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Neurology Clinical > Seizures > Flashcards

Seizures Flashcards

(45 cards)

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1
Q

What are the 3 categories of causes of syncope?

A

Reflex - bloods being taken, cough
Orthostatic - hypotension, dehydration, medication related (anti hypertensive), endocrine, ANS
Cardiogenic - arrhythmia, aortic stenosis

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2
Q

What are the typical things a patient will tell you of an account of syncope?

A 
They will have a very brief episode and will recover quickly - usually whilst still on the floor
Felt light headed, clammy, blacking out
Fully orientated quickly 
Urinary incontinence
Aborted by sitting
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3
Q

What is epilepsy?

A

Tendency to have recurrent unprovoked seizures

Neurones have a background activity and if this is disrupted then we can have a seizure

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4
Q

When is epilepsy diagnosed after 1 seizure?

A

A scan which shows high risk of recurrence i.e. stroke or tumour in part of the brain
Or an EEG which shows a tendency to seizures

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5
Q

What are the 2 main groupings of epilepsy and what are the differences between the 2?

A

Generalised seizures - electrical activity occurs across the whole brain
Focal seizures - electrical disturbance just happens in one part of the brain

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6
Q

In what age of patients is primary generalised mostly found in?

A

<20

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7
Q

What can put someone at risk of having generalised tonic clinic seizures early on in life?

A

Meningitis
Birth complications
Brain injuries
Trauma

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8
Q

What are the symptoms signs of juvenile myoclonus epilepsy?

A

Can have Absence and generalised tonic clonic seizures

Will have early morning myoclonus (brief jerks in limbs, drop things in the morning)

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9
Q

What investigations will the neurology clinic carry out to investigate referrals?

A

EEG
MRI
CT
Video telemetry

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10
Q

What is the first line treatment for primary generalised epileptics?

A

Sodium valproate
Lamotrigine
Levetiracetam

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11
Q

What is the acute treatment for a seizure?

A

Lorazepam / diazepam

Phenytoin / valporate

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12
Q

What anti epileptic drug shouldn’t be used in pregnancy?

A

Sodium valproate

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13
Q

What is the first line treatment for focal and secondary generalised seizures?

A

Lamotrigine
Carbamezapine
Levetiracetam

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14
Q

If someone has a single seizure when can they drive agin?

A

After 6 months if they have no further seizures and investigations are normal

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15
Q

What is status epilepticus?

A

Prolonged or recurrent tonic clonic seizures persisting for more than 30 mins with no recovery period between seizures

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16
Q

What is the first line treatment for status epilepticus?

A

Midazolam
Lorazepam
Diazepam

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17
Q

What is non-convulsive status epilepticus?

A

Prolonged unresponsiveness following a seizure

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18
Q

What is the typical history of a cardiogenic syncopal episode?

A 
Syncope on exertion
May have chest pain, palpitations, SOB
Comes round fairly quickly
May be sweaty/clammy
Unable to feel pulse 
May have few brief jerks
Rapid recovery
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19
Q

What things provoke seizures?

Study These Flashcards
A 
Alcohol withdrawal 
Drug withdrawal
Few days after head injury
Within 24hrs stroke
Within 24hrs brain surgery
Severe electrolyte disturbance 
Eclampsia
20
Q

Describe an absence seizure?

Study These Flashcards
A

Often in children and are unaware of them
May be provoked by hypoventillation / photic stimulation
Sudden arrest of activity for a few seconds - staring, may have eye fluttering

21
Q

What are the types of generalised seizures?

Study These Flashcards
A

Generalised tonic clonic seizure
Absence seizure
Myoclonic seizures
Atonic seizures

22
Q

What are juvenile myoclonic seizures provoked by?

Study These Flashcards
A

Alcohol

Sleep deprivation

23
Q

What type of seizures does a patient with juvenile myoclonic epilepsy have?

Study These Flashcards
A

Absence seizures

Generalised tonic clonic seizures

24
Q

What is a typical feature of juvenile myoclonic epilepsy?

Study These Flashcards
A

Early morning myoclonus

25
What are the types of focal seizures?
Secondary generalised Simple partial Complex partial
26
What might a patient feel before a complex partial seizure?
Rising feeling in their stomach Funny smell/taste De ja vu
27
What is the presentation of a complex partial seizure?
Sudden arrest in activity Staring into space Automatisms i.e. limp smacking, repetitive picking at clothes
28
What is the first line treatment for secondary generalised eizures?
Carbamezapine Lamotrigine Levetiracem
29
What is the first line treatment for status epilepticus?
Midazolan Lorazepam Diazepam
30
Mortality is highest in status epilepticus if it occurs after....
Stroke Encephalitis Mass lesion Trauma
31
What is the percentage of mortality in status epilepticus?
5-10%
32
What is a pseudoseizure?
Non epileptic attack Psychological attack No abnormal brain activity
33
What is a pseudoseizure like?
Psychological attack, may occur at times of stress or rest Patients will give lots of details of what’s going on around them but little of themselves May describe dissociation Patient retains awareness - tracking eye movements Movements not typical of a seizure i.e. pelvic thrusts, asynchronous movements, tremor
34
How would you diagnose a seizure as a pseudoseizure?
Clinical features of the attack | Try and catch typical episode on EEG as it will show no abnormal brain activity
35
What factors influence seizure risk?
``` Alcohol / drug use Drug interactions Hormonal changes Sleep disturbance, fatigue Photic stimulation (other rare triggers include noise & patterns) Stress/anxiety ```
36
State 3 side effects of the drug phenytoin.
Arrhythmias Hepatitis Medication interactions (releases liver enzymes so make other drugs ineffective)
37
State the side effects of sodium valproate.
``` Tremor Weight gain Ataxia Nausea Drowsiness Hepatitis Teratogenic ```
38
State side effects of carbamezapine.
``` Low serum Na Nystagmus Blurred vision Ataxia Drowsiness Skin rash ```
39
State the side effects of lamotrigine.
Skin rash | Difficulty sleeping
40
State the side effects of levetiracetam.
Irritability | Depression
41
What anti-epileptic drugs can cause hepatitis?
Sodium valproate | Phenytoin
42
What anti-epileptic drugs can cause drowsiness?
Carbamezapine | Sodium valproate
43
What anti-epileptic drug can cause other drugs to become ineffective and why?
Phenytoin | Because it releases liver enzymes
44
What anti-epileptic drugs cause ataxia?
Sodium valproate | Carbamezapine
45
in the event of status epileptics, why may midazolam be the first line treatment of choice before diazepam?
because of the route of administration; midazolam can be given buccal or nasal whereas diazepam has to be IV or rectal therefore more uncomfortable for the patient

Neurology Clinical (21 decks)

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