Transient Loss of Consciousness Flashcards by Aishani Somaiya

what is epilepsy?

tendency to have seizures = a transient episode of ABNORMAl electrical activity in the brain

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what is the post-ictal period

prolong period of confusion, drowsiness, irritability and disorientation following a seizure

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what is the pathophysiology of seizures?

look in notes for synapses and receptor notes

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what are generalised tonic clonic seizures, and how are they managed?

USUALLY starts on both sides of brain

LOC
Tonic (muscle tensing)
Clonic (muscle jerking) movements 
Tonic phase comes before clonic phase
Tongue biting, incontinence, groaning and irregular breathing
After seizure: post-ictal period

Management of tonic-clonic seizures:
First line: sodium valproate
Second line: lamotrigine or carbamezapine

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what are focal seizures?

affects just ONE part of brain

starts in temporal lobes

Affect hearing, speech, memory and emotions
Various ways that focal seizures can present
 Hallucinations
 Memory flashbacks
 Déjà vu
 Doing strange things on autopilot

Management:
First line: carbamezapine (or lamotrigine)
Second line: sodium valproate or levetiracetam

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what are absence seizures?

Typically in children
Patient becomes black, stares into space and returns to normal quickly
During episode: unaware of surroundings and won’t respond
Only lasts 10-20s
Most patients stop having absence seizures as they get older

Management:
 Sodium valproate or ethosuximide

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what are atonic seizures?

Drop attacks
Characterised by brief lapses in muscle tone
Usually lasts less than 3 minutes
Typically begins in childhood

Management:
 1st line sodium valproate
 Second line lamotrigine

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what are myoclonic seizures (part of generalised)

Sudden brief muscle contractions like a sudden jump
Patient usually remains awake during the episode
Occur in various forms of epilepsy but typically happen children as part of juvenile myoclonic epilepsy

Management:
 1st line: sodium valproate
 Others: lamotrigine, levetiracetam, topiramate

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what are infantile spasms?

West syndrome
Rare disorder starting around 6 months of age 
Full body spasms = clusters 
Poor prognosis: 1/3 die by age 35
o	First line: prednisolone
o	Second: vigabatrin

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what are febrile convulsions?

seizures in children age 6m to 5y who have a fever simultaneously

not caused by neuro pathology

no lasting damage

but slight increase risk for future epilepsy diagnosis

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what are alcohol withdrawal seizures and how do you manage or prevent them

patients w history of alcohol excess who suddenly stop drinking

seizures occur around 36h following cessation

give benzos following cessation of drinking to reduce the risk

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what is the pathophysiology of alcohol withdrawal seizures

chronic alcohol consumption = enhances GABA and inhibits NMDA glutamate

withdrawal = opposite so inhibition of GABA is decreased and increased NMDA glutamate

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what are non-epileptic seizures / seizure disorder

present with epileptic like seizures but no characteristic electrical discharges

patients may have a history of mental health problems or a personality disorder

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what are other, rare causes of seizures?

migranous events
vestibular disorders
cerebrovascular disorders
sleep disorders

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what investigations would you do for a seizure?

history 
EEG
MRI brain
ECG to exclude heart problems
electrolytes, blood glc, blood cultures where sepsis or encephalitis is suspected

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when do you offer an EEG and what is it?

electroencephalogram of brain

perform after 2nd simple tonic clonic seizure in adults, or 1 for kids

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what is the DVLA advice for people with epilepsy?

6 months seizure free if isolated

or 12 months seizure free if epileptic patient

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what is the aim of AEDs

to raise seizure thershold and reduce patients risk of having a seizure

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what are the side effects of sodium valproate

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Teratogenic – hence MUST be avoided in girls unless there are no suitable alternatives – make sure they are on contraception and will NOT get pregnant
Liver damage and hepatitis
Hair loss
Tremor

what are the side effects of carbamezapine?

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Agranulocytosis
Aplastic anaemia
Induces the P450 system so there are many drug interactions

what are the side effects of phenytoin?

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Folate and vitamin D deficiency
Megaloblastic anaemia (folate deficiency)
Osteomalacia (vitamin D deficiency)

what are the side effects of ethosuximide?

