Are the episodes definitely seizures?

Cristina Villacorta
Mind Map by Cristina Villacorta, updated more than 1 year ago
Cristina Villacorta
Created by Cristina Villacorta over 6 years ago
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Description

Seizures Algorithim

Resource summary

Are the episodes definitely seizures?
  1. Questions to ask?

    Annotations:

    • 1) Is there abnormal mentation during an episode? 2) Are there autonomic signs (salivation, urination) 3) Are the episodes short in duration <5 min? 4) Are there postictal signs?
    1. No
      1. Ask for the owners to film an episode
        1. Consider conditions that mimic seizures
          1. DDX

            Annotations:

            • - Myokymia - Movement disorders - Cataplexy/Narcolepsy - Postural myoclonus - Atypical seizures - Focus of pain - Syncope
      2. Yes
        1. Are seizures recurrent?
          1. Yes
            1. Investigate extra-cranial causes for seizures

              Annotations:

              • - H&B - UA - Fasting glucose - Pre/post prandial bile acid concentrations - Fasted triglycerides/cholesterol - Blood pressure measurement - ECG
              1. Hypoglycemia
                1. If <5 mmol/l repeat every 2 hours for 6 hours in total
                  1. DDX
                  2. If <3.5 mmol/l, take concurrent serum insulin concentration
                    1. DDX

                      Annotations:

                      • - Insulinoma - Addisons - Hepatic disease - Other neoplasia - Toy breed/juvenile hypoglycemia - Sepsis - Toxic - Glycogen storage disease - Polycythemia - Insulin overdose - Lab/sampling error
                  3. Normal
                    1. Investigate intra-cranial causes for seizures
                      1. Neuro check

                        Annotations:

                        • Abnormal mentation? Loss of learned behaviour? Pacing round the house/unsettled Abnormal menace response Postural reaction or hping deficits?
                        1. Repeat neurological examination in 24 hours
                          1. Yes
                          2. Yes
                            1. Had a seizure in the last 24 hours?
                              1. Yes
                                1. No
                                  1. Consider MRI/CT/+/- CSF
                                    1. Juvenile dog <6 months old
                                      1. DDX

                                        Annotations:

                                        • Meningoencephalitis (GEME) Neoplasia Congenital malformation Infectious encephalitis (distemper, bacterial, FIP)
                                      2. Adult dog 6 months to 6 years old
                                        1. DDX

                                          Annotations:

                                          • Meningoencephalitis (GEME) Neoplasia Congenital malformation Infectious encephalitis (Neospora, bacterial) Cerebrovascular accident (stroke)
                                        2. Older dog >6 years old
                                          1. DDX

                                            Annotations:

                                            • Neoplasia Infectious encephalitis (disptemper, Neospora, bacterial, FIP) Cerebrovascular accident "stroke"
                                  2. No
                                    1. Aged b/w 6 months and 6 years when had first seizure?
                                      1. Yes
                                        1. Consider idiopathic epilepsy the most likely cause
                                          1. Consider MRI/CT/+/- CSF
                                        2. No
                                2. Hypertension
                                  1. Systolic blood pressure > 180 mmHg
                                    1. DDX
                                    2. Fundic examination
                                      1. DDX

                                        Annotations:

                                        • Renal disease Cushings Phaeochromocytoma Primary idiopathic hypertension
                                    3. Increased pre/post prandial bile acid concentrations
                                      1. Abdominal US
                                        1. DDX

                                          Annotations:

                                          • Hepatic insufficiency (PSS)
                                        2. +/- Ammonia
                                          1. DDX
                                        3. Fasting hyperlipidaemia
                                          1. Measure T4 and TSH

                                            Annotations:

                                            • Hypothyroidism Idiopathic familial hyperlipidaemia Cushings DM Pancreatitis Hepatic disease
                                      2. No
                                        1. Consider toxin exposure
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