Seizure, Adult
Seizure, Adult is a topic covered in the 5-Minute Emergency Consult.
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Basics
Description
Description
- Generalized seizures:
- Classically tonic–clonic (grand mal)
- Begin as myoclonic jerks followed by loss of consciousness
- Sustained generalized skeletal muscle contractions
- Nonconvulsive generalized seizures:
- Absence seizures (petit mal); alteration in mental status without significant convulsions or motor activity
- Partial seizures:
- Simple:
- Brief sensory or motor symptoms without loss of consciousness (i.e., Jacksonian)
- Complex:
- Mental and psychological symptoms
- Affect changes
- Confusion
- Automatisms
- Hallucinations
- Associated with impaired consciousness
- Simple:
- Status epilepticus:
- Variable definitions:
- Seizure lasting longer than 5–10 min
- Recurrent seizures without return to baseline mental status between events
- Life-threatening emergency with mortality rate of 10–12%
- Highest incidence in those <1 yr and >60 yr of age
- Variable definitions:
- At least one-half of patients presenting to the ED in status do not have a history of seizures.
- Alcohol withdrawal seizures (“rum fits”):
- Peak within 24 hr of last drink
- Rarely progress to status epilepticus
- Patients with a single seizure have a 35% risk of recurrent seizure within 5 yr
Pediatric Considerations
Febrile seizures are generalized seizures occurring between 3 mo and 5 yr of age:
- Typically lasts <15 min
- Associated with a rapid rise in temperature
- Without evidence of CNS infection or other definitive cause
Etiology
Etiology
- Hypoxia
- Hypertensive encephalopathy
- Eclampsia
- Infection:
- Meningitis
- Abscess
- Encephalitis
- Vascular:
- Ischemic stroke
- Hemorrhagic stroke
- Subdural hematoma
- Epidural hematoma
- Subarachnoid hemorrhage
- Arteriovenous malformation
- Structural:
- Primary or metastatic neoplasm
- Degenerative disease (i.e., multiple sclerosis)
- Scar from previous trauma
- Metabolic:
- Electrolytes
- Hypernatremia
- Hyponatremia
- Hypocalcemia
- Hypo/hyperglycemia
- Uremia
- Toxins/drugs:
- Lidocaine
- Tricyclic antidepressants
- Salicylates
- Isoniazid
- Cocaine
- Alcohol withdrawal
- Benzodiazepine withdrawal
- Congenital abnormalities
- Idiopathic
- Trauma
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Citation
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TY - ELEC
T1 - Seizure, Adult
ID - 307574
ED - Barkin,Adam Z,
ED - Barkin,Roger M,
ED - Hayden,Stephen R,
ED - Rosen,Peter,
ED - Schaider,Jeffrey J,
ED - Shayne,Philip,
ED - Wolfe,Richard E,
BT - 5-Minute Emergency Consult
UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307574/all/Seizure__Adult
PB - Lippincott Williams & Wilkins
ET - 5
DB - Emergency Central
DP - Unbound Medicine
ER -