seizures and LOC

Question 1

Activation of NMDA receptors leads to influx of

Answer 1

Na+ and Ca2+

Question 2

Activation of Kainate and AMPA receptors leads to influx of

Answer 2

Na+
Variable Ca2+

Question 3

Activation of NMDA, Kainate, and AMPA receptors leads to efflux of

Answer 3

`K+

Question 4

postsynaptic kainate receptor allows for

Answer 4

excitation

Question 5

presynaptic kainate receptor allows for

Answer 5

inhibition by inhibiting the release of GABA

Question 6

IPSP for GABA-A receptor

Answer 6

-70 mV

Question 7

IPSP for GABA-B receptor

Answer 7

-100 mV

Question 8

binding of GABA-A receptor leads to influx of

Answer 8

Cl-

Question 9

binding of presynaptic GABA-B receptor leads to

Answer 9

decreased Ca2+ influx

Question 10

binding of postsynaptic GABA-B receptor leads to

Answer 10

increased K+ efflux

Question 11

what med binds to GABA-A receptor

Answer 11

BZDs

Question 12

what cardiac issues do we see in status epilepticus

Answer 12

high output cardiac failure
ventricular arrhythmias

Question 13

ventricular arrhythmia in status epilepticus is due to

Answer 13

incongruent signals from parasympathetic and sympathetic

Question 14

skeletal muscle contractions during status epilepticus and effect on metabolism

Answer 14

skeletal muscle contractions increase metabolism

Question 15

increased metabolism in status epilepticus leads to

Answer 15

increased lactic acid production

Question 16

muscle breakdown in status epilepticus causes

Answer 16

hyperkalemia

Question 17

hyperkalemia in status epilepticus causes

Answer 17

potassium is unable to efflux from neurons so the cell is unable to hyper polarize

Question 18

muscle breakdown can also damage what organ

Answer 18

kidneys

Question 19

is the diaphragm contracted or relaxed in status epilepticus

Answer 19

diaphragm contraction

Question 20

do we see hyper or hypoventilation during status epilepticus

Answer 20

hypoventilation

Question 21

hypoventilation causes us to switch to

Answer 21

anaerobic metabolism

Question 22

anaerobic metabolism increases

Answer 22

lactic acid

Question 23

does hypoventilation cause respiratory acidosis or alkalosis

Answer 23

hypoventilation causes respiratory acidosis

Question 24

increased pulmonary pressure causes

Answer 24

pulmonary edema

Question 25

why do we have hypoglycemia in later stages of status epilepticus

Answer 25

insulin > available glucose

Question 26

how does vasodilation affect cerebral blood flow

Answer 26

vasodilation --> decreased cerebral blood flow

Question 27

if parasympathetic is activated in status epilepticus, what will we see in terms of our bowels

Answer 27

detrusor muscle contraction --> urination defecation reflex activation --> defecation

Question 28

what lowers the threshold and causes a seizure after a stroke

Answer 28

changes in ions related to ischemia excessive glutamate alteration in penumbra tissue

Question 29

what type of stroke has a greater risk of seizure

Answer 29

multi-infarct stroke

Question 30

patients who develop seizure 2 weeks post stroke are more likely to develop epilepsy. this may be related to

Answer 30

glial scarring

Question 31

where is the reticular activating system located

Answer 31

brainstem

Question 32

in decorticate posturing, where is the lesion located

Answer 32

above the red nuclei = above midbrain

Question 33

in decerebrate posturing, where is the lesion located

Answer 33

below the red nuclei = below midbrain

Question 34

which has a worse prognosis between decerebrate and decorticate posturing

Answer 34

decerebrate posturing has a worse prognosis

Question 35

what pathways are damaged in both decerebrate and decorticate posturing

Answer 35

descending motor pathways

Question 36

if descending motor pathways are damaged in decerebrate and decorticate posturing, what does this mean in terms of our muscle tone?

Answer 36

increased tone due to decreased inhibition from those pathways

Question 37

is brainstem function present in decorticate and decerebrate posturing?

Answer 37

yes, some brainstem function is present in both

Question 38

what cranial nerves are connected through MLF

Answer 38

3, 4, 6

Question 39

what else is connected through MLF besides cranial nerves

Answer 39

vestibular nuclei upper cervical nuclei

Question 40

what does the MLF do

Answer 40

yokes eye movements (conjugate gaze)

Question 41

before checking the oculocephalic reflex, what should you check FIRST

Answer 41

make sure no cervical injury!!!!

Question 42

how to perform oculocephalic reflex

Answer 42

hold eyelids open move head from side to side

Question 43

during the oculocephalic reflex, if the brainstem is intact, what would we expect

Answer 43

eyes will move in opposite direction of head rotation

Question 44

if brainstem is intact for oculocephalic reflex, what is this reflex called (street name)

Answer 44

doll's eye response/reflex

Question 45

for oculocephalic reflex, if brainstem is injured, what would we expect

Answer 45

eyes are fixed in MIDPOSITION and will move with head

Question 46

can an awake and non-injured person overcome oculocephalic reflex?

Answer 46

YES -- no doll's eye reflex in awake and uninjured patient

Question 47

oculovestibular testing: cold calorics has two components. what are they

Answer 47

fast component slow component

Question 48

fast component of oculovestibular testing: cold calorics

Answer 48

nystagmus is directed AWAY from ear stimulated

Question 49

slow component of oculovestibular testing: cold calorics

Answer 49

eye movement TOWARD cold

Question 50

what would a normal response be fore oculovestibular testing: cold calorics

Answer 50

both components present both are in appropriate directions

Question 51

in an unconscious patient, and the brainstem is intact, what would we expect for oculovestibular testing: cold calorics

Answer 51

slow response is PRESENT toward cold fast response is ABSENT BOTH eyes respond

Question 52

why do both eyes respond in oculovestibular testing: cold calorics in an unconscious patient when brainstem is intact

Answer 52

MLF is intact

Question 53

what would you expect for oculovestibular testing: cold calorics in unconscious patient who has a brainstem lesion

Answer 53

both components are ABSENT eyes remain in fixed position

Question 54

why do eyes remain in fixed position for oculovestibular testing: cold calorics in patient who is unconscious and brainstem is injured

Answer 54

MLF is not intact