tailieunhanh - Neurological Differential Diagnosis - part 4

Lịch sử gia đình cũng có thể mang lại thông tin quan trọng. Cẩn thận thi nên tập trung vào bất kỳ dấu hiệu thần kinh đầu mối. 2 Electroencephalogram. Ban đầu, một giấc ngủ / thức dậy EEG thường xuyên nên được đặt hàng. Nó được phổ biến để quan sát một 'bình thường' ghi trên 30 phút | 154 Chapter 4 persons whom actually witnessed the event. Family history can also yield critical information. Careful exam should focus on any focal neurologic signs. 2 Electroencephalogram. Initially a routine sleep wake EEG should be ordered. It is common to observe a normal recording over 30 minutes even in patients with known seizure disorders. Therefore a routine interictal EEG may not demonstrate epileptiform activity and should not be interpreted as definitive in ruling out seizures. Sensitivity can be increased by repeat exams records obtained within 24 hours of an ictal event or prolonged monitoring such as continuous telemetry. 3 Neuroimaging. MRI is the modality of choice and should include gadolinium contrast to assess infectious or neoplastic processes. A CT scan with and without contrast is acceptable only when MRI is not available or contraindicated. Risk factors for recurrent seizures The decision to initiate anti-epileptic medication following a single seizure should take into account the likelihood of recurrence. Lifetime incidence of a single seizure in the general population is approximately 10 . This does not necessarily imply epilepsy requiring lifelong treatment. Good candidates for discontinuation of previously initiated anti-epileptic medical treatment include seizures easily controlled with monotherapy prior two-year seizure-free period idiopathic seizure normal EEG 2x seizure onset in childhood and normal neurological exam. The following list are features that should be considered risk factors for recurrent seizure. 1 EEG demonstrating epileptiform discharges 2 Abnormal neurological exam findings 3 History of neurological deficit from birth such as mental retardation or cerebral palsy 4 Age less than 16 years old 5 Seizure occurring during sleep 6 Status epilepticus or multiple seizures within 24 hours as the initial presentation 7 Partial seizures 8 Todd paralysis Differential diagnosis of recurrent seizures Seizure recurrence should be .