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EEG, vascular, infectious Flashcards

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1
Q

Diff bet sleep spindle and vertex, what stage makikita?

A

sleep spindle 6-8 wks begin, must be symmteric at 2 yrs age, centroparietal - St 2 of sleep ( tog with K complexes)

vertex- 8 weeks begins, frontocentral, - stage 1 ( tog with POST)

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2
Q

Diff tonic vs clonic phase?

A

Tonic - spread of excitation cortex to subcortical area

  • mydriasis, LOC, respi arrest, HTN, tachy, extension and spasm
  • EEG- polyspikes
  • excitatory phase: glutamate , aspartate, Na and Ca influx

Tonic-clonic- diencp inhibition

Clonic- flaccid

  • inhibitory- GABA, Cl influx, K efflux
  • EEg- spike and wave

Paralysis- excessive inhibition

  • metabolic exhaustion, glucose is low and lactic acid high
  • EEG- slowing
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3
Q 
Triad of west syndrome ? 
EEG ?
Prognosis? 
Treatment?
Genetic ?
A

Hypsarryhtmia , epileptic spasms, Dev delay

EEG- unreadable on 7 mv, multifocal spikes/polyspikes, very high amplitude, chaotic

prognosis- may [proceed to LGS , moratlity 33%, Dev delay

Treatment- ACTH, Vigabatrin, pyridoxine

Genetics- TSC 1 and TSC2, ARX

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4
Q 
a.k.a. severe myoclonic syndrome of epilepsy 
EEG ?
Prognosis? 
Genetic ? 
Treatment?
A

Dravet syndrome - 1st yr of life , behavioral changes, intractable seiz
EEg- initially N but evolving spike, wave multifocal
Genetic- SCN A1 gene mutation
Txt: avoid Na channel blockers ( valproic, lamotrigine, lcosamide, zonisamide, carba/ oxcarba, phenytoin/ fospho)

Topiramate- AMPA
Levetricetam- SVA2
Cannabidiol

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5
Q

Onset febrile seizure

A

6 mos- 6 years

like DOOSE syndrome- Epilepsy with Myoclonic-Atonic seiz

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6
Q

Diff absence vs juvenile absence ?

A

absence - 5yrs old onset

juvenile - 8 yrs old, once/ day

EEG : 3 Hz spike wave

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7
Q 
Myocolinc- Atonic seiz
hx? 
Prognosis? 
Genetic ? 
Treatment?
A

Famiky hx febrile seiz- 50%
genetics- SCNA1, SLCA 1
txt: valproic: DOC,
steroids, levet, ketgenic

While seizures often respond poorly to medication, about 2 out of 3 children ultimately outgrow their epilepsy and can wean off medication.
About one third have persisting seizures.
Development typically improves once seizures are controlled, with some children returning to normal function. Others may be left with varying degrees of intellectual disability.

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8
Q

onset is 3-6 yrs old, px present with visual hallucination , focal autonomic seiz

A

panayiotopoulos syndrome
EEG- multifocal, spikes, shraps waves over the end of chain (o1, 02)

activate- eye closure and sleep

TXT : carba, levet, valproic

prognosis- self limiting, remission 1-2 yrs after onset

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9
Q

Charact Rassmusen syndrome

A

chronic focal enceph, focal intractable epilepsy , hemioparesis progressive

  • assoc hemiatrophy/ fovcal atrophy cerebrum
    onset 3-5 yrs

txt: high dose steroid, plasma exchange, immune globulin, partial hemispherectomy

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10
Q

Marfan syndrome characterize

A 
MVP
Aortic dissection
Retinal detachment
Fibrillin 1 mutation
Arachnodactylyl
Nearsightedness
scoliosis
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11
Q

Diff traumatic tap vs SAH?

A

SAH - pressure is elevated 250-500mmH20
brisk leukocytosis 1000/mm3

systemic chnages with SAH
hyponat- effect of ANF
leukocytosis- 15-18000mm3

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12
Q

Txt aneursym, ruptured

A

fluids
CCB- Nimodipine 60mngtab evry 4 hours
SBP 150mmHg
pain reliever for HA

obliteration- within 24 hrs - for H and H 1 and 2, 3 controversial, 4 no benefit

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13
Q

Hunt and Hess state , does it require imaging ?

