Fits / faints (paeds)

Mind Map by hazel_121, updated more than 1 year ago
Created by hazel_121 about 6 years ago


Paeds Mind Map on Fits / faints (paeds), created by hazel_121 on 02/14/2014.

Resource summary

Fits / faints (paeds)
1 Seizure
1.1 Epileptic
1.1.1 Consciousness may (complex) or map not (simple) be impaired, focal signs, may be aura, may or may not be asscoaited with generalised tonic clonic Focal frontal motor phenomena - clonic movements, may travel proximally (jacksonian march) temporal auditory or sensory phenomena inc automatisms, deja-vu and jamais vu, consciousness may be impaired (complex partial) Secondary generalised starts focal then spreads Parietal contralateral altered sensation (dysthesia) Occipital +ve or -ve visual phenomena
1.1.2 Consciousness always impaired, no warning / aura, symmetrical seizure, Generalised Absence transient loss of awareness, few motor signs Myoclonic brief repetitive jerkng movements of limbs, neck, trunk, Tonic-clonic Tonic phase - rigid and may fall, do not breath and become cyanosed. clonic phase - rhythmical jerking, irregular breathing, cyanosis and salivation. may be biting of lateral tongue and incontinence. last several minutes and followed by unconsciousness or deep sleep Tonic generalised increased tone Atonic often combined with a myoclonic jerk, followed by a transient loss of muscle tone
1.1.3 Secondary causes cerebral tumour cerebral dysgenesis / malformation cerebral vascular occlusion cerebral damage e.g. HIE, congenital infection neurodegenerative disorders Neurocutaneous syndromes
1.1.4 treatment sodium valproate first line; generalised seizures and focal TERTOGENIC, weight gain, hair loss, liver failure Stabalises Na channels? carbamazepine First line tonic clonic and focal seizures Rash, neutropenia, hyponatraemia, ataxia, liver enzyme induction - medication interaction lamotrigine first line; focal. second line; generalised Rash ethosuximide first line; absence Nausea and vomitting topiramate 2nd line; tonic clonic, focal drowsiness, withdrawl, weight loss vigabatrin 2nd line; focal restricted visual fields, sedation gabapentin 2nd line; focal insomnia ketogenic diet, vagal nerve stimulation, surgery
1.1.5 epilepsy syndromes
1.2 Non epileptic
1.2.1 Non epileptic attack disorder (NEAD)
1.2.2 Brief tonic clonic seizure associated with rise in temperature (in 6mnths -6yrs) febrile Simple no increased epilepsy risk Complex - focal, prolonged or repeated in same ilness increased risk of subsequent epilepsy Management Investigate and treat cause especially if suspected bacterial or meniningitic advise parents on seizure management - 30-40% likely to have another RFs for 2nd seizure; +ve FH, low temp when seizure, young child, short illness before seizure
1.2.3 metabolic - hypoglycaemia, hypocalcaemia, hypomagnesaemia, hypo/hypernatraemia
1.2.4 head trauma
1.2.5 Meningitis / encephalitis
1.2.6 Pseudoseizures or fabricated
1.3 investigations
1.3.1 EEG - abnormal supports epilepsy diagnosis
1.3.2 Biochem - metabolic abnormalities
1.3.3 MRI / CT - structural causes
2 Paroxysmal disorders; quick recovery, may jerk, normal EEG
2.1 Syncope
2.1.1 Cardiac arrhythmia e.g. prolonged QT interval (related to exercise)
2.2 Neurocardiogenic
2.2.1 Reflex anoxic seizure; Prodrome, provocation, posture (stood up), precipitated by pain, head trauma, fright, cold food
2.3 Breath holding attacks
2.4 migraine
2.5 Benign paroxysmal vertigo
2.6 Self gratification
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