Seizures amp Syncope
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Seizures & Syncope Refer to Chapter 8 of Clinical Neurology Textbook
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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
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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
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Seizures Disorders characterized by transient disturbance of cerebral fcn caused by excessive or over synchronized cerebral neuronal discharges.
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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
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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
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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
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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)
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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
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Seizures Classification Generalized Tonic-Clonic Absence Clonic Myoclonic Atonic Partial Simple Complex
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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
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Seizures Generalized Status Epilepticus: Continuous seizures for > 30 min or if they reoccur so frequently that consciousness does not return Medical emergency
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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
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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
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Seizures Partial Simple: Motor, sensory, or autonomic phenomena common Jacksonian March Autonomic Phenomena Consciousness is not lost Todd’s Paralysis may occur
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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
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Seizures Diagnosis Based on clinical recognition EEG is confirmatory Standard Evaluation Includes: Hx GPE Complete Neurological Exam Blood Studies EEG & MRI
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Syncope Episodic loss of consciousness associated w/ loss of postural tone due to hypo perfusion of the brainstem.
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Syncope Vasovagal Syncope: AKA: Simple faints Precipitating Factors Pain Fatigue Sight of blood Pathophysiology Vagus stimulation
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Syncope Vasovagal Syncope Order of Events: Pt in standing or sitting position (rarely horizontal) Prodromal Symptoms (lasts <10 s – few minutes) Pt falls Unconsciousness Recovery Postictal Phase
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Syncope Cardiovascular Syncope Pathophysiology Causes: (Table 8-10) Indicated
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Syncope Orthostatic Hypotension Demographics Men > women 60-70’s yoa Occurs: Standing rapidly from seated position Standing motionless for long periods Standing after prolonged recumbency
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Syncope Orthostatic Hypotension Pathophysiology 2 Neurological Causes: Idiopathic Orthostatic Hypotension Shy-Drager Syndrome:
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Seizures & Syncope. Refer to Chapter 8 of. Clinical Neurology Textbook. Approach to Diagnosi
Seizures & Syncope. Refer to Chapter 8 of. Clinical Neurology Textbook. Approach to Diagnosis. Rule out serious conditions; Episodes: ...
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