer 31

A) chewing, swallowing ,salivation