Focal Seizures
Abnormal electrical activity, at least initially, in one hemisphere of the brain (subcortical structures or neocortex); localizes to specific area on EEG or clinical findings. Often spreads bilaterally to become generalized. Subtypes Motor onset: Automatisms, tonic, atonic, clonic, myoclonic, epileptic spasms, hyperkinetic Non-motor onset: Autonomic, emotional, sensory, cognitive, behavior arrest clinical presentation Many different signs […]
Case Study 2: Smelling Burning Rubber
Case study 2: Rebekah—Smelling burning rubber Tap the image to view the case. A 37-year-old female presents to clinic to discuss a year-long history of brief episodes of “speaking gibberish,” which are preceded by a subtle smell of burning rubber. She says her husband never smells the burning smell, and says that during her “spells,” […]
Generalized Seizures
Generalized motor (“tonic clonic”) seizures Pathophysiology Clinical presentation Workup Abnormal electrical activity in bilateral cortical or subcortical areas; often initially localizes to one side of the brain (focal seizure) and then spreads bilaterally to become generalized. “Grand mal” seizuresGreat video by Epilepsy Toronto Vocalization (patients may cry out, grunt, or make other noises). Loss of […]
Case Study 1: Seizure during a Final Exam
Case study 1: Akbar—Seizure during a final exam Tap the arrow to view the case.A 24-year-old man is brought into the ER after a witnessed tonic-clonic seizure during a college final exam. He is tachycardic and appears mildly somnolent and disoriented. He does not remember the seizure and was confused as to how he ended […]
10. Seizure
Authors Keely Coxon, MD Dawn DeWitt, MD In this module Introduction Excessive, disorderly neuronal activity (“hyperexcitability”) in the abnormal brain, intermittent or episodic (except in the case of status epilepticus). Normal electrical impulse transmission: Action potential causes depolarization via net-positive movement of ions across the cell membrane. Hyperexcitability prevented by inhibitory neurotransmitters and counterbalance of […]
Knowledge Check: Matching
To really cement your knowledge, write down everything you know about the items before or after doing the matching exercise. (Freehand writing will make it even more easily recalled than typing.) Tap two cards to make a pair To redo or start over on these matching activities: Click on the hamburger icon in the upper […]
Case Study 3: Dropping Cards
Case study 3: Mac—Dropping cards Tap the arrow to view the case.A 64-year-old male visits your clinic for worsening Parkinson’s disease symptoms. He was diagnosed a year and a half ago. At the time, he was prescribed a dopamine agonist such as pramipexole. He is capable of performing most ADLs without assistance, but he has […]
Case Study 2: Mother with a Twitchy Baby
Case study 2: Macrena—Mother with a twitchy baby Tap the arrow to view the case.A 32-year-old college history professor is admitted to L&D in labor with her first child. The baby is born and is generally healthy but is very “twitchy.” The doctors are worried because the mother also has a notable tremor on examination […]
Case Study 1: Michael J. Fox
Case Study 1: Michael J. Fox As you watch these videos, notice the physical manifestations of PD and his medication/treatment. Make a list of your “physical examination” findings. https://youtu.be/5OLzuUVfoJ8https://youtu.be/DShQytVKeSA Drug-induced parkinsonism Note Removal of drug will reverse symptoms. Commonly cause PD sx Read More Antipsychotics Haloperidol, chlorpromazine Risperidone, olanzapine, ziprasidone, aripiprazole Antiemetics Metoclopramide Prochlorperazine Dopamine […]
9. Movement Disorders
Authors Dawn DeWitt, MD In this module Optional activity Watch the movie Awakenings. Characterize as hypokinetic vs. hyperkinetic Speed, amplitude, and frequency of movement; fatigability, suppressibility; randomness, directionality. Detailed assessment of motor function and gait. Assess muscle tone for rigidity—increase in resistance to passive movement. Gait: Base, pace, stride, foot clearance, postural stability, arm swing. […]