Neuroscience and Seizure Management Overview

Hyperventilation and Intracranial Pressure

• Hyperventilation decreases intracranial pressure by causing vasoconstriction, lowering PaCO2. This reduces IICP.

Ketogenic Diet

• A ketogenic diet (high fat, low protein) can help manage seizure disorders.

Seizure Management

• For seizures lasting more than 5 minutes, administer diazepam (Ativan) and call paramedics.
• Chiari malformation type 2 is a common cause of brainstem issues

Cervical Canal

• Structures that are normally inside the brain may protrude into the cervical canal.

Symptoms of Brainstem/Mid Brain Injury

• Signs of brainstem damage include weak cry, stridor, and apnea

Meningitis Vaccines

• Vaccines exist to prevent bacterial meningitis, including Hib, pneumococcal, and meningococcal vaccines

Reye's Syndrome

• Reye's syndrome only develops in response to a viral infection, not bacterial. Aspirin use is linked to developing this syndrome.

Early Signs of Increased Intracranial Pressure

• Headache (projectile vomiting)
• Visual disturbances
• Dizziness
• Decreasing heart rate, respiration
• Changes in pupil responses
• "Sunset eyes" (eyes looking upwards)
• Changes in level of consciousness (LOC)
• Seizures
• Bulging fontanelle/increasing head circumference (infants)

Late Signs of Increased Intracranial Pressure

• Decreased level of consciousness (LOC)
• Decreased motor or sensory responses
• Bradycardia (slow heart rate)
• Irregular breathing patterns (Cheyne-Stokes respirations)
• Abnormal body postures (decorticate/decerebrate)
• Fixed and dilated pupils

Neonatal Seizures

• Phenobarbital is the first-line anti-seizure medication for neonatal seizures.

Seizure Types (Diagram)

• Partial Seizures: Simple (localized awareness), Complex (altered awareness)
• Generalized Seizures: Absence (brief lapses of awareness), Tonic-Clonic (muscle stiffening and jerking), Myoclonic (jerking), Atonic (muscle loss)

Seizure Management - Tonci-Clonic

• During a tonic-clonic seizure, maintain the airway, protect the patient from harm, do not restrain, do not place objects in mouth, and observe and record. Check for:
  • Onset
  • Body Part Affected
  • Level of Consciousness (LOC)
  • Muscle Tone
  • Pupils
  • Cyanosis
  • Altered Salivation
  • Incontinence

Pediatric Glasgow Coma Scale (GCS)

• A score of 8 or less on the pediatric GCS scale indicates possible need for intubation.
• A normal doll's eye maneuver (eyes look directly ahead during head movement) indicates no mid-brain or pons injury. A deviated eye could signal brain stem or mid brain damage.
• Decorticate posturing (flexed extremities) and decerebrate posturing (extended extremities) are both indications of possible brain stem damage

Anti-epileptic Drugs

• Common anti-epileptic drugs like phenytoin, carbamazepine, and valproic acid
• Adverse effects of each drug must be considered

Important Considerations for Seizure Patients

• Non-compliance with treatment is a frequent cause of seizure treatment failure.

This quiz covers critical topics related to hyperventilation, intracranial pressure, and seizure management. It includes essential information on the ketogenic diet, signs of brainstem injury, and preventive measures for meningitis. Test your knowledge on these vital areas of neurology and emergency response.