A

grade 1
asymptomatic or minimal headache and slight neck stiffness
70% survival

grade 2
moderate to severe headache; neck stiffness; no neurologic deficit except cranial nerve palsy
60% survival

grade 3
drowsy; minimal neurologic deficit
50% survival

grade 4
stuporous; moderate to severe hemiparesis; possibly early decerebrate rigidity and vegetative disturbances
20% survival

grade 5
deep coma; decerebrate rigidity; moribund
10% survival

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14
Q

Hemorrhagic Brain tumors

A

ChorioCA
Melanoma
Renal cell Ca

spine hemorrhages
- trauma, AVF , HBL

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15
Q

Criteria for CAA Boston, probable

A

Age >/= 55 , multiple lobar/ cortocal , no other casue

possible- single lesion, age

definite- post mortem patho

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16
Q

Differentiate AD vs CAA

A

AD - AB 42, CAA- AB 40

CAA both assoc with APO e4 and APO e2

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17
Q

infectious cause of cerebral vasculitis :

A

menigoivascular syphilis- subacute stage
TB
suabute bact meningitis
cerebral malaria

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18
Q

Give ex of Giant/ large vessel arteritis

A

Titans
temporal arteritis
takayasus
granulomatous

small- susac

others- medium - PAN, churgs,, Wegener, Bechet., SLE

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19
Q

diff presentation of temporal arteritis vs Takayasu

A

Temporal arteritis- bilateral HA, jaw claud, occ of opthal artery

Takayasu- nonconsti symp ( fever, malaise)
Pulselessness of affected vessels

txt : steroid for both

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20
Q

medium sized vasculitis, peripheral neuropathy and cranial neuropathies , also with episodic hemicrania

A

Wegener

txt : cyclophsophamide

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21
Q

sterile nonbacterial thrombotic endocarditis (NBTE) secondary to inflammation.

A

Libman-Sacks endocarditis is a type of sterile nonbacterial thrombotic endocarditis (NBTE) secondary to inflammation.

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22
Q

Binswanger and CADASIL both have?

A

dementia, small vessel involvement

bingswanger- subcortical vascular dementia, pseudobulbar , gait

CADASIL- migraine, subcortical infarcts and leukoenceph

small vessel- susac, binswanger, CADASIL

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23
Q

Binswanger dse criteria for dx?

A 
clinical hx dementia, bilateral abn on imaging 
and 2/ 3: 
- vascular risk factor
- focal CV dse ( occipital / temporal) 
- subcortical dys( gait/ parkinsonism)
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24
Q

