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Diseases » Temporal lobe epilepsy » Causes

Causes of Temporal lobe epilepsy

Contents

Temporal lobe epilepsy Causes: Book Excerpts

Related information on causes of Temporal lobe epilepsy:

As with all medical conditions, there may be many causal factors. Further relevant information on causes of Temporal lobe epilepsy may be found in:

Hidden causes of Temporal lobe epilepsy

Causes of Temporal lobe epilepsy: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the causes of Temporal lobe epilepsy.

Chorea: Differential Diagnosis
(In a Page: Signs and Symptoms)

Huntington's disease (chronic progressive hereditary chorea)
–Autosomal dominant transmission
–Associated with psychiatric symptoms and progressive dementia
–Caudate atrophy on neuroimaging studies
–Marker on chromosome 4

Sydenham's chorea
–Symptoms follow febrile illness (20–30%
of cases are associated with group A strep)
–Seen in rheumatic fever
–Peak ages: 5–13 years
–More common in females

Systemic lupus erythematosus

AIDS

Hyperthyroidism

Chorea gravidarum
–Develops in the first 4–5 months of
pregnancy
–Resolves following delivery

Drug-induced (e.g., levodopa, stimulants, anticonvulsants, antidepressants, neuroleptics, oral contraceptives)

Stroke

Neoplasm

Wilson's disease
–Autosomal recessive disorder
–Deficiency in copper metabolism
–Associated with hepatic dysfunction,
dystonia, dysarthria

Benign hereditary chorea
–Autosomal dominant
–Onset before age 5
–Symptoms are nonprogressive

Neuroacanthocytosis
–Etiology unknown
–Characterized by chorea and deformed
erythrocytes

DRPLA
–Most common in Japan
–Characterized by chorea, ataxia, epilepsy, and dementia

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Seizures/Convulsions: Differential Diagnosis
(In a Page: Signs and Symptoms)

Partial seizure (involve only part of the brain)
–Simple (no altered consciousness)
–Complex (with altered consciousness)
Generalized seizure (involve both hemispheres)
–Tonic-clonic
–Atonic
–Tonic
–Myoclonic
–Absence
Epilepsy
–Recurrent unprovoked seizures of any or multiple types, which may be idiopathic or symptomatic
- Secondary seizure
  –Metabolic abnormalities (e.g., electrolyte disturbances, hypoglycemia)
  –Drug effects, intoxication, or withdrawal
  –Head injury/trauma
  –Febrile seizures in children
  –Structural lesions (e.g., tumor, subdural hematoma)
  –Cerebrovascular etiologies (e.g., cerebral infarct, intracerebral hemorrhage, subarachnoid hemorrhage
  –Hypoxic-ischemic encephalopathy
  –Infection (e.g., meningitis, encephalitis)
  –Hypoxia
- Nonepileptic seizure
  –Not associated with abnormal electrical activity in the brain
  –Patients with loss of consciousness secondary to cerebral hypoperfusion (fainting, syncope) may occasionally exhibit brief periods of twitching or convulsive movements resembling seizure activity
  –Psychological disturbances (pseudoseizure)
- Inborn errors of metabolism
  –Disorders of amino acid metabolism
  –Organic acidemias
  –Urea cycle disorders
  –Mitochondrial disorders
  –Peroxisomal disorders
  –Glycogen storage disorders
  –Disorders of sugar metabolism
- Rasmussen's encephalitis
  –Causes seizures and progressive hemispheric dysfunction in infants

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Chorea: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

Toxins
–Neuroleptics, phenytoin, antiemetics, oral contraceptives, theophylline, L-dopa, stimulants, lithium, carbon monoxide, manganese

Sydenham chorea (in rheumatic fever)
–Migratory chorea, hypotonia, dysarthria, emotional liability
–Usually 4 months after group A β-hemolytic Streptococcus infection
–Molecular mimicry between streptococcal and CNS antigens results in formation of cross-reactive antibodies that disrupt basal ganglia function
–Carditis is present in 80% of Sydenham chorea patients
- Postinfectious: Mycoplasma, HSV, EBV, echovirus 25, varicella
- Encephalitis: viral, mycoplasma, Lyme
- Post-cardiac surgery
  –“Post-pump chorea”
  –Usually 2 weeks after cardiac surgery
- Syndrome or disease associated
  –Wilson disease
  –Hallervorden-Spatz (disorder of iron metabolism with degeneration of globus pallidus)
  –Fahr disease: Encephalopathy and progressive calcification of basal ganglia
  –Lesch-Nyhan syndrome
  –Ataxia-telangiectasia
- Endocrine: Hyperthyroidism, pregnancy (chorea gravidarum)
- Abetalipoproteinemia
- Glutaric aciduria type I
- Neuroacanthocytosis
- Systemic lupus erythematosus
- Kernicterus
- Antiphospholipid antibody syndrome
- Mitochondrial encephalopathies

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Seizures – Childhood: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

Febrile seizure
Cerebral dysgenesis: Disorders of neuronal migration, heterotopias, lissencephaly
Epilepsy syndromes
–Childhood absence
–Juvenile absence
–Juvenile myoclonic epilepsy (JME)
–Benign rolandic epilepsy (BRE)
Meningitis/encephalitis (e.g., HSV)
Cerebral abscess
Postinfectious (e.g., ADEM)
Hyponatremia
Hypernatremia
Hypocalcemia
Hypoglycemia
Toxins: Ingestions or sedative withdrawal
Trauma
Pyridoxine deficiency
Neoplasm
Degenerative
–Alpers disease
–Rett syndrome
–Unterricht-Lundborg disease
–Lafora disease
–Neuronal ceroid lipofuscinosis
Genetic
–Angelman syndrome
–Aicardi syndrome

Metabolic
–Medium chain acyl-CoA dehydrogenase deficiency (MCAD)
–Myoclonus epilepsy and ragged-red fibers syndrome (MERRF)
–Sialidosis
–Glucose transporter deficiency
–Urea cycle defects

Vascular: Stroke, hemorrhage, vasculitis
Hashimoto encephalitis
Seizure mimics
–Breath-holding spells
–Syncope, convulsive syncope
–Gastroesophageal reflux
–Cardiac arrhythmia
–Movement disorder
–Migraine
–Benign paroxysmal vertigo
–Parasomnia
–Pseudo-seizure
–Rage attack