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night terrors and rashes

what are the side effects of lamotrigine?

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DRESS syndrome (life threatening skin rashes)

leukopenia

what is the mechanism of sodium valproate and benzos?

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increases GABA activity in brain by reducing metabolism of GABA transaminase

also enhances GABA receptors

blocks sodium and calcium channels

what is the mechanism of action of lamotrigine?

blocks sodium channel in presynaptic membrane and also acts on calcium channels (so does pregabalin)

what is the mechanism of action of levetiracetam?

acts on synaptic vesicle 2 and inhibits discharge of NT onto synaptic cleft

what are some behaviours indicative of non-epileptic attack disorder? helps to differentiate from epilepsy

v gradual onset or termiantion pseudosleep discontinous irregular activity like side to side movement, stuttering, weeping unresponsiveness and eye closure - non cyanosed, no incontinence

how do you treat acute seizures?

put patient on floor in recovery position if possible something soft under head note time and end of seizure call ambulance if 1st seizure or lasting more than 4 mins patients may have been prescribed benzos so family can administer

what is status epilepticus

medical emergency = seizures lasting more than 5 minutes or > 2 seizures within a 5 minute period without person returning to normal between them

what is the priority in management of a seizure and why

terminating it, bc prolonged = irreversible brain damage

how do you manage status epilepticus in a hospital?

Secure the airway Give high-concentration oxygen Assess cardiac and respiratory function Check blood glucose levels Gain intravenous access (insert a cannula) IV lorazepam, repeated after 10 minutes if the seizure continues If seizures persist then infuse IV phenytoin, consider intubation and ventilation, and ICU care

what do you do if a seizure cannot be stopped and it has been 45 minutes?

induction of general anaesthesia

what is syncope

defined as a transient loss of consciousness due to global cerebral hypoperfusion rapid onset, short duration and spontaneous complete recovery

what are the main questions you ask in a syncope history?

pre syncopal symptoms (cold, dizzy, abnormal taste, deja vu) what were you doing before how did you feel after, and where did you wake up? eye witness history: twitching, colour change concurrent illness - fever, infection secondary injuries palpitations or chest pain neuro symptoms happened before? FH cardiac problems or sudden death

3 ways of classifying syncope

reflex orthostatic cardiac

what is reflex syncope

vasovagal: triggered by emotion, pain or stress. 'fainting' ANS has a problem regulating BF to the brain vagus nerve receives signal of pain or stress - stimulates the PNS which counteracts ANS and hence blood vessels relax o situational: cough, micturition, gastrointestinal o carotid sinus syncope

what is orthostatic syncope

primary autonomic failure: Parkinson's disease, Lewy body dementia secondary autonomic failure: e.g. Diabetic neuropathy, amyloidosis, uraemia drug-induced: diuretics, alcohol, vasodilators volume depletion: haemorrhage, diarrhoea

what is cardiac syncope

arrythmias, tachycardias structural: valvular, MI, hypertrophy PE low BP

what changes would you see on an ECG in cardiac syncope

QRS complexes may suddenly stop or change during that specific period Eye-roll and slump back is textbook characteristic

what are the primary causes of syncope?

dehydration, missed meals, extended standing in warm environment

what are the secondary causes of syncope

``` hypoglylcaemia anaemia infection anaphylaxis cardiac ```

what are the signs and symptoms of syncope

``` • Prodrome = remember in event or how you felt before • Hot or clammy • Sweaty • Dizzy and lightheaded • Vision going blurry or dark - falling to ground ```

what investigations would you do for syncope?

CV exam • postural blood pressure readings: a symptomatic fall in systolic BP > 20 mmHg or diastolic BP > 10 mmHg or decrease in systolic BP < 90 mmHg is considered diagnostic • ECG • tilt table test • 24 hour ECG • Bloods: FBC for anaemia, electrolytes, blood glucose

what are the differences between seizures and syncope?

look at table in notes

how do you manage syncope

lifestyle: water, avoid missing meals etc during episode: sit or lie down, water and food

Transient Loss of Consciousness Flashcards

(45 cards)