Brain Sparks
What is 1 lab value you should always obtain when someone comes in with seizure-like activity?
blood glucose
What is first line therapy for status epilepticus?
Benzodiazepine
- Diazepam, lorazepam, midazolam
What are 2 common causes of generalized weakness that can be found in lab work?
Anemia and hyponatremia
What are 2 factors that define status epilepticus?
seizure lasting ≥5 minutes or ≥2 seizures without a return to baseline between them
How long does the postictal period typically last? (range)
Postictal confusion typically lasts 20-60 minutes
What is the most common cause of non-traumatic, non-stroke acute flaccid paralysis in Western countries.
Guillain-Barré syndrome
What are 3 complications you should look out for in status epilepticus? (4 listed)
- Hyperthermia
- Rhabdomyolysis
- Lactic Acidosis
- Pulmonary edema
Name 2 second line agents for status epilepticus
Fosphenytoin, Levetiracetam, Phenytoin, Valproic acid
This condition causes progressive proximal muscle weakness and may present with difficulty rising from a chair, increased anxiety, and a fine tremor.
Hyperthyroidism
Disposition instructions for patients who present with seizures (example of activities & for what timeframe?)
Patients should be cautioned against:
- Driving
- Bathing
- Other activities during which unexpected loss of consciousness would be dangerous
for at least 6 months or until cleared by primary care doctor or neurologist.
The mortality rate after a first episode of status epilepticus approaches __%?
20%
This neurologic condition can cause generalized weakness and potentially progress to respiratory failure.
Myasthenia gravis crisis
This subtype of status epilepticus is characterized by altered mental status with small rhythmic movements (eg, twitches, automatisms) or psychiatric symptoms, which can be missed, in the presence of some form of seizure activity on EEG.
Subtle status epilepticus
Name 3 third like agents for status epilepticus (out of 4)
Ketamine, phenobarbital, lacosamide, propofol
Name 2 conditions for each: hyporeflexia and hyperreflexia in patients presenting with generalized weakness.
Hyporeflexia: Guillain-Barré syndrome and hypothyroidism
Hyperreflexia: upper motor neuron lesions or toxidrome (i.e. serotonin syndrome)