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Seizures – Neonatal: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

Hypoxic ishemic encephalopathy
Bacterial meningitis/sepsis
Stroke
Cerebral dysgenesis
Electrolyte disturbances
–Hypoglycemia
–Hyponatremia
–Hypomagnesemia
–Hypocalcemia
Maternal drug use
–Drug withdrawal after delivery
–Direct effect of drugs, such as cocaine
Congenital infections (TORCH)
–Toxoplasmosis
–Syphilis
–Rubella
–CMV
–HSV
HSV encephalitis

Intracranial hemorrhage
–Subdural hemorrhage
–Intraparenchymal hemorrhage
–Intraventricular hemorrhage in the premature infant
–Subarachnoid hemorrhage

Urea cycle disturbances
Smith-Lemli-Opitz syndrome
Nonketotic hyperglycinemia
Pyridoxine deficiency
Fructose dysmetabolism
Amino acidurias
–Maple syrup urine disease
–Proprionic acidemia
Molybdenum cofactor deficiency
Mitochondrial encephalopathy
Glucose transporter deficiency

Benign etiologies
–Benign idiopathic neonatal seizures (fifth day fits)
–Benign familial neonatal seizures

Movements commonly mistaken for seizures
–Benign neonatal sleep myoclonus
–Jitteriness (may be secondary to hypoglycemia, drug withdrawal, or idiopathic)
–Gastroesophageal reflux (arching, writhing)
–Breath-holding spell

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Myoclonus: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Alzheimer’s disease

Generalized myoclonus may occur in advanced stages of Alzheimer’s disease, a slowly progressive dementia. Other late findings include mild choreoathetoid movements, muscle rigidity, bowel and bladder incontinence, delusions, and hallucinations.

Creutzfeldt-Jakob disease

Diffuse myoclonic jerks appear early in Creutzfeldt-Jakob disease, a rapidly progressive dementia. Initially random, they gradually become more rhythmic and symmetrical, usually occurring in response to sensory stimuli. Associated effects include ataxia, aphasia, hearing loss, muscle rigidity and wasting, fasciculations, hemiplegia, and vision disturbances, or possibly, blindness.

Encephalitis (viral)

With viral encephalitis, myoclonus is usually intermittent and either localized or generalized. Associated findings vary, but may include a rapidly decreasing LOC, a fever, a headache, irritability, nuchal rigidity, vomiting, seizures, aphasia, ataxia, hemiparesis, facial muscle weakness, nystagmus, ocular palsies, and dysphagia.

Encephalopathy

Hepatic encephalopathy occasionally produces myoclonic jerks in association with asterixis and focal or generalized seizures.

Hypoxic encephalopathy may produce generalized myoclonus or seizures almost immediately after restoration of cardiopulmonary function. The patient may also have a residual intention myoclonus.

Uremic encephalopathy commonly produces myoclonic jerks and seizures. Other signs and symptoms include apathy, fatigue, irritability, a headache, confusion, a gradually decreasing LOC, nausea, vomiting, oliguria, edema, and papilledema. The patient may also exhibit elevated blood pressure, dyspnea, arrhythmias, and abnormal respirations.

Epilepsy

With idiopathic epilepsy, localized myoclonus is usually confined to an arm or leg and occurs singly or in short bursts, usually upon awakening. It’s usually more frequent and severe during the prodromal stage of a major generalized seizure, after which it diminishes in frequency and intensity.

Myoclonic jerks are usually the first signs of myoclonic epilepsy, the most common cause of progressive myoclonus. At first, myoclonus is infrequent and localized, but over a period of months, it becomes more frequent and involves the entire body, disrupting voluntary movement (intention myoclonus). As the disease progresses, myoclonus is accompanied by generalized seizures and dementia.

Other causes

Drug withdrawal

Myoclonus may be seen in patients with alcohol, opioid, or sedative withdrawal or delirium tremens.

Poisoning

Acute intoxication with methyl bromide, bismuth, or strychnine may produce an acute onset of myoclonus and confusion.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Seizures, generalized tonic-clonic: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Brain abscess

Generalized seizures may occur in the acute stage of abscess formation or after the abscess disappears. Depending on the size and location of the abscess, a decreased level of consciousness (LOC) varies from drowsiness to deep stupor. Early signs and symptoms reflect increased intracranial pressure (ICP) and include a constant headache, nausea, vomiting, and focal seizures. Typical later features include ocular disturbances, such as nystagmus, impaired vision, and unequal pupils. Other findings vary with the abscess, site but may include aphasia, hemiparesis, abnormal behavior, and personality changes.

Brain tumor

Generalized seizures may occur, depending on the tumor’s location and type. Other findings include a slowly decreasing LOC, a morning headache, dizziness, confusion, focal seizures, vision loss, motor and sensory disturbances, aphasia, and ataxia. Later findings include papilledema, vomiting, increased systolic blood pressure, widening pulse pressure and, eventually, a decorticate posture.

Chronic renal failure

End-stage renal failure produces the rapid onset of twitching, trembling, myoclonic jerks, and generalized seizures. Related signs and symptoms include anuria or oliguria, fatigue, malaise, irritability, decreased mental acuity, muscle cramps, peripheral neuropathies, anorexia, and constipation or diarrhea. Integumentary effects include skin color changes (yellow, brown, or bronze), pruritus, and uremic frost. Other effects include an ammonia breath odor, nausea and vomiting, ecchymoses, petechiae, GI bleeding, mouth and gum ulcers, hypertension, and Kussmaul’s respirations.

Eclampsia

Generalized seizures are a hallmark of eclampsia. Related findings include a severe frontal headache, nausea and vomiting, vision disturbances, increased blood pressure, a fever of up to 104° (40° C), peripheral edema, and sudden weight gain. The patient may also exhibit oliguria, irritability, hyperactive deep tendon reflexes (DTRs), and a decreased LOC.

Encephalitis

Seizures are an early sign of encephalitis, indicating a poor prognosis; they may also occur after recovery as a result of residual damage. Other findings include a fever, a headache, photophobia, nuchal rigidity, neck pain, vomiting, aphasia, ataxia, hemiparesis, nystagmus, irritability, cranial nerve palsies (causing facial weakness, ptosis, dysphagia), and myoclonic jerks.

