00:01
So how do we evaluate
the seizure like episode?
What are the things
we're looking at?
We've taken a history
we've done a physical exam,
we may favour a certain
diagnosis over another,
what are the diagnostic
tests that we would perform?
This really depends on the
differential diagnosis.
00:17
The history drives
diagnostic investigation,
there are certain things that
we'll do for all patients.
00:22
But if we favour a seizure, syncope,
or psychogenic non-epileptic diagnosis,
we may tailor our
diagnostic investigation.
00:30
For a nondescript spell, we will typically
think about doing a CBC and a CMP
to evaluate
electrolytes, glucose
and look for other potential
exacerbating or provoking features.
00:40
Your analysis and
urine drug screen
can also interrogate for
underlying urinary tract infection
or drug abuse that could
precipitate a seizure,
and then look at blood sugar
and blood pressure again,
looking for potential syncopal
events or sinkable triggers
as well as blood sugar
triggering a seizure.
01:02
When we're evaluating seizures,
we typically would perform
a head CT without contrast
in the emergency department looking
for underlying intracranial haemorrhage
or increased ICP.
01:11
And then usually that's followed by
an MRI with and without contrast,
and electroencephalography to
evaluate for the patient's risk
of a second seizure when we're
evaluating a first time seizure
or look for potential
abnormalities
that would make a seizure
or an epilepsy diagnosis.
01:27
If syncope is favoured,
we would consider orthostatic
blood pressure and heart rates
in the emergency
department or clinic.
01:33
Typically,
EKG and transthoracic echocardiogram
would be performed to look for
potential causes of syncope.
01:41
And the evaluation for
psychogenic non-epileptic spells
is quite variable and
depends on the situation
for the patient and the
differential diagnosis.
01:48
Ultimately,
this is a clinical diagnosis
and often a diagnosis
of exclusion
after these other
conditions are evaluated.
01:57
So in summary, when we're evaluating
a patient with a seizure like spell,
we think about seizures
syncope, TIA,
as well as two other conditions,
transient global
amnesia and migraine.
02:09
I've included two tables that walk
through these five differential diagnoses
and talk about some of
the different features
whether aura is present,
the posture of the patient,
how they begin,
what the onset is duration,
movements during the event,
whether incontinence is present,
the EG findings,
association with trauma
and how the event ends and
what happens immediately after.
02:32
I'll leave these for you to reference
in evaluating patients and vignettes
for a seizure like spell.