Alz vs vasD

A

Alz- vol loss temporal lobe/ hippocampus

VD- subcortical , basal ganglia

Cadasil- ant temporal

FTLD- knife like gyrus , behavioral

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25
CADASIL vs CARASIl
CADASIL- Notch 3 CARASIL- HTRA1 mutatio, assoc with psteoid growth- lumbar stenosis and alopecia
26
contents of the carpal tunnel ?
median nerve near the flexor pollicis longus tendon 4 flexor digitorum profundus 4 flexor dig superficialis
27
T/F , the albuminocytologic dissociation is present in GBS and CIDP?
True .
28
elective indication for ET intubation in GBS with autonomic dysf?
VC is less than 15-20l/kg | Negative inspiratory force is less than 30 cc H20
29
components of the Thoracic outlet
compromise of the subclavian middle scalene muscles, the artery (arterial TOS) 1st rib, and the clavicle, subclavian artery/ vein , apex of lung Neurologic compromise of the brachial The apex of the lung projects plexus (neurologic TOS) . trunk of the brachial plexus being stretched over a rudimentary cervical rib or fibrous band (lower trunk brachial plexopathy= C8 and T1, supply all (intrinsic hand muscles) . Wasting and weakness of the hand • Paresthesias over the medial forearm and hand • Aching of arm (pain is unusual)
30
roots of long thoracic nerve ? lesion?
C5-7, innervates the ant serratus muscles winging of scapula Nerve: Long thoracic (C5-C7) Cause: Axillary node dissection /Stab Muscle: Serratus anterior Function: unable to anchor scapula to thoracic cage
31
Mnemonic for median innervated intrinsic hand muscles is LOAF
. Lumbricals- 1 , 2 • Opponens pollicis • Abductor pollicis brevis • Flexor pollicis brevis
32
Differentias for CTS
C6 / C7 radiculopathy | TOS - Cause: Cervical rib/Pancoast tumor
33
If the median nerve passes the carpal tunnel , the ulnar nerve has ?
``` Medial cord brachial plexus Lateral wall of axilla Medial upper arm Behind the medial epicondyle of humerus Under the FCU aponeurosis Runs down the forearm between the FDP (posterior) and FCU (anterior) Enters the hand through the Guyon canal (between pisiform and hook of hamate) ```
34
what is klumpke's palsy
Klumpke monkey (Lower traction injury C8-T1) Cause: Upward force on delivery(grapping a tree) Muscle: Intrinsic hands muscles Presents: Total claw hand
35
what is erbs injury? waiters tip
UPPER roots C5-C6 (traction injury) Causes: Infants traction neck Muscle: Deltoid/Supraspinatus/Infraspinatus/Biceps Function Look at the picture adduction/Lateral rotation/ flexion/supination
36
Ulnar nerve damage cause and findings?
Fracture of medial epicondyle Fracture hook of hamate Claw hand/radial deviation of wrist with flexion Loss of sensation over the 1/2 4 and 5 digit
37
nedian nerve damag?
Supracondylar fracture or humerus Carpal tunnel or wrist laceration APE/Pope's blessing wrist flexion, thumb, 2,3 digit Loss of sensation over 1,2,3 and 1/2 4 digit Tinel sign +
38
presentation of Radial nerve injury
Mid shaft humerus fracture compress of axilla(Saturday night palsy) wrist drop decrease grip strength loss of senstation over posterior arm/forearm dosal hand
39
DDx for ulnar nerve damage
ulnar neuropathy at the elbow Diagnosis Amyotrophic lateral sclerosis C8-T1 radiculopathy
40
radial nerve lesions
Wristdrop if the lesion is in the spiral groove Fingerdrop if the lesion affects the posterior interosseous nerve Ddx C7 radiculopathy Posterior cord brachial plexopath
41
what could cause injury to common peroneal nerve?
Most commonly injured by external compression against the fibular head ``` Frequent causes include: • Habitual leg crossing • Anesthesia, coma, positioning during sleep • Below knee casts • Prolonged squatting ``` “Footdrop” caused by weak foot dorsiflexion with high-stepping gait Weak foot eversion Sensory loss in the lateral leg and dorsal foot if complete Isolated lesion of the deep peroneal nerve causes footdrop with numbness only in the webspace between first 2 toes ddx : L5 radiculopathy, Lumbosacral trunk compression (difficult labor) Sciatic neuropath
42
thigh pants/ belt causes:
meralgia paresthetica- L2-L3 lat cutaneous nerve of thigh
43
childbirth , lithotomy position :
injury to femoral nerve
44
Disorders that could affect the tibial nerve ?
