Seizure or syncope… who knows? Now you do.
- For seizure, expect a post ictal state (and ask for how long) and an elevated CK level if they were seizing for several minutes.
- Warning! Convulsions, loss of consciousness, urinary incontinence can ALL occur in both syncope and seizure.
Causes of provoked seizures
- Acute trauma
- Medications: bupropion (Wellbutrin), tramadol, cocaine
- EtOH/Benzo withdrawal
- Extreme electrolyte disturbance: eg Na+ of 104 (less likely if it’s just 120 unless previous underlying seizure disorder)
ANY patient with syncope or seizure is legally not allowed to drive for 6 months (or more if they experience another event). Here are the Penndot/ DMV forms you can fill out to revoke their license. It’s not cruel.. you’re saving their and other people’s lives.
Dr Paul Katz gave us a great intro to stroke! Here is the link to the powerpoint. And here are the highlights:
- CVA is the 5th leading cause of death.
- Cerebral perfusion is key!
- CORE trial found that the region of absent cerebral blood flow and CMRO2 (cerebral metabolic rate of oxygen) corresponded with the core of cerebral infarct.
- SURROUND trial studied the ischemic penumbra, the region around the core in which cerebral blood flow is depressed out of proportion to CMRO2.
- This region is salvageable with adequate perfusion pressure
- Techniques for Increasing Perfusion Pressure
- Induced hypertension — treat hypotension!
- Thrombolysis: tPA vs endovascular
- Despite an increased incidence of symptomatic ICH, patients treated with tPA within 3 hours of symptom onset showed improved clinical outcome at 3 months
- later studies showed benefit for MCA occlusion up to 6 hours and vertibrobasilar occlusion up to 48 hours after symptom onset.
- NIH tPA Trial: Patients given tPA were 30% more likely to have minimal or no disability at 3 months; this benefit was not associated with any increase in mortality.
- Three 2015 studies (MR CLEAN, ESCAPE and SWIFT-PRIME all showed benefit of endovascular treatment of ischemic stroke.
- Isolated diplopia, vertigo, ataxia without weakness or dysphagia is highly unlikely to be stroke. However, in combination, they may be.
- Do a FAST exam.
- Use the NIH Stroke Scale (NIHSS)
Lecture video coming soon!