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Neurology > Seizuring patient - SA/LA > Flashcards

Seizuring patient - SA/LA Flashcards

1
Q

Define seizure

A

electrical imbalance between excitation and inhibition, they have a certain rhythmicity

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2
Q

How can seizures be classified by CS?

A

FOCAL: when people appear absent
GENERALISED: tonic, clonic,
* don’t use the petit-mal and grand-mal seizure

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3
Q

Describe focal seizures

A

SIMPLE FOCAL: no loss of consciousness
COMPLEX FOCAL: impairment of consciousness
FOCAL SEIZURE WITH SECONDARY GENERALISATION

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4
Q

2 types of generalised seizures

A

Convulsive or non-convulsive

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5
Q

Define status epilepticus

A
  • prolonged seizure activity
  • > / 5 mins (clinical)
  • > / 30 mins (basic science) –> brain damage
  • life-threatening emergency always
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6
Q

Describe cluster seizures

A

> / 2 seizures in a 24 hour period, very serious!

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7
Q

Name 4 classifications of seizures

A
  • prodrome
  • aura
  • ictus
  • post-ictal
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8
Q

Define prodrome

A

behaviour changes that occur hours or days before the seizure

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9
Q

Define aura

A

sensory/ focal onset seizures may start with a sensory experience such as a perceived smell or a feeling of deja vu. The existence of aura in animals is difficult to prove but owners often report a behavior change of their dog minutes before the ictus.

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10
Q

What is ictus?

A

the seizure event itsel

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11
Q

What is post-ictus?

A

neurological status alternations hours or days after the seizure

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12
Q

How can seizures be classified over time?

A
  • self-limiting
  • clustered or continuous (status epilepticus)
  • reflexive
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13
Q

Describe a self-limiting seizure

A

= focal or generalised types

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14
Q

Describe a clustered or continuous (status epilepticus) seizure

A

= focal or generalised types

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15
Q

What causes a reflexive seizure?

A

a precipitating stimuli

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16
Q

Classic - CS - feline seizure

A
  • lip smacking
  • hypersalivation
  • yowling (consider feline dementia as alternative ddx in older cats with this CS).
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17
Q

Name 5 events that can mimic seizures.

A
  • syncope
  • narcolepsy
  • pain
  • vestibular syndrome
  • movement disorders (e.g. Scotty Cramp)
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18
Q

Outline syncope

A
  • partial or complete loss of consciousnesss
  • lack of motor activity
  • no post-ictal signs
  • shorter in duration
  • can mimic seizures
19
Q

What is narcolepsy?

A

= sleeping disorder, very rare

  • stimulated often by excited, food, drugs
  • can mimic seizures
20
Q

Outline different breeds and movement disorders

A
  • scotty cramp
  • CKCS - episodes of tetany, hypertonicity, deer-stalking
  • Norwich terriers
  • Boxers - paroxysmal dystonic choreathetosis
  • Bichon frises - similar to boxers
21
Q

Classic signs of seizures

A
  • typically last 1 minute
  • exhibit several stages
  • often, but not always, occur at rest or out of sleep
  • clonic movemetns (rhythmic mm contractions are common in both partial and generalised seizures)
  • most recurrent seizures respond at least in part to AEDs
22
Q

What is an EEG?

A

= electroencephalogram, easures the electrical activity of the brain

23
Q

T/F: a seizure can happen without pathology

A

True

24
Q

How can seizures be classified by aetiology?

A
  • SYMPTOMATIC or SECONDARY: structural brain lesion
  • REACTIVE SEIZURE: metabolic or toxic cause
  • IDIOPATHIC or PRIMARY EPILEPSY: suspected genetic cause
  • POSSIBLE SYMPTOMATIC or CRYPTOGENIC SEIZURE: rule out only via PME
25
Q

What is a cryptogenic seizure?

A

one of obscure or uncertain origin

26
Q

How can seizures be classified by location?

A

INTRA-CRANIAL: functional (idiopathic epilepsy) or structural (symptomatic epilepsy, possible symptomatic epilepsy)
EXTRA-CRANIAL: Intrinsic (metabolic - reactive seizure) or extrinsic (toxic - reactive seizures)

27
Q

3 categories of extracranial epilepsy

A
  • electrolyte imbalances
  • energy deprivation
  • organ dysfunction
28
Q

Give examples of electrolyte imbalances causing extracranial epilepsy

A

hypernatraemia, hyponatraemia, hypocalcaemia

29
Q

2 examples of energy deprivation extra-cranial seizures

A

thiamine deficiency and hypoglycaemia

30
Q

2 examples of organ dysfunction extracranial epilepsy

A
  • uraemic encephalopathy

- HE

31
Q

Outline species and idiopathic epilepsy

A

DOG: 6 months to 6 years
CAT
GENERALISED SEIZURES: various breeds, e.g GSD
PARTIAL SEIZURES with/without 2nd generalisation: springer spaniels

32
Q

Outline epilepsy in horses (signalment)

A
  • Arab foals - congenital, grow out of it
  • Foal with PAS (neonatal maladjustment syndrome)
  • Adults (due to structural or metabolic brain disease, migrating parasite, previous trauma etc, intracarotid injection!)
33
Q

Ddx (ordered) - seizures in animals

A
  • Metabolic (PSS, hypoglycaemia)
  • Infectious diseases
  • Congenital
  • (toxic, trauma)
34
Q

Ddx (ordered) - seizures in animals 6 months - 6 years

A
  • Idiopathic epilepsy
  • Inflammatory/ infectious
  • Metabolic
  • (neoplasia, toxic, trauma)
35
Q

Ddx (ordered) - seizures in animals > 6 years

A
  • Neoplasia
  • Idiopathic epilepsy (late-onset)
  • Inflammatory/ infectious
  • (metabolic)
  • (toxic, trauma)
36
Q

Describe disease progression of metabolic seizures

A

waxing and waning

37
Q

Ddx - inter-ictal exam findings, normal

A
  • Idiopathic epilepsy
  • metabolic (wax and wane phenomenon)
  • Neoplasia (silent area of brain, early in disease)
  • (toxic)
38
Q

Ddx - inter-ictal exam findings, abnormal, symmetrical

A
  • Metabolic
  • Toxic
  • Hydrocephalus
  • Degenerative
  • (midline structural disease)
39
Q

Ddx - inter-ictal exam findings, abnormal, Asymmetrical

A
  • Neoplasia
  • Inflammatory/ infectious
  • anomalies
40
Q

Ddx = lateralising seizures, symmetrical, generalised onset

A
  • idiopathic epilepsy
  • metabolic
  • toxic
  • degenerative
  • hydrocephalus
  • trauma
  • midline structural problems (pituitary tumour)
41
Q

Ddx = lateralising seizures, Asymmetrical, FOCAL onset

A
  • inflammatory/ infectious
  • neoplasia
  • anomalies
  • trauma
  • cryptogenic and idiopathic
42
Q

What is the minimum database for extracranial causes of seizures?

A
  • CBC and cytology
  • Biochem
  • Ammonia (if indicated)
  • resting bile acids (in small animals, dynamic bile acid test)
  • UA (uncommon in horses)
  • BP in mature small animals (especially cats - cardiac work up)
  • Further diagnostics depending on signalment/ hx and PE
43
Q

Diagnostics - intracranial causes of seizures

A
  • Imaging - brain - MRI and CT
  • CLINICAL PATHOLOGY:
  • CSF (wbc, differential cell count, protein content)
  • POSITIVE brain imaging or inflammatory CSF for infectious agents

Neurology (26 decks)

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