Compression by Baker’s cysts of knee Distal tibial nerve can be damaged by foot and ankle trauma Tarsal tunnel syndrome Weakness of plantarflexion, foot inversion, toe flexion Hypoactive or absent Achilles tendon reflex Numbness/tingling in distribution of sural, calcaneal, or plantar nerves tibial L5- S2 Ddx: S1 or S2 radiculopathy May be difficult to differentiate from partial sciatic neuropathy
45
whwre is the bifurcation of the tibial nerve?
Two plantar nerves (medial and lateral) form from bifurcation of tibial nerve in tarsal tunnel medial to Achilles tendon
46
disorder of the tibial nerve ?
Nerves can be damaged within tarsal tunnel by: • External compression by hard casts or tight shoes • Ankle trauma • Endocrinopathies (hypothyroidism, acromegaly Tarsal tunnel syndrome: foot pain, paresthesias, sensory loss in distribution of one or both plantar nerves
47
Tetrad for congenital rubella
cataracts- ( pigmentary degeneration of the retina (salt-and-pepper chorioretinitis); glaucoma, cloudy corneas,) deafness- sensorineural deafness, unilateral -most common complication congenital heart disease- PDA, intraventricular septal defect , and developmental delay
48
Congenital rubella infection occurs
first 10 weeks - 24 weeks AOG
49
How to diagnose rubella ?
Clinical - tetrad Ct/MRI- little help, bec of no sp focus of calcification Abs or virus isolation- throat, urine, stool, amniotic fluid , Rubella virus continues to be recoverable from the CSF for at least 18 months after birth. at times no visible lesions on light micro-m bec no inflamm cells on fetuses, 1st trimester Smallness of the brain and delay in myelination have been observed in children who died at 1 to 2 years of age.
50
TXT rubella ?
No specific txt for active infections prevention- MMRV vaccine - 1 y/o baby with booster after 6 mos , for adults - all adults, particularly non-pregnant women of child-bearing age and those who have not been previously vaccinated during childhood . ( 19-59)
51
What would be a cause / slow infections of the CNS ?
slow infections of the nervous system caused by conventional viruses include subacute sclerosing panencephalitis (measles virus), progressive rubella panencephalitis, and progressive multifocal leukoencephalopathy (JC virus).
52
speacial charact of congenital infections
HSV- early diffuse edema, hemorrhages Rubella- Ca nonspeci, lobar destruction Varicella- necrosis WM, syphilis- Basilar mengitis, nonspec calci HIV- basal ganglia Calci, fusiform arteriopathy
53
what is common on zika and CMV virus? diff them from Toxopalsmosis
Zika and CMV- microceephaly, with cortical dysf Calci- CMV- perivent , Zika- G-WM junction Toxoplasmosis- Macrocephaly, no cortical dysf, nonspecific location calcif
54
imgaing characteristics of NCC ?
black dots on MRI, infectious- nodular calcified NCC , if vascular - CAA salt and pepper on T2- hyperintense cystic lesion with blackm dots of scolex if with diff stages- NCC
55
stge of cysticercosis, malignant form..
Racemose- more malignant form of the disease, the cysticerci are located in the basilar subarachnoid space, where they induce an intense inflammatory reaction leading to hydrocephalus, vasculitis, and stroke. "bunch of grapes " on cisterns
56
TXT for cysticercosis :
Albendazole is given as 5 mg/kg tid for 15 to 30 days. Initially, treatment may seem to exacerbate neurologic symptoms, with an increase in cells and protein in the CSF, but then the patient improves and may become asymptomatic, with a striking decrease in the size and number of cysts on CT scanning. Praziquantel and Corticosteroids
57
How would you dx px with amebic enceph ?
Clinical- hx of swimming in warm fresh water , HA, fever, vomiting- rapid and severe fatal within 1 week onset. CSF- looks like ABM , tropohozoites in unspun CSF wet preparation Imaging - hemorrhagic , necrotic brain lesions Gross- purulent meningitis and numerous small granulomatous microabscesses in the underlying cortex and white matter TXT- usual anti protozoal, not effective Amphotericin , or with combi : trimethoprim-sulfamethoxazole, rifampin, and antifungal agents Miltefosine,
58
Which amebic encephalitis occur in immunocompromised pxs?
GAE- Granulomatous Amebic enceph PAM- immunocompetent
