Causes and diagnosis and management of acute convulsions

Causes and diagnosis and management of acute convulsions IN simple way  now you can recognize it in any time just read this note and you will know .

Causes:

a- Non-febrile convulsions:

•  Toxic:
• Hypoxic:

1. - Convulsant drugs: aminophylline, steroids.
2. - Bacterial toxins: tetanus, salmonella.
3. - Poisoning: CO, lead, organophosphrous
4. - Post – kernicterus.
5. - Asphyxia neonatorum.
6. - Cyanotic spells (congenital heart diseases.)

•  Ischemic:

1. - Cerebral thrombosis ( S.C. anemia )
2. - Intra cranial hemorrhage.
3. - Cerebral embolism.

•  Metabolic:

1. - Ca - Mg ( tetany + inborn error of metabolism )

• Brain:

1. Infection: - Vital: encephalitis, polio enceph.
2. Bacterial: meningitis, Brian abscess.
3. Injury: Trauma
4. Edema: AGN. - Tumors.
5. Nutritional: hypoglycemia – Vit. B6 deficiency.
6. Idiopatihic or familial.
7. ICH (trauma, hypoxic ischemic , encephalopathy)

B- febrile convulsions:

1. High environmental temperature.
2. Extra – cranial infection ( CVS , Chest , GIT , urinary ).

Diagnosis:

1- History: * Onset: ( acute – chronic ).
* Of the cause: head trauma – infection – congenital heart diseases.
2- Full neurological exam: to decide if cranial or extra-cranial.
3- Investigations:

• X-ray, CT, MRI.
• CSF analysis.
• Blood exam.
• Urine analysis.
• ECG, ECHO, EEG.

Treatment:
I- During seizure:
a- Air way: keep patent by:

• Semiprone position with head down & to the right.
• Suction of secretions.
• Mouth gag.
• Tongue depressor.

b- O2 therapy.
c- Anti-convulsant drugs: IV. Diazepam also, rectal effective ( 1 / 2 gm / kg ).
d- Symptomatic ttt: fever – anti-pyretics acetaminophen + cold fomentation.
e- Underlying cause ttt: infection antibiotic & hypoglycemia, IV glucose 10 %.
II- Long term management: ( Prophylaxis of recurrence )

• Continuous prophylaxis : about one year phenobarbitone.
• Intermittent prophylaxis : diazepam at onset of fever.

N.B.: Simple febrile convulsions is benign not has long term sequale – not need prophylaxis