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Flashcards in seizures, Cohen I Deck (46):
1

% population that will lose consciousness at least once in lifetime

50%

2

found down

slang loss of consciousness

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syncope

loss of consciousness from lack of blood flow to brain

4

faint

syncope likely vaso vagal
due to bradycardia and hypotension via vagus nerve

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seizure

neurological changes due to a sudden electrical discharge in brain

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important questions for someone who lost consciousness

light headedness, dizziness, loss of vision, nausea, sweating, pallor or gray color, shaking or convulsion, open or closed eyes, standing or lying or sitting positions, unprotected fall or gradual
duration of unconsciousness
speed of recovery to normal consciousness
previous LOC?

7

consciousness requires

functioning brain stem and one cerebral hemisphere

8

brain is absolutely dependent on

minimum blood pressure
glucose concentration
partial P of O2

9

what to make sure to measure in patient who suffers syncope

EKG

10

Vaso vagal syncope is caused by combination of

sympathetic withdrawal (vasodilation)
increased PAN activity (bradycardia)

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vaso vagal syncope precipitated by

-hot or crowded environment, ETOH, extreme fatigue, severe pain, hunger, prolonged standing, emotional or stressful situation
- church services, funerals, athletic activities
- blood drawing, insertion of IV line, dental work

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period unconsciousness in vaso vagal syncope

less than a minute
full recovery within 5 minutes

13

patient Sx vaso vagal syncope

cold and sweaty
light and woozy dizzy
vision dims
voice muffled
ears ring
palpitations
difficulty breathing
nausea
increased perspiration
numbness in hands

14

do vaso vagal syncope patients bite tongue or have urinary incontinence

no

15

CV syncope

decreased/insufficient CO caused by arrhythmias or structural cardiac abnormality

16

cardiac arrhythmias that can lead to CV syncope

bradyarrhythmias
tachyarrhythmias

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structural cardiac abnormality that can cause CV syncope

L ventricular myocardial path of various causes caused dec motility
flow obstruction

18

stroke volume impairments causing CV syncope

aortic stenosis
idiopathic subaortic hypertrophic cardiomyopathy
mitral valve prolapse

19

common cause syncope and sudden death in high school and college athletes

idiopathic subaortic hypertrophic cardiomyopathy

20

very common cause CV syncope in young women

mitral valve prolapse

21

cough syncope

repeated coughing
may increase thoracic P and lower venous return to right atrium

22

micturition syncope

elderly patients
almost always men who stand to urinate late at night
LOC due to vagal response needed to urinate in patients who are sleepy

23

other disorders that may resemble syncope

hypoglycemia
anemia
hypoxia
diminished CO2 d/t hyperventilation
anxiety attacks
hysterical fainting
seizure

24

seizure

widespread electrical discharge originating in neurons in cerebral Cx causing abrupt loss or decline in consciousness, new movements, altered bodily sensation or unusual psychic feeling

25

what mediates seizures

ion channels
Na K Ca and NT
glutamate, GABA

26

Epilepsy

2+ spontaneous seziures
unprovoked!!

27

Lunatic definition

patient with seizure once a mo

28

preferred term to epileptics

seizure disorder

29

2 most common causes of provoked seizures

1 hypoglycemia
2 alcohol withdrawal (less than 48 hours after stopped drinking)

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common causes provoked seizures

hypoNa, hypoMg, hypoCa
hypoxia
fever
benzo withdrawal
illicit drugs
prescription drugs
head trauma
brain tumors
brain hemorrhages
strokes

31

idiopathic epilepsies

have seizures for unknown reasons

32

patient with first seizures should be evaluated for

full Hx
physical exam
neuro exam
MRI of brain and full blood tests

33

Dx seizure disorder

unless strong evidence from Hx, due to reliable witnesses of 2+ unprovoked seizures

34

can seizure patient have normal EEG

yes

35

partial seizure

1 cerebral hemisphere "focal"

36

generalized tonic clonic seizure

grand mal

37

status epilepticus

1 seizure after another

38

when do generalized tonic clonic seizures begin

adolescence and in 20s
never in infants <5 mo

39

before tonic clonic seizure

aura

40

tonic phase of generalized seizure

clenching or tightening of mm in fixed position
arms flexed, legs extended
breathing mm can lock
mouth can close quickly causing biting of tongue or lip
loss of urinary and rarely bowel continence

41

eyes roll up and open at start of seizure

tonic clonic seizure

42

clonic phase generalized seizure

repetitive synchronous movements of the arms and or legs

43

tonic clonic seizure time duration

lasts 2 minutes with gradual slowing of movements
respiration resumes
unresponsive for 5+ minutes
slowly gain orientation after
no memory of seizure
may be combative or agitated at time

44

post ictal seizure

confusion for hours after tonic clonic seizure

45

vitals for tonic clonic seizures

HR increase
O2 saturated
BP increase
pupils dilate no reaction to light
metabolic acidosis with decline in HCO3

46

Todds paralysis

patients remain weak on one side for another day due to seizures focus itself