59
Risks for cryptococcal meningitis ?
Immunocompromised : HIV (6-12% pxs) , ymphoma, Hodgkin disease, leukemia, carcinoma, tuberculosis pupu bird, inhaled , subacute vs. (Amewbic mengioen- rapid)
60
Pathologic findings in cryptococcus
small granulomas and cysts within the cerebral cortex, and sometimes larger granulomas and cystic nodules deep in the brain (cryptococcomas)
61
Dx of cryptococcus
CSf- C. neoformans antigens in the CSF. The organism may be seen as spherical cells, 5 to 15 μm in diameter, which retain Gram stain and are surrounded by a thick, refractile capsule. India ink preparations. lymphocytic pleocytosis, usually fewer than 50 cells/mm3 A latex agglutination test for the cryptococcal polysaccharide antigen Sabouraud glucose agar at room temperature and at 37°C
62
TXT of px with cryptococcus-
without HIV- IV , amphotericin B, given in a dose of 0.7 to 1.0 mg/kg/d, or 3–4 mg/kg/d of liposomal amphotericin. addition of flucytosine (100 mg/kg/d) to amphotericin B results in fewer failures or relapses, more rapid sterilization of the CSF, and less nephrotoxicity than the use of amphotericin B alone. WOF amphotericin- RTA , discontinued if the blood urea nitrogen reaches 40 mg/dL HIV pxs- amphotericin + flucytosine ( 2 weeks) + fluconazole ( 1 yr or indefinitely to prevent relpase) , discontinued if the CD4 exceeds 100/mm3 and HIV viral load is suppressed.
63
common cause of HSV encephalitis ?
usually HSV 1- and on diffuse neonatal enceph HSV 2- neonatal with hx of mom genital ulcers, aseptic meningitis, myelitis , localized adult type encephalitis
64
Dx of HSV
Imaging - predilection to inferiormedial frontal lobe, temporal lobe , insula- memory problems, behavior, seizure, olfactory and gustatory hallucinations. CSF- inc pressure, pleocytosis/ lympho 10-200 cells/mm3, sugar is dec, protein is inc , xanthocromia of CSF bec of hemorrhagic necrosis EEG- PLEDS titer Ab, CSF HSV Ag- PCR, Fluo Ab, culture from biopsy TxT : Acyclovir 30mg/kg/day 2-3 weeks prognosis- age and consciousness, so unconscious on start of txt- poor, txt m,just be started within 4 days onset , awake px neuro sequela- Korsakoff amnestic defect
65
when you should consider a post herpetic neuralgia ?
If pain over the affected dermatomal region is >3mos .
66
Neurtotropism, location of latency Varicella and Ramsay Hunt syndrome ?
VZV- trigeminal ganglion ( Gasserian) , dorsal root ganglion Herpes Zoster - corresponding thoracic ganglion Ramsay hunt - Facial nerve, geniuculate ganglion
67
syndromes in Varicella?
``` Zoster encephalitis Ophthalmic herpes Herpes occipitocollaris Zoster myelitis Zoster angitiis Post her[petic neuralgia ``` encephalitis-0 usually normal, antibody to VZV membrane antigen (VAMA) has been found in the CSF and serum. ``` TXT : acute stage of shingles, analgesics and drying and soothing lotions, such as calamine, 48 h (some authorities say 72 h) of the appearance of the rash. ``` Famciclovir (500 mg tid for 7 days) or the better absorbed valacyclovir (2 g orally qid) are possibly better alternatives opthal- eye ointment acyclovir immunocompromised or have disseminated zoster (lesions in more than 3 dermatomes) should generally receive intravenous acyclovir for 10 days.
68
Post herpetic txt ?
TCA -amytriptylline 50mg ODHS carbamazepine, gabapentin, pregabalin, valproate nerve blocks- inconsistent
69
incubation period of Rabies ?
20-60 days prodormal - 2-4 days HA, fever, malaise
70
stages of Rabies ? after prodormal
Rabid - ( Medullary tegmnental area) apprehension, dysarthria, dyspahagia, hydrophobia, spasms throat face, diplopia Paralytic stage- coma, SC , w/in 4-10 days- death
71
How to Dx Rabies ?
Fluoresent Ab - gold standrard Histopathology - Negri bodies are pathognomonic of rabies. 71% of cases. Virus cultivation - The most definitive means of tissue culture lines, such as WI-38, BHK-21, or CER. Serology -The most commonly used serological tests were the mouse infection neutralization test (MNT) or the rapid fluorescent focus inhibition test (RFFIT). Rapid virus antigen detection - The cells are examined by fluorescent microscopy for the presence of fluorescent intracytoplasmic inclusions. corneal impressions (obtained by gently abrading the cornea with a microscopic slide) or neck skin biopsy (the cells examined are the sensory nerves).