Epilepsy (idiopathic)

In most cases, the cause of recurrent seizures is unknown.

Head trauma

In severe cases, generalized seizures may occur at the time of injury. (Months later, focal seizures may occur.) Severe head trauma may also cause a decreased LOC, leading to coma; soft-tissue injury of the face, head, or neck; clear or bloody drainage from the mouth, nose, or ears; facial edema; bony deformity of the face, head, or neck; Battle’s sign; and a lack of response to oculocephalic and oculovestibular stimulation. Motor and sensory deficits may occur along with altered respirations. Examination may reveal signs of increasing ICP, such as a decreased response to painful stimuli, nonreactive pupils, bradycardia, increased systolic pressure, and widening pulse pressure. If the patient is conscious, he may exhibit visual deficits, behavioral changes, and a headache.

Hepatic encephalopathy

Generalized seizures may occur late in hepatic encephalopathy. Associated late-stage findings in the comatose patient include fetor hepaticus, asterixis, hyperactive DTRs, and a positive Babinski’s sign.

Hypoglycemia

Generalized seizures usually occur with severe hypoglycemia, accompanied by blurred or double vision, motor weakness, hemiplegia, trembling, excessive diaphoresis, tachycardia, myoclonic twitching, and a decreased LOC.

Hyponatremia

Seizures develop when serum sodium levels fall below 125 mEq/L, especially if the decrease is rapid. Hyponatremia also causes orthostatic hypotension, a headache, muscle twitching and weakness, fatigue, oliguria or anuria, cold and clammy skin, decreased skin turgor, irritability, lethargy, confusion, and stupor or coma. Excessive thirst, tachycardia, nausea, vomiting, and abdominal cramps may also occur. Severe hyponatremia may cause cyanosis and vasomotor collapse, with a thready pulse.

Hypoparathyroidism

Worsening tetany causes generalized seizures. Chronic hypoparathyroidism produces neuromuscular irritability and hyperactive DTRs.

Hypoxic encephalopathy

Besides generalized seizures, hypoxic encephalopathy may produce myoclonic jerks and coma. Later, if the patient has recovered, dementia, visual agnosia, choreoathetosis, and ataxia may occur.

Neurofibromatosis

Multiple brain lesions from neurofibromatosis cause focal and generalized seizures. Inspection reveals café-au-lait spots, multiple skin tumors, scoliosis, and kyphoscoliosis. Related findings include dizziness, ataxia, monocular blindness, and nystagmus.

Stroke

Seizures (focal more commonly than generalized) may occur within 6 months of an ischemic stroke. Associated signs and symptoms vary with the location and extent of brain damage. They include a decreased LOC, contralateral hemiplegia, dysarthria, dysphagia, ataxia, unilateral sensory loss, apraxia, agnosia, and aphasia. The patient may also develop visual deficits, memory loss, poor judgment, personality changes, emotional lability, urine retention or urinary incontinence, constipation, a headache, and vomiting.

Other causes

Arsenic poisoning

Besides generalized seizures, arsenic poisoning may cause a garlicky breath odor, increased salivation, and generalized pruritus. GI effects include diarrhea, nausea, vomiting, and severe abdominal pain. Related effects include diffuse hyperpigmentation; sharply defined edema of the eyelids, face, and ankles; paresthesia of the extremities; alopecia; irritated mucous membranes; weakness; muscle aches; and peripheral neuropathy.

Barbiturate withdrawal

In chronically intoxicated patients, barbiturate withdrawal may produce generalized seizures 2 to 4 days after the last dose. Status epilepticus is possible.

Diagnostic tests

Contrast agents used in radiologic tests may cause generalized seizures.

Drugs

Toxic blood levels of some drugs, such as theophylline, lidocaine, meperidine, penicillins, and cimetidine, may cause generalized seizures. Phenothiazines, tricyclic antidepressants, amphetamines, isoniazid, and vincristine may cause seizures in patients with preexisting epilepsy.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Seizures, absence: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Idiopathic epilepsy

Some forms of absence seizure are accompanied by learning disabilities.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Seizures, complex partial: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Brain abscess

If the brain abscess is in the temporal lobe, complex partial seizures commonly occur after the abscess disappears. Related problems may include a headache, nausea, vomiting, generalized seizures, and a decreased level of consciousness (LOC). The patient may also develop central facial weakness, auditory receptive aphasia, hemiparesis, and ocular disturbances.

Head trauma

Severe trauma to the temporal lobe (especially from a penetrating injury) can produce complex partial seizures months or years later. The seizures may decrease in frequency and eventually stop. Head trauma also causes generalized seizures and behavior and personality changes.

Herpes simplex encephalitis

The herpes simplex virus commonly attacks the temporal lobe, resulting in complex partial seizures. Other features include a fever, a headache, coma, and generalized seizures.

Temporal lobe tumor

Complex partial seizures may be the first sign of a temporal lobe tumor. Other signs and symptoms include a headache, pupillary changes, and mental dullness. Increased intracranial pressure may cause a decreased LOC, vomiting and, possibly, papilledema.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Seizures, simple partial: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Brain abscess

Seizures can occur in the acute stage of abscess formation or after resolution of the abscess. A decreased LOC varies from drowsiness to deep stupor. Early signs and symptoms reflect increased intracranial pressure and include a constant, intractable headache; nausea; and vomiting. Later signs and symptoms include ocular disturbances, such as nystagmus, decreased visual acuity, and unequal pupils. Other findings vary according to the abscess site and may include aphasia, hemiparesis, and personality changes.

Brain tumor

Focal seizures are commonly the earliest indicators of a brain tumor. The patient may report a morning headache, dizziness, confusion, vision loss, and motor and sensory disturbances. He may also develop aphasia, generalized seizures, ataxia, a decreased LOC, papilledema, vomiting, increased systolic blood pressure, and widening pulse pressure. Eventually, he may assume a decorticate posture.

Head trauma

Any head injury can cause seizures, but penetrating wounds are characteristically associated with focal seizures. The seizures usually begin 3 to 15 months after injury, decrease in frequency after several years, and eventually stop. The patient may develop generalized seizures and a decreased LOC that may progress to coma.

