Differential Diagnosis A Seizures

1. Generalized. Present with sudden onset of loss of consciousness, because they are a manifestation of widespread abnormal electrical discharges.

2. Partial. Result from localized abnormal electrical discharge and can present with altered arousal or GI symptoms, confusion, hallucinations, localized motor or sensory activity, or auto-nomic changes.

3. Etiology. Seizures have many etiologies, including cerebral malformations, hypoxia, head trauma, structural or destructive lesions (neoplasm, stroke, vascular anomalies), infections (meningitis or encephalitis), toxicity (lidocaine, theophylline, psychotropic agents, isoniazid, chemotherapeutic agents, cocaine, amphetamines, heroin, PCP, methanol, ethylene glycol, or carbon monoxide), metabolic alterations (hypo-glycemia, hyponatremia, hypocalcemia, or phenylketonuria), or degenerative disorders. Systemic disorders may be associated with seizures (tuberous sclerosis, neurofibromatosis, sickle cell anemia, or acute lymphocytic leukemia).

B. Increased Intracranial Pressure. Lethargy may reflect the presence of increased intracranial pressure secondary to space-occupying lesions within the cranial vault (hematoma, abscess, or tumor), progressive hydrocephalus, or cerebral edema.

C. Trauma. A patient can remain lethargic for a variable period of time following closed head injury. There may be a transient lucid period between the traumatic event and the alteration of arousal. Trauma may be severe enough to produce intracranial hemorrhage (subarachnoid hemorrhage) or even a space-occupying hematoma (subdural or epidural), which, in turn, can lead to increased intracranial pressure and, potentially, to herniation.

1. Concussion. Defined as an alteration of brain function following head trauma. Classified as grade 1, 2, or 3 based on symptoms and their duration.

a. Grade 1. Manifested by transient confusion (not loss of consciousness) with resolution of symptoms within 15 minutes.

b. Grade 2. Similar to grade 1, but symptoms persist for more than 1 hour.

c. Grade 3. Occurs when there is any loss of consciousness.

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