72
Txt for Dog bite with rabies ?
bite/ scratch- benzyl ammonium chloride broken skin- tetanus prophylaxis animal - observe 10 days, if with symp - kill and send brain for F-Ab if escaped- PEP- HRIG- 20u/kg of BW , (1/2 infli, 1/2 IM) Human diploid cell line -1ml- day 0,3, 7, 14, 28
73
Cns regions affected by rabies
thalamus, limbic, brainstem, medullary tegmental area, SC
74
affected regions that could explain symptoms in rabies and polio>?
Rabies- medulla tegemental area , limbic, thalamus and SC Polio- Nucleus ambiguus- disturbances in swallowing, respi and vasomotor control , also in polio- destruction with neuronopagia of motor neurons in the ant horn ( atrophy, areflexia) sometimes with autonomic - lesions on reticular subs on the int horn of SC also in polio- pre central area, BS and SC
75
What type of stage in polio is found in pxs with effective immune response ?
Abortive - pharyngitis and Gastroenteritis Nonpralytic- neck and back pain and prodromal fever, HA, spasm- aseptic menigitis on CSF Pralytic muscle weakness- occurs while fever is high atrophy seen on 3 weeksof onset, max weakness/ permanent - 12-15 weeks
76
Earkiest patho change in polio ?
changes in anterior horn- motor neurons- central chromatolysis , formation of intranuclear inclusions, invasion of PMNs, inflammatory cells contributing to necrosis then neuronophagia.
77
TXT fro polio>?
wala. supportive lang.
78
pag nakakain ka ng pupu, ilan ang incubation period ng polio?
1-3 weeks
79
prognosis in polio? -
5-10% may have paralytic polio may pagasa pa na bumalim ang lakas within 3-4mos, bec of reconstitution of partially damaged cells.
80
stages of Brain abcess? | which one has vascularization?
stage III- Early capsule formation- Day 10-13 Stage 1- Day 1-3, Early cerebritis, Bacteria, Focal necrosis, Pus, (some neutrophils), edema Stage II- Dauy 4-9, Late cerebritis- Centre: demarcated necrosis ,(bacteria) , neutrophils Border: inflammatory infiltrate, • neutrophils, • macrophages/monocytes,, edema activated microglia activated astrocyte Satge III- Day 10-13, Early capsule - neovascularization • capillaries, fibroblast proliferation ``` Stage IV- Late capsule- >2 or = weeks, Centre: demarcated necrosis ↓ Border: granulation tissue ↑ fibrous capsule • collagen fibres • glial fibres ```
81
stages of neuro syphilis ? , manefestation, lesions
early - asymptomatic meningitis , chancre 3-18mos from exposure/ inoculation late/ secondary - 1- 12 yrs after just with asymp meningitis/ menigivascular syphilis - chance for txt prior to symptoms - condylomata lata- wart like inguinal area tertiary - optic atrophy, tabes dorsalis, general paresis
82
General paresis pathology
atrophy of cerebrum- frontal and temporal | spared occipital and sensory
83
Dx of syphilis
Nontreponemal - RPR, VDRL | Treponemal - FTA-ABS
84
TXT
Pen G- 18-24 million units/ IV x 10 - 14 days or Doxycycline oral Monitoring : reexamined every 3 to 6 months after treatment and the CSF should be retested after a 6-month intervals - CSF goal : (disappearance of cells as well as reduction in protein, gamma globulin, and serology titers), if achieved , clinical exam and CSF exam after 12months vs if NOT, give another full course of penicillin.
85
manifestation of congenital syphilis?
``` frontal bossing interstitial keratitis 8th nerve deafness Hutchinson teeth perforated hard palate rhagades- fissure over corners mouth saber shins ```
86
dependeble sign of malaria
A retinopathy consisting of macular whitening, orange or white discoloration of retinal vessels, and intraretinal blot-type hemorrhages, has been suggested as a dependable sign of severe malaria
87
common symptoms in severe malaria?
bruxism and hiccups CNS manifesttaion may occur on 2-3 rd week infection anemia, parasitized RBC
88
Malaria sp that could present with drowsiness even without parasite on the brain?
Plasmodium vivax
89
TXt and prognosis
Quinine and Artesunate 20-30% of pxs will not survive if with coma and seziures
90
MTS treatment
Medications Temporal lobe resection amygdalohippocampectomy ablation with laser/ gamma knife Prognosis- control of seizure within 1 yr in 80% pxs