Stroke

A major cause of seizures in patients older than age 50, a stroke may induce focal seizures up to 6 months after its onset. Related effects depend on the type and extent of the stroke, but may include a decreased LOC, contralateral hemiplegia, dysarthria, dysphagia, ataxia, unilateral sensory loss, apraxia, agnosia, and aphasia. A stroke may also cause visual deficits, memory loss, poor judgment, personality changes, emotional lability, a headache, urinary incontinence or retention, and vomiting. It may result in generalized seizures.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Myoclonus: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Alzheimer’s disease

Generalized myoclonus may occur in advanced stages of this slowly progressive dementia. Other late findings include mild choreoathetoid movements, muscle rigidity, bowel and bladder incontinence, delusions, and hallucinations.

Creutzfeldt-Jakob disease

Diffuse myoclonic jerks appear early in this rapidly progressive dementia. Initially random, they gradually become more rhythmic and symmetrical, often occurring in response to sensory stimuli. Associated effects include ataxia, aphasia, hearing loss, muscle rigidity and wasting, fasciculations, hemiplegia, and visual disturbance, or possibly, blindness.

Encephalitis (viral)

With this disease, myoclonus is usually intermittent and either localized or generalized. Associated findings vary but may include rapidly decreasing level of consciousness, fever, headache, irritability, nuchal rigidity, vomiting, seizures, aphasia, ataxia, hemiparesis, facial muscle weakness, nystagmus, ocular palsies, and dysphagia.

Encephalopathy

Hepatic encephalopathy occasionally produces myoclonic jerks in association with asterixis and focal or generalized seizures.

Hypoxic encephalopathy may produce generalized myoclonus or seizures almost immediately after restoration of cardiopulmonary function. The patient may also have a residual intention myoclonus.

Uremic encephalopathy commonly produces myoclonic jerks and seizures. Other signs and symptoms include apathy, fatigue, irritability, headache, confusion, gradually decreasing level of consciousness, nausea, vomiting, oliguria, edema, and papilledema. The patient may also exhibit elevated blood pressure, dyspnea, arrhythmias, and abnormal respirations.

Epilepsy

Other causes

Drug withdrawal

Myoclonus may be seen in patients with alcohol, opioid, or sedative withdrawal, or delirium tremens.

Poisoning

Acute intoxication with methyl bromide, bismuth, or strychnine may produce an acute onset of myoclonus and confusion.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Seizures, generalized tonic-clonic: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Alcohol withdrawal syndrome

i> Sudden withdrawal from alcohol dependence may cause seizures 7 to 48 hours later as well as status epilepticus. The patient may also be restless and exhibit hallucinations, profuse diaphoresis, and tachycardia.

Brain abscess

Generalized seizures may occur in the acute stage of abscess formation or after the abscess disappears. Depending on the size and location of the abscess, decreased level of consciousness (LOC) varies from drowsiness to deep stupor. Early signs and symptoms reflect increased intracranial pressure (ICP) and include constant headache, nausea, vomiting, and focal seizures. Typical later features include ocular disturbances, such as nystagmus, impaired vision, and unequal pupils. Other findings vary with the abscess site but may include aphasia, hemiparesis, abnormal behavior, and personality changes.

Brain tumor

Generalized seizures may occur, depending on the tumor’s location and type. Other findings include a slowly decreasing LOC, morning headache, dizziness, confusion, focal seizures, vision loss, motor and sensory disturbances, aphasia, and ataxia. Later findings include papilledema, vomiting, increased systolic blood pressure, widening pulse pressure, and (eventually) decorticate posture.

Cerebral aneurysm

Occasionally, generalized seizures may occur with an aneurysmal rupture. Premonitory signs and symptoms may last several days, but onset is typically abrupt with severe headache, nausea, vomiting, and decreased LOC. Depending on the site and amount of bleeding, related signs and symptoms vary but may include nuchal rigidity, irritability, hemiparesis, hemisensory defects, dysphagia, photophobia, diplopia, ptosis, and unilateral pupil dilation.

Chronic renal failure

End-stage renal failure produces rapid onset of twitching, trembling, myoclonic jerks, and generalized seizures. Related signs and symptoms include anuria or oliguria, fatigue, malaise, irritability, decreased mental acuity, muscle cramps, peripheral neuropathies, anorexia, and constipation or diarrhea. Integumentary effects include skin color changes (yellow, brown, or bronze), pruritus, and uremic frost. Other effects include ammonia breath odor, nausea and vomiting, ecchymoses, petechiae, GI bleeding, mouth and gum ulcers, hypertension, and Kussmaul’s respirations.

Eclampsia

Generalized seizures are a hallmark of this disorder. Related findings include severe frontal headache, nausea and vomiting, vision disturbances, increased blood pressure, fever of up to 104° F (40° C), peripheral edema, and sudden weight gain. The patient may also exhibit oliguria, irritability, hyperactive deep tendon reflexes (DTRs), and decreased LOC.

Encephalitis

Seizures are an early sign of this disorder, indicating a poor prognosis; they may also occur after recovery as a result of residual damage. Other findings include fever, headache, photophobia, nuchal rigidity, neck pain, vomiting, aphasia, ataxia, hemiparesis, nystagmus, irritability, cranial nerve palsies (causing facial weakness, ptosis, dysphagia), and myoclonic jerks.

Epilepsy (idiopathic)

In most cases, the cause of recurrent seizures is unknown.

Head trauma

In severe cases, generalized seizures may occur at the time of injury. (Months later, focal seizures may occur.) Severe head trauma may also cause a decreased LOC, leading to coma; soft-tissue injury of the face, head, or neck; clear or bloody drainage from the mouth, nose, or ears; facial edema; bony deformity of the face, head, or neck; Battle’s sign; and lack of response to oculocephalic and oculovestibular stimulation. Motor and sensory deficits may occur along with altered respirations. Examination may reveal signs of increasing ICP, such as decreased response to painful stimuli, nonreactive pupils, bradycardia, increased systolic pressure, and widening pulse pressure. If the patient is conscious, he may exhibit visual deficits, behavioral changes, and headache.

Hepatic encephalopathy

Generalized seizures may occur late in this disorder. Associated late-stage findings in the comatose patient include fetor hepaticus, asterixis, hyperactive DTRs, and a positive Babinski’s sign.

