dxtxpx
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16 yr boy is brought to doctor after apparently trying to take off his clothes during the showing of a filmstrip. He described having started to see wavy lines onthe screen, then experiencing a brief period of mental blankness, followed by fatigue and headache. The most probable diagnosis is:
a) grand mal epilepsy
b) migraine behavioral syndrome
c) partial complex seizure
d) exhibitionism
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| asmi
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i go with B
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| peekay
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grand mal seizure( loss of consciousness and tired after waking up)
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| dxtxpx
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correct answer is c
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| mjl1717
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Grand mal
aura :arrow: outcry :arrow: seizure continues with LOC :arrow: falling :arrow: severe tonic/clonic contractions :arrow: postictal state/deepsleep
urinary or fecal incontinence may occur attacks may last 2-5 miutes
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Smell the coffee! "Is That an Osler move??"
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| asmi
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all three of us have different answers.
We need ur help dxpx :idea:
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| dxtxpx
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Because EEG measures only the top few mm of brain activity, epileptic foci deep in the limbic system are difficult to detect. When they fire without spreading to the rest of the brain, they may produce sx and behaviors that are easily mistaken for primary psychiatric disorders. Seizures confined to limbic structures are called partial complex seizures (formerly temporal lobe epilepsy) Recognized aspects of partial complex seizures include pre-seizure auras invloving sensory distortions (olfactory and gustatory hallucinations, visual distortions; rarely abdominal pain). During ictal phase, pt may show stereotypic, elemental motor activity (standing and sitting, buttoning and unbuttoning), and disruptions of cognitive functioning (trance, depersonalization, repetitive thoughts). A partial seizure may also generalize to the rest of the brain producing a grand mal seizure. Pts are typically amnestic for the ictal phase of either grand mal or partial seizure and sometimes for events immediately beforehand (anterograde amnesia). Intense dysphoria, anxiety or rage may occur in conjunction with partial seizures and also in periods far removed from the actual seizure
Organized, directed, violent behavior rarely if ever occurs during a seizure. However, violent beh may occur interictally in pts with partial complex seizures or those with non-epileptic EEG abnormalities in temporal lobes. Interictal irritability is very common, Frequent deja vu or jamais vu and feelings of depersonalization r other interictal clues that pt may have partial complex seizures. Over many yrs, pts with partial complex seizures may develop personality changes, including passivity, unusual sexual beh, loss of sexual interest, obsessiveness, religious preoccupations and even a chronic psychosis that closely resembles chronic schizophrenia. In pts with grand mad epilepsy, these changes are found more commonly in those with primary lesions in limbic system than in those with other foci.
The diagnosis of partial complex seizures is sometimes hard to confirm. EEG abnormalities are most easily detected during transition from waking to sleep, so its best to study sleep deprived pts who fall asleep during the test. While partial complex seizure may be idiopathic, a clinical neurologic exam and brain imaging studies may detect structural lesions that account for the abnormal electrical activity
Projective psychological tests, though often helpful in studying personality and uncovering psychosis, suffer from lact of standardization and unacceptably low reliability. Thus, they have little place in standard neuropsychiatric evaluation
Partial complex seizures respond best to anticonvulsants, with carbamazapine and valproic acid often more effective and less toxic then phenytoin, barbiturates or benzodiazepines. Lithium, which may reduce impulsiveness and violence, is analeptic (lowers the seizure threshold), and not advisable as a single agent in pts with seizures. Behavior therapy is sometimes effective for compulsions, but not for those related to epilepsy. Ergotamine is used specifically for tx of migraine headaches
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