91
Similarities and diff of gabapentin and pregabalin?
receptors- alpha 2 - delta L type presynaptic Ca channels gabapentin- non linear, high dose and when receptors are saturated, less is absorbed . Pregabalin- linear
92
Diff bet SF seizure vs. complex FS?
Simple FS : <15 minutes in duration, generalized seizure, lack of focality, normal neurologic examination, no persistent deficits, and negative family history for seizures. Complex FSs occur in approximately 20% of FSs and : >15 minutes in duration, focal features, abnormal neurologic examination, seizure recurrence in <24 hours, and postictal signs (Todd’s paralysis), and are more likely to be due to meningitis, encephalitis, or an underlying seizure disorder.
93
Syndrome - focal epilepsy with eventual hemiparesis
Rassmusen syndrome - mutation in GLUR3, focal cortical dysplasia TXT; high dose steroid, plasma exchange, hemispherectomy
94
side effect of phenytoin not present with fosphophenytoin?
Purple glove syndrome - n phenytoin infiltrates into the subcutaneous tissue, resulting in swelling, pain, and discoloration of the extremity because ofblood vessel leakage.
95
AED hepatic enz inhibitor, kaisa isa lang siya
Valproic acid inhibitor- it decreases activity of enz, dec metabolism so high drug conce inducer- more activity of enz, inc metabolism, so low drug conc
96
pathophysio of absence seiz
Absence- 6yrs , women bklank stares 3Hz spike and wave low threshold T type Ca channels in thalamus TXT : ethosuximide - inhibitor of T type Ca channel if absence with GTCS- Valrpoic / lamotrigine NO Gaba potetiators- exacerbate absence dDx; Juvenile absence- 8-12yrs, infrequent and seiz
97
Whuch viral infection can cause PLEDS?
HSV- type 2 hemorrhagic encephalitis inferomedial temporal lobe- petechial hemorrhages EEG- PLEDS Dx: HSV Ag PCR Cowdry type A, intranuclear ( like VZV) TXT: Acyclovir 30mg/kg/day 2-3 weeks prognosis- if txt within 4 days of onset- 90% survival
98
8-12 y/o, clusiness during the am and freq dropping of things
``` JME 8-12 y/o (like juvenile absence) EEG: 4-6 Hz polyspkie and wave TXT : 1st- valrproic, 2nd- lamo, levet, topi and zoni NO carba and phenytoin- could exacerbate ```
99
Age of known Epilepsy
``` Febrile- 6mos- 6yrs Absence- 6 yrs Juv Absence- 8 y/o JME- 8 -12 y/o BECCTS- 5-9y/o ```
100
character of this epilepsy: nocturnal, 5-9 y/o, assoc with devt dyslexia
BECCTS EEG: high volatge spikes, pred on CT area , with normal background TXT : carabamazepine
101
Triad of west / IS ?
Hypsarrtyhmia- high ampliyude slow waves , with disorganized background, multifocal spikes Devt delay spasm Risk: pre/peri/post natal insults, TSC 3-12mos Txt: ACTH, vigabatrin, pyridoxine prognosis- Devt delay/ proceed to LGS
102
side effects of phenytoin andd valproic?
Phenytoin- purple glove syndrome, coarse facial features, cerebellar atrophy, SJS, aplastic anemia gingival hyperplasia, osteoporosis, hirsutism Valproic- pcos, acne, thinning, tremor, wt gain
103
AED that can cause autoinduction
Carbamazepine MOA: Na channel inhibitor autoinduction- decreases its own half life after 30 hrs/ few days, if quick control seiz is needed hindi pwd. USE : GCTS and partial side effects : hyponat, dizz, nausea, nystagmus, rashes active metabolite: 10, 11 carbamazepine epoxide vs. Oxcarbazepine- no autoinduction, less side effects
104
How to differentiate BET from epileptiform discharge ?
Benign Epileptiform Transients of sleep- normal variant - temporal areas, brief, low amplitude, occurs in few
105
Charac 14 and 6 Hz positive spikes
occurs in 1 -2 sec runs, mainly in the posterior quad, drowsy
106
POSTS vs PSWY
POST- sleep, bioccipital area, 8-35y/o PSWY- eyes closed but wakefulness, disappear in sleep, C3-01, C4-02
107
AED used for partial and GTCS, absence and LGS , safest for pregnancy
Lamotrigine - MOA : inhinbits Na and glutamate, SJS if with valproic acid use Ethynil estradiol- inc celarance
108
MOA lacosamide
inihinitor of CRMP2
109
5th day fits
associated with voltage-gated potassium channels, in the genes KCNQ2 on chromosome 20 and KCNQ3 on chromosome 8. Benign neonatal or benign familial neonatal seizures
NP dreams
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