Neurology. Seizure

Август 22, 2022

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Neurology. Seizure

Содержание

2. Seizure
3. Seizure and epilepsy Seizure An acute, transient neurological event caused by abnormal electrical discharge within the
4. Causes of seizure Vascular Infection Trauma Autoimmune Metabolic Ingestion/withdrawal Neoplasm pSych General vs Partial(focal) Complex vs
5. Epilepsy SIMPLE Small area of the brain Strange sensation Jerking movements Jacksonian march Often remember COMPLEX
6. Epilepsy
7. Epilepsy Stages Prodromal When symptoms start to appear prior to the big event Aura Does not
8. Status epilepticus Seizure lasts more than 5 min Ongoing or without returning to normal Usually tonic-clonic
9. Epilepsy Diagnosis Symptoms Medical history EEG Genetic testing Brain imaging: MRI, CT Treatment Daily medications Anticonvulsants
10. Epilepsy treatment
11. Stroke Damage to part of the brain caused by a problem with the blood supply There
12. Stroke ISCHEMIC Death of tissue due to blockage by Thrombotic – atherosclerotic plaque Embolic – any
13. Stroke
14. Transient ischemic attack Effects last no longer than 24 hours from onset or the symptoms start
15. Stroke The right cerebrum controls muscles on the left & vice versa
16. Stroke Feets and legs Hands, arms, face and speech Visual cortex coordination
17. Stroke Diagnosis and Treatment CT scan of the head +blood to drop blood pressure a lot;
18. Stroke Acute tPA (tissue plasminogen activator) For Ischemic Stroke! Dissolve the clot by activating the protein
19. Hemorrhage
20. Hemorrhage Subarachnoid hemorrhage Causes by aneurysm (leaks or bleeds) Thunder clap headache (suddenly and maximally intensive),
21. Hemorrhage Treatment: BP coil or clip Hydrocephalus: serial lumbar punctures, VP shunt Seizure prophylaxis: levetiracetam Increased
22. Hemorrhage Intraparenchymal Caused by hypertension Focal neurologic deficit, headache, nausea and vomiting, coma Diagnosis: CT scan
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Seizure

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Seizure and epilepsy
Seizure
An acute, transient neurological event caused by abnormal

electrical discharge within the brain

Status epilepticus
Seizure activity that fails to terminate within the anticipated time period or it refers to a series of consecutive seizures without recovery in between them

Epilepsy
Syndrome or recurrent, unprovoked seizures

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Causes of seizure
Vascular
Infection
Trauma
Autoimmune
Metabolic
Ingestion/withdrawal
Neoplasm
pSych
General vs Partial(focal)
Complex vs Simple
Atonic
Myoclonic
Absence
Trigeminal neuralgia
Type of seizure

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Epilepsy
SIMPLE
Small area of the brain
Strange sensation
Jerking movements
Jacksonian march
Often remember
COMPLEX
Loss consciousness

Impaired awareness and responsiveness
Not remember

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Epilepsy

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Epilepsy
Stages
Prodromal
When symptoms start to appear prior to the big event
Aura
Does

not happen with all types
Focal seizures or tonic-clonic types

Ictus
Actual seizure 1-3 min
Greater >5 min or back-to-back
Status Epilepticus
Post Ictus/Postictal state
After the seizure
Takes hours to days
Todds paralysis

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Status epilepticus
Seizure lasts more than 5 min
Ongoing or without returning to

normal
Usually tonic-clonic
Treatment: benzodiazepines
(enhance GABA)

20XX

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Epilepsy
Diagnosis
Symptoms
Medical history
EEG
Genetic testing
Brain imaging: MRI, CT
Treatment
Daily medications
Anticonvulsants
Epilepsy surgery
Remove cause of problem
Nerve

stimulation
Stimulate vagus nerve
Ketogenic diet

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Epilepsy treatment

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Stroke
Damage to part of the brain caused by a problem with

the blood supply
There is a blockage or burst
Usually happens quickly

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Stroke
ISCHEMIC
Death of tissue due to blockage by
Thrombotic – atherosclerotic plaque
Embolic –

any other (fat, cholesterol, blood platelets, stenosis)
Much more common
Damage depends on location and time