Hypertensive encephalopathy

This life-threatening disorder may cause seizures along with severely increased blood pressure, decreased LOC, intense headache, vomiting, transient blindness, paralysis, and (eventually) Cheyne-Stokes respirations.

Hypoglycemia

Hyponatremia

Seizures develop
when serum sodium levels fall below 125 mEq/L, especially if the decrease is rapid. Hyponatremia also causes orthostatic hypotension, headache, muscle twitching and weakness, fatigue, oliguria or anuria, cold and clammy skin, decreased skin turgor, irritability, lethargy, confusion, and stupor or coma. Excessive thirst, tachycardia, nausea, vomiting, and abdominal cramps may also occur. Severe hyponatremia may cause cyanosis and vasomotor collapse, with a thready pulse.

Hypoparathyroidism

Worsening tetany causes generalized seizures. Chronic hypoparathyroidism produces neuromuscular irritability and hyperactive DTRs.

Hypoxic encephalopathy

Besides generalized seizures, this disorder may produce myoclonic jerks and coma. Later, if the patient has recovered, dementia, visual agnosia, choreoathetosis, and ataxia may occur.

Multiple sclerosis

This disorder rarely produces generalized seizures. Characteristic findings include vision deficits, paresthesia, constipation, muscle weakness, paralysis, spasticity, hyperreflexia, intention tremor, ataxic gait, dysphagia, dysarthria, impotence, and emotional lability. Urinary frequency, urgency, and incontinence may also occur.

Neurofibromatosis

Multiple brain lesions from this disorder cause focal and generalized seizures. Inspection reveals café-au-lait spots, multiple skin tumors, scoliosis, and kyphoscoliosis. Related findings include dizziness, ataxia, monocular blindness, and nystagmus.

Porphyria (intermittent acute)

Generalized seizures are a late sign of this disorder, indicating severe CNS involvement. Acute porphyria also causes severe abdominal pain, tachycardia, psychotic behavior, muscle weakness, and sensory loss in the trunk.

Sarcoidosis

Lesions may affect the brain, causing generalized and focal seizures. Associated findings include a nonproductive cough with dyspnea, substernal pain, malaise, fatigue, arthralgia, myalgia, weight loss, tachypnea, dysphagia, skin lesions, and impaired vision.

Stroke

Seizures (focal more often than generalized) may occur within 6 months of an ischemic stroke. Associated signs and symptoms vary with the location and extent of brain damage. They include decreased LOC, contralateral hemiplegia, dysarthria, dysphagia, ataxia, unilateral sensory loss, apraxia, agnosia, and aphasia. The patient may also develop visual deficits, memory loss, poor judgment, personality changes, emotional lability, urine retention or urinary incontinence, constipation, headache, and vomiting.

Other causes

Arsenic poisoning

Barbiturate withdrawal

In chronically intoxicated patients, barbiturate withdrawal may produce generalized seizures 2 to 4 days after the last dose. Status epilepticus is possible.

Diagnostic tests

Contrast agents used in radiologic tests may cause generalized seizures.

Drugs

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Chorea [Choreiform movements]: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Cerebral infarction

An infarction that involves the thalamic area produces unilateral or bilateral chorea. The patient may also experience dysarthria, tremors, rigidity, weakness, and sensory disturbances such as paresthesia.

Encephalitis

Chorea may occur in the recovery phase of encephalitis. Low-grade fever and athetosis may also be present, in addition to such focal neurologic signs as hemiparesis, hemiplegia, and facial droop.

Huntington’s disease

In this inherited disease, chorea may be the first sign or it may accompany the intellectual decline that leads to emotional disturbances and dementia. The patient’s movements tend to be choreoathetotic and may be accompanied by dysarthria, dystonia, prancing gait, dysphagia, and facial grimacing.

Wilson’s disease

Chorea and dystonia affecting the arms and legs are early indicators of Wilson’s disease. The patient typically experiences dysarthria, tremors, hoarseness, dysphagia, and slowed body movements; he may also exhibit emotional and behavioral disturbances, drooling, rigidity, and mental deterioration. The pathognomonic Kayser-Fleischer ring in the cornea appears as the disease progresses.

Other causes

Carbon monoxide poisoning

A patient who survives severe carbon monoxide poisoning may have neurologic signs and symptoms, such as chorea, rigidity, dementia, impaired sensory function, masklike facies, generalized seizures, and myoclonus.

Drugs

Phenothiazines (especially the piperazine derivatives), haloperidol, thiothixene, and loxapine commonly produce chorea. Metoclopramide, metyrosine, hormonal contraceptives, levodopa, and phenytoin may also cause this sign.

Lead poisoning

In the later stages, lead poisoning produces chorea in addition to seizures, headache, memory lapses, and severe mental impairment. The patient may also develop masklike facies, footdrop, wristdrop, dizziness, ataxia, weakness, lethargy, abdominal pain, anorexia, nausea, vomiting, constipation, lead line on the gums, and a metallic taste in his mouth.

Manganese poisoning

In miners who have been exposed to manganese dioxide for prolonged periods, chorea characteristically occurs with a propulsive gait, dystonia, and rigidity. Initially, the patient may have masklike facies, a resting tremor, and personality changes; later, extreme muscle weakness and lethargy occur.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Seizures, absence: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Idiopathic epilepsy

Some forms of absence seizure are accompanied by learning disabilities.

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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Seizures, complex partial: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Brain abscess

If the brain abscess is in the temporal lobe, complex partial seizures commonly occur after the abscess disappears. Related problems may include headache, nausea, vomiting, generalized seizures, and a decreased level of consciousness (LOC). The patient may also develop central facial weakness, auditory receptive aphasia, hemiparesis, and ocular disturbances.

Head trauma

Herpes simplex encephalitis

The herpes simplex virus commonly attacks the temporal lobe, resulting in complex partial seizures. Other features include fever, headache, coma, and generalized seizures.

Temporal lobe tumor

Complex partial seizures may be the first sign of this disorder. Other signs and symptoms include headache, pupillary changes, and mental dullness. Increased intracranial pressure may cause a decreased LOC, vomiting and, possibly, papilledema.

