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Neurology aNd Special SeNSeS ` neurology—PAthology Neurology aNd Special SeNSeS ` neurology—PAthology SecTioN iii 517

Seizures Characterized by synchronized, high-frequency neuronal firing. Variety of forms.
Partial (focal) seizures Affect single area of the brain. Most commonly Epilepsy—disorder of recurrent, unprovoked
originate in medial temporal lobe. Types: seizures (febrile seizures are not epilepsy).
ƒ Simple partial (consciousness intact)— Status epilepticus—continuous (≥ 5 min) or
motor, sensory, autonomic, psychic recurring seizures that may result in brain
ƒ Complex partial (impaired consciousness, injury.
automatisms) Causes of seizures by age:
Generalized seizures Diffuse. Types: ƒ Children—genetic, infection (febrile),
ƒ Absence (petit mal)—3 Hz spike-and-wave trauma, congenital, metabolic
discharges, no postictal confusion, blank stare ƒ Adults—tumor, trauma, stroke, infection
ƒ Myoclonic—quick, repetitive jerks ƒ Elderly—stroke, tumor, trauma, metabolic,
ƒ Tonic-clonic (grand mal)—alternating infection
stiffening and movement, postictal confusion,
urinary incontinence, tongue biting
ƒ Tonic—stiffening
ƒ Atonic—“drop” seizures (falls to floor);
commonly mistaken for fainting
Seizure

Partial (focal) seizures Generalized seizures
2° generalized
Impaired consciousness?

Tonic-clonic Absence
Simple partial Complex partial (grand mal) Tonic Myoclonic Atonic (petit mal)

Alternating Quick Drop seizure Blank stare
sti ening and Sti ening and repetitive (falls to floor) no postictal
movement jerks confusion

Tonic phase
Drop
Clonic phase

Fever vs heat stroke
Fever Heat stroke

PAthoPhysiology Cytokine activation during inflammation (eg, Inability of body to dissipate heat (eg, exertion)
infection)
temPerAture Usually < 40 °C Usually > 40 °C

ComPliCAtions Febrile seizure (benign, usually self-limiting) CNS dysfunction (eg, confusion), end-organ
damage, acute respiratory distress syndrome,
rhabdomyolysis
mAnAgement Acetaminophen or ibuprofen for comfort (does Rapid external cooling, rehydration and
not prevent future febrile seizures), antibiotic electrolyte correction
therapy if indicated

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