HEMORRHAGE

When an artery in the brain breaks, creating a pool of blood that damage the brain
Bleeding in the brain
Due to burst blood vessel

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Stroke

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Transient ischemic attack
Effects last no longer than 24 hours from onset

or the symptoms start to resolve within 1-20 min
Minimal long-term damage
The FAST test helps people t o quickly recognize

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Stroke
The right cerebrum controls muscles on the left & vice versa

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Stroke
Feets and legs
Hands, arms, face and speech
Visual cortex
coordination

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Stroke
Diagnosis and Treatment
CT scan of the head
+blood to drop

blood pressure a lot; neurosurgery: to coil, clip or craniotomy; give fresh frozen plasma
-blood less than 3-4,5 hours tPA
ECG – Atrial fibrillation, Atrial flutter. Warfarin, NOAC
ECHO – Thrombose. Warfarin, NOAC, heparin bridge
Carotid u/s –Carotid artery stenosis. Carotid endarterectomy stenting

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Stroke Acute
tPA (tissue plasminogen activator)
For Ischemic Stroke! Dissolve the clot by

activating the protein that cause fibrinolysis
Given within 3 hours (3-4,5) from onset
Criteria: CT scan negative, labs within normal limits (glucose, INR, platelets), BP controlled <180/105; hasn’t recently receive (heparin or other anticoagulants), any recent surgery
Aspirin Prevent more clots – Aspirin 325mg
Surgery Mechanical Embolus Removal in Cerebral Ischemia; Suction removal

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Hemorrhage

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Hemorrhage
Subarachnoid hemorrhage
Causes by aneurysm (leaks or bleeds)
Thunder clap headache (suddenly and

maximally intensive), the sentinel bleed, neck stiffness, neurological deficit into coma
Diagnosis: CT scan, MR/CT Angiogram , a lumbar puncture (xanthochromia)

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Hemorrhage
Treatment:
BP <140/<90 (beta blockers, calcium channels blockers);
coil or clip
Hydrocephalus:

serial lumbar punctures, VP shunt
Seizure prophylaxis: levetiracetam

Increased intracranial pressure:
Hypertonic solution (mannitol or hypertonic saline)
Elevated the head of the bed
Hyperventilate
Vasospasm: calcium channel blockers

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Hemorrhage
Intraparenchymal
Caused by hypertension
Focal neurologic deficit, headache, nausea and vomiting, coma
Diagnosis: CT

scan
Treatment: decrease intracranial pressure, craniotomy, evacuated the hematoma

Neurology. Seizure

Содержание

Seizure

Seizure and epilepsySeizure An acute, transient neurological event caused by abnormal

Causes of seizureVascularInfectionTraumaAutoimmuneMetabolicIngestion/withdrawalNeoplasmpSychGeneral vs Partial(focal)Complex vs SimpleAtonicMyoclonicAbsenceTrigeminal neuralgiaType of seizure

EpilepsySIMPLE Small area of the brainStrange sensationJerking movementsJacksonian marchOften rememberCOMPLEXLoss consciousness

Epilepsy

EpilepsyStagesProdromalWhen symptoms start to appear prior to the big eventAura Does

Status epilepticusSeizure lasts more than 5 minOngoing or without returning to

EpilepsyDiagnosisSymptomsMedical historyEEGGenetic testingBrain imaging: MRI, CTTreatmentDaily medicationsAnticonvulsantsEpilepsy surgeryRemove cause of problemNerve

Epilepsy treatment

StrokeDamage to part of the brain caused by a problem with

StrokeISCHEMICDeath of tissue due to blockage byThrombotic – atherosclerotic plaqueEmbolic –

Stroke

Transient ischemic attackEffects last no longer than 24 hours from onset

StrokeThe right cerebrum controls muscles on the left & vice versa

StrokeFeets and legsHands, arms, face and speechVisual cortexcoordination

StrokeDiagnosis and Treatment CT scan of the head +blood to drop

Stroke AcutetPA (tissue plasminogen activator)For Ischemic Stroke! Dissolve the clot by