Intracranial seizures

Acute complications of stroke include cerebral edema, increased intracranial pressure, seizures, and hemorrhagic conversion. In the acute setting, several supportive interventions and treatments to prevent acute complications should be initiated. 

Allogeneic hematopoietic stem cell transplantation (HSCT) is the only potential cure for SCD. The best candidates are children with SCD who are younger than 16 years of age with severe complications who have an identical H LA-matched donor, usually a sibling. The transplant-related mortality rate is between 5% and 10%, and graft rejection is approximately 10%. Other risks include secondary malignancies, development of seizures or intracranial bleeding, and infection in the immediate posttransplant period.6,25,32,33... 

Acute neurologic events, such as stroke, will require hospitalization and close monitoring. Patients should have physical and neurologic examinations every 2 hours.27 Acute treatment may include exchange transfusion or simple transfusion to maintain hemoglobin at around 10 g/dL (100 g/L or 6.2 mmol/L) and HbS concentration at less than 30%. Patients with a history of seizure may need anticonvulsants, and interventions for increased intracranial pressure should be initiated if necessary. Children with a history of stroke should be initiated on chronic transfusion therapy. Adults presenting with ischemic stroke should be considered for thrombolytic therapy if it has been less than 3 hours since the onset of symptoms.6,27... 

Suggested Alternatives for Differential Diagnosis Meningitis, basilar artery blood clots (thrombosis), cardioembolic stroke, cavernous sinus syndromes, cerebral venous blood clots (thrombosis), confusional states and acute memory disorders, epileptic and epileptiform encephalopathies, febrile seizures, haemophilus meningitis, intracranial hemorrhage, leptomeningeal carcinomatosis, subdural pus (empyema), or bruise (hematoma). 

Zinc is important to the normal functioning of the central nervous system (CNS). At low concentrations, zinc protects mammalian brain neurons by blocking N-methyl-D-aspartate receptor-mediated toxicity. At high concentrations, zinc is a potent, rapidly acting neurotoxicant in the mammalian brain, as judged by zinc-induced neuronal injury of in vitro mature cortical cell cultures (Choi et al. 1988). Increased brain levels of zinc are associated with Pick s disease in certain strains of rodents with inherited epileptic seizures. Intravenous injection of zinc in rats with genetically inherited epilepsy produces seizures a similar response occurs with intracranial injection of zinc in rabbits with inherited audiogenic seizures (Choi et al. 1988). 

Side effects are increased blood pressure and heart rate, respiratory depression, apnea, muscular hypertonus, and dystonic reactions. In overdose, seizures, polyneuropathy, increased intracranial pressure, and respiratory and cardiac arrest may occur. 

CNS CNS effects including convulsions, increased intracranial pressure, and toxic psychosis have been reported with nalidixic acid therapy. Convulsive seizures have been reported with other drugs in this class. Quinolones also may cause CNS stimulation, which may lead to confusion, hallucinations, light-headedness, restlessness, and tremor. Therefore, use nalidixic acid with caution in patients with known or suspected CNS disorders (eg, cerebral arteriosclerosis, epilepsy) or other factors that predispose to seizures. If these reactions occur in patients receiving... 

Seizures Increased intracranial pressure, convulsions, and toxic psychosis have occurred. CNS stimulation also may occur and may lead to tremor, restlessness, lightheadedness, confusion, dizziness, depression, hallucinations, and rarely, suicidal thoughts or acts. 

Most of the contraindications specific to pentazocine stem from its excitatory effects. Other contraindications are similar to those for morphine. Pentazocine is contraindicated in patients with myocardial infarction because it increases heart rate and cardiac load. Similarly, it is contraindicated in epileptic patients because it decreases seizure threshold. In addition, in head trauma patients, it can increase intracranial pressure and brain injury. Pentazocine use in patients with psychoses is contraindicated because of its psychotomimetic side effects. 

Lumbar puncture is considered mandatory in patients with suspected bacterial meningitis but the procedure can be hazardous with a risk of brain herniation in patients with raised intracranial pressure, and imaging with computed tomography or MRI is recommended for selected patients to detect brain shift. Patients who are in an immunocompromised state, have new-onset seizures, moderate-to-severe impairment of consciousness or signs that are suspicious of space-occupying lesions (e.g. papilloedema - oedema of the optic disk) should undergo neuroimaging prior to lumbar puncture. 

Moyamoya seems to be mainly confined to the Japanese and other Asians, and in most cases the cause is unknown (Bruno et al. 1988 Chiu et al. 1998). Some cases are familial (Kitahara et al. 1979) others appear to be caused by a generalized fibrous disorder of arteries (Aoyagi et al. 1996), and a few may result from a congenital hypoplastic anomaly affecting arteries at the base of the brain, or associated with Down s syndrome (Cramer et al. 1996). The syndrome may present in infancy with recurrent episodes of cerebral ischemia and infarction, mental retardation, headache, epileptic seizures and, occasionally, involuntary movements. In adults, subarachnoid or primary intracerebral hemorrhage are also common owing to rupture of collateral vessels. There have also been a few reports of associated intracranial aneurysms (Iwama et al. 1997) and also of cerebral arteriovenous malformations. 

Arteriovenous malformations present most commonly with signs consistent with a space-occupying lesion or seizures and consist of an abnormal fistulous connection(s) between one or more hypertrophied feeding arteries and dilated draining veins (Clatterbuck et al. 2005) (Fig. 7.5). The blood supply is derived from one cerebral artery or, more often, several, sometimes with a contribution from branches of the external carotid artery. Arteriovenous malformations vary from a few millimeters to several centimeters in diameter. Approximately 15% are associated with aneurysms on their feeding arteries. Some grow during life but a few shrink or even disappear, and some are multiple. These fistulae occur in or on the brain, or in the dura of the intracranial sinuses. 

Intracranial tumor, e.g. glioma, meningioma Subdural hematoma Epileptic seizure... 

Partial or generalized epileptic seizures occur for the first time in about 2% of those with acute strokes at around the time of onset, rising to approximately 10% at five years, more with large cortical infarcts or intracranial hemorrhage (Ch. 9) (Ferro and Pinto 2004). Seizures are more common with large strokes, especially if hemorrhagic, and with cortical as opposed to lacunar strokes. Cerebrovascular disease is the most common cause of epilepsy in the elderly, and late-onset epilepsy is a predictor of subsequent stroke (Cleary et al. 2004). Seizures may cause neurological deterioration or be mistaken for recurrent stroke. Intractable recurrent seizures are distinctly unusual. 

Neurologic Neurotoxicity, intracranial hypertension, headache, tremor, encephalopathy, seizure... 

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