Ebook Rapid neurology and neurosurgery: Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Rapid neurology and neurosurgery: Part 2
Ebook Rapid neurology and neurosurgery: Part 2
EPILEPSY 75EpilepsyDEFINITION Epilepsy IS a disorder characterised by recurrent (>2) unprovoked seizures. A seizure is a paroxysmal event marked by ab Ebook Rapid neurology and neurosurgery: Part 2bnormal discharge of cerebral neurons resulting in alteration or impairment of consciousness, sensation or motor function.Remember: A single seizure does not lead to a diagnosis of epilepsy.EPIDEMIOLOGY•Up to 5% of population may experience a single seizure; incidence similar in males and females.•G Ebook Rapid neurology and neurosurgery: Part 2eneralised seizure disorders usually commence in childhood or adolescence. Focal seizures can start at any age and can be related in younger patientsEbook Rapid neurology and neurosurgery: Part 2
to hippocampal sclerosis. In older patients it may be associated with cerebrovascular disease or a structural abnormality (tumour).AETIOLOGY AetiologiEPILEPSY 75EpilepsyDEFINITION Epilepsy IS a disorder characterised by recurrent (>2) unprovoked seizures. A seizure is a paroxysmal event marked by ab Ebook Rapid neurology and neurosurgery: Part 2on (meningitis, encephalitis, subdural empyema and cerebral abscess), (iv) structural CNS diseases, including tumours (primary or metastatic), arteriovenous malformations and congenital CNS abnormalities, (iv) systemic disorders, including elec trolyle disturbance (hyponatraemia or hypernatraemia, h Ebook Rapid neurology and neurosurgery: Part 2ypoglycaemia, hypercalcaemia, uraemia and magnesium level disturbances), hepatic encephalopathy and porphyria, (vi) toxin, illicit drug or medicationEbook Rapid neurology and neurosurgery: Part 2
related, including alcohol withdrawal or excess and (vii) eclampsia. In paediatric population, the first seizure may be due to a febrile episode or thEPILEPSY 75EpilepsyDEFINITION Epilepsy IS a disorder characterised by recurrent (>2) unprovoked seizures. A seizure is a paroxysmal event marked by ab Ebook Rapid neurology and neurosurgery: Part 2 CHARACTERISTICS This relies primarily on the mode of onset. Two main categories are primary generalised versus partial (fcxal) seizures with or without subsequent secondary generalisation.Primary generalised seizures (40% of all seizures): Bilateral hemispheric symmetrical and sync hronous discharg Ebook Rapid neurology and neurosurgery: Part 2e asscxiated with loss of consc iousness from the onset.•Generalised tonic-clonic (GTC) seizure (grand maf): Sudden onset with loss of consciousness aEbook Rapid neurology and neurosurgery: Part 2
nd initial Ionic (stiffening of limbs) and then a clonic (jerking) phase; may be associated with urinary and/or faecal incontinence and tongue biting.EPILEPSY 75EpilepsyDEFINITION Epilepsy IS a disorder characterised by recurrent (>2) unprovoked seizures. A seizure is a paroxysmal event marked by ab Ebook Rapid neurology and neurosurgery: Part 2n leading to Ionic or clonic seizures, respectively.•Absence (petit mal): Presents in childhood with episodes of transient (<10 s) impairment of consciousness or pauses (staring episode) with minimal or no motor involvement. Three Hertz spike and wave activity on EEG. No postictal phase. Usual remis Ebook Rapid neurology and neurosurgery: Part 2sion in teens.•Myoc Ionic seizures: c haracterised by sudden body jerks.•Atonic seizures: Sudden transient loss of tone (flaccidity) leading to fallsEbook Rapid neurology and neurosurgery: Part 2
and high incidence of injury.Partial seizures (around 50-60% of seizures): Attributed to seizure activity in one hemisphere or part of one hemisphere EPILEPSY 75EpilepsyDEFINITION Epilepsy IS a disorder characterised by recurrent (>2) unprovoked seizures. A seizure is a paroxysmal event marked by ab Ebook Rapid neurology and neurosurgery: Part 2ng—contralateral motor strip arm region; lip smacking/chewing movements, olfactory or gustatory hallucination—contralateral medial temporal lobe; visual hallucination—occipital lobe and paraesthesia—contralateral somatosensory cortex. Classified as simnle or comolex. dpoendinu on whether consciousne Ebook Rapid neurology and neurosurgery: Part 2ss is or is not imnaired.76 CONDITIONS: APPLYING THE BASICS•Simple partial seizure: No impairment of consciousness, for example Jacksonian motor seizuEbook Rapid neurology and neurosurgery: Part 2
re.•Complex partial seizure: With associated impairment of consciousness, often due to temporal lobe pathology; for example, hippocampal sclerosis leaEPILEPSY 75EpilepsyDEFINITION Epilepsy IS a disorder characterised by recurrent (>2) unprovoked seizures. A seizure is a paroxysmal event marked by ab Ebook Rapid neurology and neurosurgery: Part 2nd the automatisms (e.g. lip smacking or chewing).•Partial seizure with secondary generalisation: A seizure which is initially localization related (focal in onset and producing simple or complex phenomena) and then spreading to involve both hemispheres and hence evolving into, for example, a tonic- Ebook Rapid neurology and neurosurgery: Part 2clonic episode.Remember: The distinction between partial and generalised seizures is important clinically, not only for therapeutic purposes but alsoEbook Rapid neurology and neurosurgery: Part 2