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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Seizures, simple partial: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Brain abscess

Seizures can occur in the acute stage of abscess formation or after resolution of the abscess. Decreased LOC varies from drowsiness to deep stupor. Early signs and symptoms reflect increased intracranial pressure and include a constant, intractable headache, nausea, and vomiting. Later signs and symptoms include ocular disturbances, such as nystagmus, decreased visual acuity, and unequal pupils. Other findings vary according to the abscess site and may include aphasia, hemiparesis, and personality changes.

Brain tumor

Focal seizures are commonly the earliest indicators of a brain tumor. The patient may report morning headache, dizziness, confusion, vision loss, and motor and sensory disturbances. He may also develop aphasia, generalized seizures, ataxia, decreased LOC, papilledema, vomiting, increased systolic blood pressure, and widening pulse pressure. Eventually, he may assume a decorticate posture.

Head trauma

Multiple sclerosis

Focal or generalized seizures may occur with this disorder, usually during the late stages. Other findings include visual deficits, paresthesia, constipation, muscle weakness, spasticity, paralysis, hyperreflexia, intention tremor, gait ataxia, dysphagia, dysarthria, emotional lability, impotence, and urinary frequency, urgency, and incontinence.

Neurofibromatosis

Multiple brain lesions cause focal seizures and, at times, generalized seizures. Inspection reveals café-au-lait spots, multiple skin tumors, scoliosis, and kyphoscoliosis. Related findings include dizziness, ataxia, progressive monocular blindness, nystagmus, and endocrine abnormalities.

Sarcoidosis

Multiple lesions from this disorder affect the brain, producing focal and generalized seizures. Associated findings include a nonproductive cough with dyspnea, substernal pain, malaise, fatigue, arthralgia, myalgia, weight loss, tachypnea, dysphagia, skin lesions, and impaired vision.

Stroke

A major cause of seizures in patients older than age 50, a stroke may induce focal seizures up to 6 months after its onset. Related effects depend on the type and extent of the stroke but may include decreased LOC, contralateral hemiplegia, dysarthria, dysphagia, ataxia, unilateral sensory loss, apraxia, agnosia, and aphasia. A stroke may also cause visual deficits, memory loss, poor judgment, personality changes, emotional lability, headache, urinary incontinence or retention, and vomiting. It may result in generalized seizures.

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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Seizures: Differential Overview

(Field Guide to Bedside Diagnosis)

❑ Generalized (grand mal)

❑ Partial (focal)

❑ Complex partial (temporal lobe)

❑ Absence (petit mal)

❑ Vasovagal syncope

❑ Myoclonic

❑ Akinetic (drop attacks)

❑ Psychomotor

❑ Pseudoseizures

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Source: Field Guide to Bedside Diagnosis, 2007

Myoclonus: Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

Alzheimer’s disease

Generalized myoclonus may occur in advanced stages of Alzheimer’s disease, which is a slowly progressive dementia. Other late findings include mild choreoathetoid movements, muscle rigidity, bowel and bladder incontinence, delusions, and hallucinations.

Creutzfeldt-Jakob disease

Diffuse myoclonic jerks appear early in Creutzfeldt-Jakob disease — a rapidly progressive dementia. Initially random, they gradually become more rhythmic and symmetrical, often occurring in response to sensory stimuli. Associated effects include ataxia, aphasia, hearing loss, muscle rigidity and wasting, fasciculations, hemiplegia, and vision disturbance, or possibly, blindness.

Encephalitis (viral)

With encephalitis, myoclonus is usually intermittent and either localized or generalized. Associated findings vary but may include rapidly decreasing level of consciousness, fever, headache, irritability, nuchal rigidity, vomiting, seizures, aphasia, ataxia, hemiparesis, facial muscle weakness, nystagmus, ocular palsies, and dysphagia.

Encephalopathy

Hepatic encephalopathy occasionally produces myoclonic jerks in association with asterixis and focal or generalized seizures.

Hypoxic encephalopathy may produce generalized myoclonus or seizures almost immediately after restoration of cardiopulmonary function. The patient may also have a residual intention myoclonus.

Epilepsy

Other causes

Drug withdrawal

Myoclonus may be seen in patients with alcohol, opioid, or sedative withdrawal, or delirium tremens.

Poisoning

Acute intoxication with methyl bromide, bismuth, or strychnine may produce an acute onset of myoclonus and confusion.

» READ BOOK EXCERPT ONLINE »

Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007

Seizures, generalized tonic-clonic: Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

Alcohol withdrawal syndrome

Seizures as well as status epilepticus may develop 7 to 48 hours after abrupt cessation of alcohol consumption by the individual with alcohol dependency. Restlessness, hallucinations, profuse diaphoresis, and tachycardia may also occur.

Brain abscess

Generalized seizures may occur in the acute stage of abscess formation or after the abscess disappears. Decreased level of consciousness (LOC) varies from drowsiness to deep stupor according to the size and location of the abscess. Early signs and symptoms reflect increased intracranial pressure (ICP) and include constant headache, nausea, vomiting, and focal seizures. Typical later features include ocular disturbances, such as nystagmus, impaired vision, and unequal pupils. Other findings vary with the abscess site, but may include aphasia, hemiparesis, abnormal behavior, and personality changes.

Brain tumor

Cerebral aneurysm

Occasionally, generalized seizures may occur with an aneurysm rupture. Premonitory signs and symptoms may last several days, but the onset is typically abrupt with severe headache, nausea, vomiting, and a decreased LOC. Related signs and symptoms vary according to the site and amount of bleeding, but may include nuchal rigidity, irritability, hemiparesis, hemisensory defects, dysphagia, photophobia, diplopia, ptosis, and unilateral pupil dilation.

Chronic renal failure

End-stage renal failure produces the rapid onset of twitching, trembling, myoclonic jerks, and generalized seizures. Related signs and symptoms include anuria or oliguria, fatigue, malaise, irritability, decreased mental acuity, muscle cramps, peripheral neuropathies, anorexia, and constipation or diarrhea. Integumentary effects include skin color changes (yellow, brown, or bronze), pruritus, and uremic frost. Other effects include ammonia breath odor, nausea and vomiting, ecchymoses, petechiae, GI bleeding, mouth and gum ulcers, hypertension, and Kussmaul’s respirations.

