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Seizures & Syncope

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Slide 1 :

Seizures & Syncope Refer to Chapter 8 of Clinical Neurology Textbook

Slide 2 :

Approach to Diagnosis Rule out serious conditions Episodes: Number of episodes Are repeated episodes similar

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Approach to Diagnosis History: A detailed Hx of the pre-episode s/s will help localize the CNS abnormality responsible for the episode Phenomena @ Onset Generalized seizure Contralateral Fronto-parietal seizure Temporal Lobe seizure Cerebral hypo-perfusion ONLY

Slide 4 :

Approach to Diagnosis Events During the Spell: Grand mal or major motor seizures Cerebral Hypoperfusion Posture During the Spell: Orthostatic hypotension, simple faints Seizure or cardiac arrhythmia

Slide 5 :

Seizures Disorders characterized by transient disturbance of cerebral fcn caused by excessive or over synchronized cerebral neuronal discharges.

Slide 6 :

Seizures Epilepsy Group of disorders characterized by recurrent seizures Common cause of episodic loss of consciousness 3% incidence in the general population Etiology: 1o Neurological Disorder Metabolic derangement Systemic disease

Slide 7 :

Seizures Primary Neurological Disorders Benign Febrile Seizures: Occurs in children 3 month-5 yoa MC during 1st day of febrile illness No CNS infection Duration < 15 min Episode lacks focal features 66% of children experience only 1 episode Generally self-limiting

Slide 8 :

Seizures Primary Neurological Disorders Idiopathic Epilepsy: No specific cause Account for 75% of all seizure disorders Onset: 5-25 yoa 75% have 1st episode before the age of 18 Head Trauma: Common cause esp. if assoc. w/ Perinatal injury (28wks-28 dys) Intracerebral or subdural hematoma If occur w/i 1st wk after non-penetrating injury is not predictive of a chronic problem

Slide 9 :

Seizures Primary Neurological Disorders Stroke: Account for 5-15% of cases Can occur w/ thrombotic or embolic infarction or w/ intracerebral hemorrhaage Assoc w/ Arteriol Venous Malformations (AVM)

Slide 10 :

Seizures Metabolic Disorders Hypoglycemia: levels of 20-30 ng/dl or rapid rate of fall Hyponatremia: Na levels < 120 meq/l Hypocalcemia: Ca levels of 4.3-9.2 mg/dl Uremia: esp if it develops rapidly

Slide 11 :

Seizures Classification Generalized Tonic-Clonic Absence Clonic Myoclonic Atonic Partial Simple Complex

Slide 12 :

Seizures Generalized Tonic-Clonic: Attacks in which consciousness is lost usually w/o aura Four Phases: Prodromal Phase Tonic Phase

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Seizures Generalized Tonic-Clonic: Four Phases: Clonic Phase Recovery Phase

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Seizures Generalized Tonic-Clonic: Labs CO2 Glucose Prolactin Causes Systemic Disease Drugs

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Seizures Generalized Tonic-Clonic: Duration:< 1 minute Complications: Oral & Head Trauma Vertebral Body Stress Fx Sudden Death Prognosis

Slide 16 :

Seizures Generalized Status Epilepticus: Continuous seizures for > 30 min or if they reoccur so frequently that consciousness does not return Medical emergency

Slide 17 :

Seizures Generalized Absence: Genetically transmitted Onset: childhood – always Rarely continues into adolescence Two Types: Typical Atypical

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Seizures Generalized Tonic: Continued muscle contraction Fixation of Limbs Arrest of Respiration Occurrence & Duration Cause drop attacks Consciousness is lost No Clonic Phase

Slide 19 :

Seizures Generalized Clonic: Repetitive clonic jerking accompanied by loss of consciousness No initial tonic component Myoclonic: Sudden Contractions that are localized to a few muscles or 1 or more extremitities or that may have a more generalized distribution

Slide 20 :

Seizures Partial Simple: Motor, sensory, or autonomic phenomena common Jacksonian March Autonomic Phenomena Consciousness is not lost Todd’s Paralysis may occur

Slide 21 :

Seizures Partial Complex: Consciousness, responsiveness, or memory impaired MC arises from a lesion in the temporal or medial frontal lobe Prodromal Events Duration Motor manifestations – Automatism

Slide 22 :

Seizures Diagnosis Based on clinical recognition EEG is confirmatory Standard Evaluation Includes: Hx GPE Complete Neurological Exam Blood Studies EEG & MRI

Slide 23 :

Syncope Episodic loss of consciousness associated w/ loss of postural tone due to hypo perfusion of the brainstem.

Slide 24 :

Syncope Vasovagal Syncope: AKA: Simple faints Precipitating Factors P

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Seizures & Syncope. Refer to Chapter 8 of. Clinical Neurology Textbook. Approach to Diagnosi more Seizures & Syncope. Refer to Chapter 8 of. Clinical Neurology Textbook. Approach to Diagnosis. Rule out serious conditions; Episodes: ... less

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