Diagnosis status epilepticus management we should

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Diagnosis – status epilepticus Management – we should transport her to ICU and start emergency drug therapy: IV tranquilizer (diazepam), if she’s not responding - IV anticonvulsive drug(valproic acid, phosphenytoin or phenobarbital), if still not responding - IV or inhalation general anesthesia; 3 Patient, male, 64 years old, during last half a year has been suffering from recurring twitching of left mimic muscles that extends to the left arm and subsequently – leg and sometimes is associated with consciousness loss and clonic jerks affecting the whole body, foam in the mouth, biting the tongue and involuntary urination. During neurological examination some assymetric tendon reflexes were observed. What diagnosis can we think about? How to confirm it? How to treat the guy? Diagnosis: Partial simple motor seizure with secondary generalization into clonic seizure EEG, MRI, blood chemistry (glucose, electrolytes, liver enzymes, toxicology – heavy metals, narcotics, psychostimulants) Treatment : antiepileptic drug (valproic acid) 4 Patient, male, 45 years old, suffering from alcoholic epilepsy during last 3 years, today closer to the evening emptied bottle of whiskey and next morning developed generalized tonic- clonic seizure that goes on already for 25 minutes. IV infusion of diazepam was ineffective. What pathologic condition can we suspect? How to manage the patient? Diagnosis: status epilepticus Treatment: if diazepam was ineffective, fosphenytoin IV, with blood pressure and ECG monitoring is required. If there is still no effect of fosphenytoin – intubation and IV phenobarbital/midazolam/propofol should be given. 5 Patient, male, 27 years old, 1 year ago experienced severe car accident, complicated with cranial vault fracture in left temporal area and acute subdural hematoma that required subsequent neurosurgical intervention. After this event guy started suffering from short- lasting episodes of changed consciousness after which he found himself in absolutely unknown places and was unable to define himself due to confusion. Patient also complained of déjà vu phenomena, auditory and olfactory hallucinations (voices, unpleasant smell). What is your probable diagnosis? What diagnostic tools can be suitable for its confirmation? How to treat the guy? Diagnosis: partial complex seizure due to affection of frontal and temporal lobes Diagnostic tools: Interictal EEG showing focal temporal slowing and epileptiform sharp waves or spikes over the anterior temporal region; MRI Treatment: antiepileptic drugs (valproic acid) are usually successful in suppressing secondarily generalized seizures, but most patients continue to have partial attacks. When seizures persist, anterior temporal lobe resection or selective amygdalohippocampectomy is the treatment of choice TOPIC “MULTIPLE SCLEROSIS, ACUTE DESSEMINATED ENCEPHALOMIELITIS, AMYOTROPHIC LATERAL SCLEROSIS + SYRINGOMYELIA” TEST QUESTIONS 1 What structures are predominantly affected in case of syringomyelia?
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  • Winter '18
  • Jane doe
  • Neurology, Seizure, Seizure types

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