Seizures and Syncope

Question 1

Syncope

Answer 1

means losing consciousness/passing out/fainting

the whole brain does not get blood

Question 2

___ is the most common cause of fainting

Answer 2

vasovagal

Question 3

Vasovagal

Answer 3

when brain overreacts to a trigger

brain shuts down heart (neurocardiogenic syncope)

Question 4

Triggers for vasovagal syncope

Answer 4

a lot

emotional stress
blood being drawn or sight of blood 
fear 
gastrointestinal illness
bowel movements 
heat 
pain 
standing for a long time 
standing up quickly 
trauma

Question 5

What is the most common cause of syncope in younger adults?

Answer 5

vasovagal

Question 6

Vasovagal warning features

Answer 6

diaphoresis (excessive sweating) 
tunnel vision 
dizziness/light headed
turning pale 
nausea

Question 7

Shaking/jerking caused by syncope is called

Answer 7

convulsive syncope

Question 8

How long before bouncing back to normal after syncope?

Answer 8

5 min

Question 9

Vasovagal tx

Answer 9

avoid triggers 
hydration 
volume expanders like fludrocortisone (steroid)- conserve fluids
vasoconstrictors like midodrine 
SSRIs in some pts

Question 10

Orthostatic hypotension

Answer 10

pass out after standing up

get dizzy when standing

Question 11

Orthostatic hypotension symptoms

Answer 11

pots- postural orthostatic tachycardia syndrome

dizziness 
heat palpitations 
sweating 
chest pain 
fatigue 
sob

Question 12

Orthostatic hypotension causes

Answer 12

hypovolemia-
cardiac impairment
vasodilation

Question 13

Postural hypotension

Answer 13

drop in systolic BP by 20 or diastolic by 10 after standing for 3 min

Question 14

What can cause syncope?

Answer 14

Medications

cardiac (arrhythmia)

Question 15

What test tests for POTS

Answer 15

tilt table test

Question 16

Carotid sinus syncope

Answer 16

common in elderly

slowing of HR and fall in BP
poor blood perfusion

Question 17

Myoclonus =

Answer 17

muscle jerk

seizure meds can make it worst

Question 18

Epilepsy is most commonly diagnosed by what ages?

Answer 18

before 20

after 65

Question 19

Epilepsy means at least __ seizures

Answer 19

2

Question 20

Seizure types

Answer 20

partial (small, remains conscious)

complex (confused, lose consciousness)

generalized= tonic clonic (all over, unconsciousness)

Question 21

Temporal lobe seizure symptoms cause

Answer 21

nausea and deja vu

Question 22

Frontal lob seizures cause

Answer 22

personality changes

Question 23

Generalized tonic- clonic seizure phases

Answer 23

tonic- shift

clonic- shake

post-ictal confusional fatigue- out

Question 24

Seizures typically have ___ symptoms for at least 15 minutes

Answer 24

post-ictal (post seizure)

Question 25

Seizures can result in

Answer 25

tongue biting incontinence

Question 26

_____ is weakness after a seizure

Answer 26

Postictal paralysis (Todd's)

Question 27

____ is when seizures last more than 5 minutes

Answer 27

status epilepticus

Question 28

What should you do when someone has a seizure?

Answer 28

Roll on side keep things away 2-3 minutes

Question 29

Generalized tonic- clonic seizure causes

Answer 29

``` brain tumor trauma alcohol or drugs low glucose, calcium or magnesium stroke ```

Question 30

What should be ordered for new onset seizure patients?

Answer 30

MRI brain with and without gadolinium -gliobastoma can cause seizures

Question 31

What can causes seizures?

Answer 31

anything that scars the brain ``` ischemic strokes head bleeds tumors hippocampal sclerosis atrophy tbi ```

Question 32

EEGs can ____ but cannot ____

Answer 32

can catch a seizure disorder cannot rule out a seizure

Question 33

Low ___, ____, and ____ can cause seizures

Answer 33

sodium magnesium calcium NOT potassium

Question 34

_________ are spells associated with emotional situations

Answer 34

psychogenic non epileptic seizures events correlate with normal EEG activity it is not faking a seizure !- it is how brain processes stress

Question 35

How long to seizures typically last?

Answer 35

1-3 min

Question 36

What type of seizure is the most common?

Answer 36

Partial then generalized and nonepileptic

Question 37

Eyes in stokes vs seizures

Answer 37

in strokes eyes are away from stroke side in seizures eyes are toward seizing side

Question 38

What three questions can you ask patients that have a breakthrough seizure?

Answer 38

miss doses of medications? how has sleep been? changes in stress?

Question 39

What medications can cause seizures?

Answer 39

wellbutrin (bupropion) abx tramadol

Question 40

Seizure tx starts after ____

Answer 40

2 spells

Question 41

What medication is great for headaches and seizures?

Answer 41

topiramate (topamax) se: forget words

Question 42

What seizure med is good for clinic but slow for hospitals

Answer 42

Lamictal (lamotrigine)- great med for mood and IQ | se: itchy rash

Question 43

What seizure med is good in hospitals because it works fast and does not hurt

Answer 43

Keppra (levetiracetam) | se: makes you cranky and depressed

Question 44

What meds are used in pregnancy for seizures?

Answer 44

Keppra (levetiracetam) | Lamictal (lamotrigine)

Question 45

What med if effective for seizures but causes weight gain?

Answer 45

Valproic acid (depakote) not good in pregnancy

Question 46

What med is good for trigeminal neuralgia and seizures?

Answer 46

carbamazepine/ tegretol

Question 47

What medications are typically not strong enough for seizures?

Answer 47

Gabapentin and lyrica (pregabalin) | se: leg swelling

Question 48

What meds are band-aids for seizures but fast?

Answer 48

benzos (ativan/lorazepam) and valium/midazolam

Question 49

What is used in the ICU for seizures?

Answer 49

propofol versed (midazolam) drip

Question 50

What med helps with seizures and essential tumors?

Answer 50

primidone

Question 51

What works like a pacemaker that stops seizures?

Answer 51

vagus nerve stimulator