for the exams!AS soci ATI o N S/RI s K FACTORS Refer to Section 'Aetiology'. Certain factorscan lower seizure threshold including photic stimulation (EPILEPSY 75EpilepsyDEFINITION Epilepsy IS a disorder characterised by recurrent (>2) unprovoked seizures. A seizure is a paroxysmal event marked by ab Ebook Rapid neurology and neurosurgery: Part 2c disturbances (as above) and infec tion of the CNS.PATHOLOGY/PATHOGENESIS Seizures may occur due to an imbalance between excitatory and inhibitory components within cortical neurone networks leading Io abnormal excitation.Possible inherited predisposition to seizures as in primary generalised seizu Ebook Rapid neurology and neurosurgery: Part 2res. Some seizure syndromes like West arid Lennox-Geslaul syndrome occur in childhood in association with struơural CNS disease, for example tuberousEbook Rapid neurology and neurosurgery: Part 2
sclerosis.HISTORYThis is extremely important! An account of the events should be sought from a witness if available. See Chapter 6 regarding key pointEPILEPSY 75EpilepsyDEFINITION Epilepsy IS a disorder characterised by recurrent (>2) unprovoked seizures. A seizure is a paroxysmal event marked by ab Ebook Rapid neurology and neurosurgery: Part 2ssible compromise of consciousness often allows a clinical classification of seizures as above. Impairment of consciousness is reflec led by the patient’s partial or complete lack of memory about the episode. For example, a complex partial seizure with secondary generalisation to a tonic-clonic even Ebook Rapid neurology and neurosurgery: Part 2t may evolve as follows. A prodromal phase (not part of seizure and lasting hours Io days) with a possible change in behaviour may be noted followed bEbook Rapid neurology and neurosurgery: Part 2
y an aura (part of the seizure, for example epigastric sensation and unusual smell, which is typically brief and may be associated with an altered levEPILEPSY 75EpilepsyDEFINITION Epilepsy IS a disorder characterised by recurrent (>2) unprovoked seizures. A seizure is a paroxysmal event marked by ab Ebook Rapid neurology and neurosurgery: Part 2ic movements. Grunting noises, frothing at the mouth and rolling back of eyes may occur. Facial skin may be red or blue in colour (rather than deathly pale). Jerking movements may be seen usually for several minutes with possible associated urinary incontinence and tongue biting. The 'offset' of the Ebook Rapid neurology and neurosurgery: Part 2 seizure is typically abrupt followed by a period of marked confusion; the patient subsequently recalls that near clear memory was being in the EmergeEbook Rapid neurology and neurosurgery: Part 2
ncy Department. Question about any precipitating factors, for example alcohol use, with further questions directed towards other aetiological factors,EPILEPSY 75EpilepsyDEFINITION Epilepsy IS a disorder characterised by recurrent (>2) unprovoked seizures. A seizure is a paroxysmal event marked by ab Ebook Rapid neurology and neurosurgery: Part 2etween seizures (inter-ictal period). In partial seizures with or without generalisation, clinical examination may demonstrate a persistent focal deficit between seizures.•If the seizure is witnessed by a doctor or a nurse, a detailed description (pre-event warn-EPILEPSY 77closed, duration of event, Ebook Rapid neurology and neurosurgery: Part 2 associated features (incontinence) and offset) should be noted in a seizure chart.•In the immediate 'postictal' phase, patients may be drowsy and conEbook Rapid neurology and neurosurgery: Part 2
fused following a GTC seizure.•'Todd's paralysis': Transient weakness or paralysis IS observed in an affected limb following a partial seizure, for exEPILEPSY 75EpilepsyDEFINITION Epilepsy IS a disorder characterised by recurrent (>2) unprovoked seizures. A seizure is a paroxysmal event marked by ab Ebook Rapid neurology and neurosurgery: Part 2otor cortex and may start in fingers, followed by hands and then move to more proximal areas.INVESTIGATIONS In an adult presenting with a first seizure, direct tests towards establishing a possible underlying cause, particularly if no provoking factors are obvious, for example alcohol withdrawal (re Ebook Rapid neurology and neurosurgery: Part 2fer to aetiologies). Test should include the following:•Blood tests: FBC, u & E, serum glucose level (also fingerstick glucose), calcium, magnesium, LEbook Rapid neurology and neurosurgery: Part 2
FT and blood and urine toxin levels if suspected drug or alcohol abuse.•Imaging studies: Perform a CT with or without contrast to look for a structuraEPILEPSY 75EpilepsyDEFINITION Epilepsy IS a disorder characterised by recurrent (>2) unprovoked seizures. A seizure is a paroxysmal event marked by ab Ebook Rapid neurology and neurosurgery: Part 2vernomas). Repeat imaging studies may be needed.Gọi ngay
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