Eclampsia

Generalized seizures are a hallmark of eclampsia. Related findings include severe frontal headache, nausea and vomiting, vision disturbances, increased blood pressure, fever of up to 104° (40° C), peripheral edema, and sudden weight gain. The patient may also exhibit oliguria, irritability, hyperactive deep tendon reflexes (DTRs), and a decreased LOC.

Encephalitis

Seizures are an early sign of encephalitis, indicating a poor prognosis; they may also occur after recovery as a result of residual damage. Other findings include fever, headache, photophobia, nuchal rigidity, neck pain, vomiting, aphasia, ataxia, hemiparesis, nystagmus, irritability, cranial nerve palsies (causing facial weakness, ptosis, and dysphagia), and myoclonic jerks.

Epilepsy (idiopathic)

In most cases, the cause of recurrent seizures is unknown.

Head trauma

In severe cases, generalized seizures may occur at the time of injury. (Months later, focal seizures may occur.) Severe head trauma may also cause a decreased LOC, leading to coma. Other signs and symptoms may include soft-tissue injury of the face, head, or neck as well as facial edema and clear or bloody drainage from the mouth, nose, or ears. The patient may also exhibit Battle’s sign, lack of response to oculocephalic and oculovestibular stimulation, and bony deformity of the face, head, or neck. Motor and sensory deficits may occur along with altered respirations. Examination may reveal signs of increasing ICP, such as decreased response to painful stimuli, nonreactive pupils, bradycardia, increased systolic pressure, and widening pulse pressure. If the patient is conscious, he may exhibit visual deficits, behavioral changes, and headache.

Hepatic encephalopathy

Hypertensive encephalopathy

A life-threatening disorder, hypertensive encephalopathy may cause seizures along with severely increased blood pressure, a decreased LOC, intense headache, vomiting, transient blindness, paralysis and, eventually, Cheyne-Stokes respirations.

Hypoglycemia

Hyponatremia

Seizures develop when serum sodium levels fall below 125 mEq/L, especially if the decrease is rapid. Hyponatremia also causes orthostatic hypotension, headache, muscle twitching and weakness, fatigue, oliguria or anuria, cold and clammy skin, decreased skin turgor, irritability, lethargy, confusion, and stupor or coma. Excessive thirst, tachycardia, nausea, vomiting, and abdominal cramps may also occur. Severe hyponatremia may cause cyanosis and vasomotor collapse, with a thready pulse.

Hypoparathyroidism

Worsening tetany causes generalized seizures. Chronic hypoparathyroidism produces neuromuscular irritability and hyperactive DTRs.

Hypoxic encephalopathy

Besides generalized seizures, hypoxic encephalopathy may produce myoclonic jerks and coma. Later, if the patient has recovered, dementia, visual agnosia, choreoathetosis, and ataxia may occur.

Multiple sclerosis (MS)

MS rarely produces generalized seizures. Characteristic findings include vision deficits, paresthesia, constipation, muscle weakness, paralysis, spasticity, hyperreflexia, intention tremor, ataxic gait, dysphagia, dysarthria, impotence, and emotional lability. Urinary frequency, urgency, and incontinence may also occur.

Neurofibromatosis

Porphyria (intermittent acute)

Generalized seizures are a late sign of porphyria, indicating severe CNS involvement. Acute porphyria also causes severe abdominal pain, tachycardia, psychotic behavior, muscle weakness, and sensory loss in the trunk.

Sarcoidosis

Stroke

Seizures (focal more common than generalized) may occur within 6 months of an ischemic stroke. Associated signs and symptoms vary with the location and extent of brain damage. They include a decreased LOC, contralateral hemiplegia, dysarthria, dysphagia, ataxia, unilateral sensory loss, apraxia, agnosia, and aphasia. The patient may also develop visual deficits, memory loss, poor judgment, personality changes, emotional lability, urine retention or urinary incontinence, constipation, headache, and vomiting.

Other causes

Arsenic poisoning

Besides generalized seizures, arsenic poisoning may cause a garlicky breath odor, increased salivation, and generalized pruritus. GI effects include diarrhea, nausea, vomiting, and severe abdominal pain. Related effects include diffuse hyperpigmentation, paresthesia of the extremities, alopecia, irritated mucous membranes, weakness, muscle aches, peripheral neuropathy, and sharply defined edema of the eyelids, face, and ankles.

Barbiturate withdrawal

In chronically intoxicated patients, barbiturate withdrawal may produce generalized seizures 2 to 4 days after the last dose. Status epilepticus is possible.

Diagnostic tests

Contrast agents used in radiologic tests may cause generalized seizures.

Drugs

Toxic blood levels of some drugs, such as theophylline, lidocaine, Indocin, meperidine, penicillins, and cimetidine, may cause generalized seizures. Phenothiazines, tricyclic antidepressants, amphetamines, isoniazid, and vincristine may cause seizures in patients with preexisting epilepsy.

» READ BOOK EXCERPT ONLINE »

Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007

Chorea: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Carbon monoxide poisoning

Cerebral infarction

A cerebral infarction that involves the thalamic area produces unilateral or bilateral chorea. The patient may also experience dysarthria, tremors, rigidity, weakness, and sensory disturbances such as paresthesia.

Encephalitis

Chorea may occur in the recovery phase of encephalitis. Low-grade fever and athetosis may also be present, in addition to such focal neurologic signs as hemiparesis, hemiplegia, and facial droop. Other signs and symptoms include headache, vomiting, photophobia, stiff neck, confusion, and drowsiness.

Huntington’s disease

In Huntington’s disease, an inherited disease, chorea may be the first sign or may occur with the intellectual decline that leads to emotional disturbances and dementia. The patient’s movements tend to be choreoathetotic and may be accompanied by dysarthria, dystonia, prancing gait, dysphagia, and facial grimacing.

Lead poisoning

In the later stages of lead poisoning, chorea occurs in addition to seizures, headache, memory lapses, and severe mental impairment. The patient may also develop masklike facies, footdrop, wristdrop, dizziness, ataxia, weakness, lethargy, abdominal pain, anorexia, nausea, vomiting, constipation, lead line on his gums, and a metallic taste in his mouth.

