Stroke and Epilepsy

Question 1

Describe features of total anterior circulation strokes (TACS)

Answer 1

• Stroke of both the anterior and middle cerebral artery.
• Must have three of the following; hemiparesis/hemi-sensory loss, homonymous hemianopia and higher cerebral dysfunctions (dysphagia or visuospatial disorder)

Question 2

Describe features of partial anterior circulation stokes (PACS)

Answer 2

• Either anterior or middle cerebral artery is compromised.

- Must have two of the following; hemiparesis/hemisensory loss, homonymous hemianopia and higher cerebral dysfunction.

Question 3

Describe features of a posterior circulation stroke (POCS)

Answer 3

Must have one of the following;

• cranial nerve palsy and contralateral motor/sensory deficit.
• Bilateral motor/sensory loss,
• Conjugate eye movement disorder,
• cerebellar dysfunction,
• Isolated hemianopia

Question 4

Describe features of a lacunar stroke

Answer 4

One of the following must be present;

• Pure sensory stroke,
• Pure motor stroke,
• Sensori-motor stroke,
• Ataxic hemiparesis

Question 5

Describe the management of strokes

Answer 5

• Immediate head CT to rule out haemorrhagic stroke,
• Give oxygen and control blood sugar,
• If ischaemic stroke then give aspirin, do thrombolysis using alteplase if onset of symptoms was UNDER 4.5 hours or thrombectomy.

Question 6

What is the secondary prevention for strokes

Answer 6

• Anti-thrombotics (clopidogrel for long term, or aspirin),
• If AF then give doacs or warfarin,
• Control BP (systolic under 130mmHg) using CCB, diuretics or ACE inhibitors,
• Control cholesterol using statins if it is above 4mmol/l

Question 7

What is SUDEP?

Answer 7

Rare risk of sudden death in epileptic patients

Question 8

What are relevant questions to ask when taking a history from someone who had a seziures?

Answer 8

• Aura? (warning, fear, deja vu etc),
• Any abnormal movements such as lip smacking, patting or stroking,
• Any after effects such as memory loss, confusion.

Question 9

What are the different classifications of seziures?

Answer 9

Partial - focal aware or focal onset impaired awareness.
Generalised - Abscent, myoclonic, clonic, tonic, clonic-tonic or atonic.
Unclassified

Question 10

What are simple focal aware seziures?

Answer 10

Conciousness is preserved. The symptoms relate to the area of brain affected.

Question 11

What is a focal onset impaired awareness seizure?

Answer 11

A seizures that begins as a focal but progresses to a generalised.

Question 12

Describe the features of Absence seizures (petit mal)

Answer 12

• Sudden onset with abrupt cessation. Only brief and may present with mild clonic jerking of eyelids or postural tone changes.
• Treat with Ethosuximide

Question 13

What are features of myoclonic seziures?

Answer 13

• Myoclonic jerking.

- DO NOT treat with carbamazepine as this will make them worse

Question 14

What are atonic seizures?

Answer 14

• Sudden loss of postural tone

Question 15

What are tonic-clonic seizures (grand mal)

Answer 15

Major convulsions with ridigity (tonic) and jerking (clonic). Followed by stuperous state

Question 16

What is status epilepticus

Answer 16

More than 30 mins of continous seizures.

Question 17

What investigations are used in epilepsy?

Answer 17

• ECG to check for abnormal function.
• EEG (interictal),
• CT scan if suspect tumour,
• MRI to identify area of scarring, reduced perfusion etc.

Question 18

What are seizure triggers?

Answer 18

Tiredness, alcohol, certain drugs (tricyclics), change of medication.

Question 19

Name some antiepileptics

Answer 19

• Sodium valproate,
• Lamotrigine
• Carbamazepine,
• Ethosuximide

Question 20

Explain the treatment of status epilepticus

Answer 20

IV lorazepam or PR diazepam

- Followed by phenytoin, or phenobarbital once control is established