Manganese poisoning

In miners who have been exposed to manganese dioxide for prolonged periods, chorea characteristically occurs with propulsive gait, dystonia, and rigidity. Initially, the patient may have masklike facies, a resting tremor, and personality changes; later, extreme muscle weakness and lethargy occur.

Other causes

Drugs

Such drugs as phenothiazines (especially the piperazine derivatives), haloperidol, thiothixene, and loxapine commonly produce chorea. Metoclopramide, metyrosine, hormonal contraceptives, levodopa, and phenytoin may also cause this sign.

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Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Myoclonus: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Alzheimer’s disease

Generalized myoclonus may occur in advanced stages of this slowly progressive dementia. Other late findings in Alzheimer’s disease include mild choreoathetoid movements, muscle rigidity, bowel and bladder incontinence, delusions, and hallucinations.

Creutzfeldt-Jakob disease

Diffuse myoclonic jerks appear early in Creutzfeldt-Jakob disease — a rapidly progressive dementia. Initially random, they gradually become more rhythmic and symmetrical, typically occurring in response to sensory stimuli. Associated effects include ataxia, aphasia, hearing loss, muscle rigidity and wasting, fasciculations, hemiplegia, and vision disturbances or, possibly, blindness.

Encephalitis (viral)

With viral encephalitis, myoclonus is usually intermittent and either localized or generalized. Associated findings vary but may include rapidly decreasing LOC, fever, headache, irritability, nuchal rigidity, vomiting, seizures, aphasia, ataxia, hemiparesis, facial muscle weakness, nystagmus, ocular palsies, and dysphagia.

Encephalopathy

Hepatic encephalopathy occasionally produces myoclonic jerks in association with asterixis and focal or generalized seizures.

Hypoxic encephalopathy may produce generalized myoclonus or seizures almost immediately after restoration of cardiopulmonary function. The patient may also have a residual intention myoclonus.

Uremic encephalopathy commonly produces myoclonic jerks and seizures. Other signs and symptoms include apathy, fatigue, irritability, headache, confusion, gradually decreasing LOC, nausea, vomiting, oliguria, edema, and papilledema. The patient may also exhibit elevated blood pressure, dyspnea, arrhythmias, and abnormal respirations.

Epilepsy

Other causes

Drug withdrawal

Myoclonus may be seen in patients with alcohol, opioid, or sedative withdrawal, or delirium tremens.

Poisoning

Acute intoxication with methyl bromide, bismuth, or strychnine may produce an acute onset of myoclonus and confusion.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Seizures, generalized tonic-clonic: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Alcohol withdrawal syndrome

Sudden withdrawal from alcohol dependence may cause seizures 7 to 48 hours later as well as status epilepticus. The patient may also be restless and exhibit hallucinations, profuse diaphoresis, and tachycardia.

Arsenic poisoning

Brain abscess

Brain tumor

Cerebral aneurysm

Eclampsia

Generalized seizures are a hallmark of eclampsia. Related findings include severe frontal headache, nausea and vomiting, vision disturbances, increased blood pressure, fever of up to 104° F (40° C), peripheral edema, and sudden weight gain. The patient may also exhibit oliguria, irritability, hyperactive deep tendon reflexes (DTRs), and decreased LOC.

Encephalitis

Head trauma

In severe cases, generalized seizures may occur at the time of injury. (Months later, focal seizures may occur.) Severe head trauma may also cause a decreased LOC, leading to coma; soft-tissue injury of the face, head, or neck; clear or bloody drainage from the mouth, nose, or ears; facial edema; bony deformity of the face, head, or neck; Battle’s sign; and lack of response to oculocephalic and oculovestibular stimulation. Motor and sensory deficits may occur along with altered respirations. Examination may reveal signs of increasing ICP, such as decreased response to painful stimuli, nonreactive pupils, bradycardia, increased systolic pressure, and widening pulse pressure. If the patient is conscious, he may exhibit vision deficits, behavioral changes, and headache.

Hepatic encephalopathy

Hypertensive encephalopathy

Hypertensive encephalopathy, a life-threatening disorder, may cause seizures along with severely increased blood pressure, decreased LOC, intense headache, vomiting, transient blindness, paralysis, and (eventually) Cheyne-Stokes respirations.

Hypoglycemia

Hyponatremia

Seizures develop when serum sodium levels fall below 125 mEq/L, especially if the decrease is rapid. Hyponatremia also causes orthostatic hypotension, headache, muscle twitching and weakness, fatigue, oliguria or anuria, cold and clammy skin, decreased skin turgor, irritability, lethargy, confusion, and stupor or coma. Excessive thirst, tachycardia, nausea, vomiting, and abdominal cramps may also occur. Severe hyponatremia may cause cyanosis and vasomotor collapse, with a thready pulse.

Hypoparathyroidism

Worsening tetany causes generalized seizures. Chronic hypoparathyroidism produces neuromuscular irritability, Chvostek’s sign, dysphagia, tetany, and hyperactive DTRs.

Hypoxic encephalopathy

Besides generalized seizures, hypoxic encephalopathy may produce myoclonic jerks and coma. Later, if the patient has recovered, dementia, visual agnosia, choreoathetosis, and ataxia may occur.

Neurofibromatosis

Renal failure (chronic)

Stroke

Other causes

Barbiturate withdrawal

In chronically intoxicated patients, barbiturate withdrawal may produce generalized seizures 2 to 4 days after the last dose. Status epilepticus is possible.

Diagnostic tests

Contrast agents used in radiologic tests may cause generalized seizures.

Drugs

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Seizures, complex partial: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Brain abscess

Head trauma

Temporal lobe tumor

Complex partial seizures may be the first sign of a tumor in the temporal lobe. Other signs and symptoms include headache, pupillary changes, and mental dullness. Increased intracranial pressure may cause a decreased LOC, vomiting and, possibly, papilledema.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Seizures, simple partial: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Brain abscess

Brain tumor

Head trauma

Multiple sclerosis

Focal or generalized seizures may occur with multiple sclerosis, usually during the late stages. Other findings include visual deficits, paresthesia, constipation, muscle weakness, spasticity, paralysis, hyperreflexia, intention tremor, gait ataxia, dysphagia, dysarthria, emotional lability, impotence, and urinary frequency, urgency, and incontinence.

Neurofibromatosis

With neurofibromatosis, multiple brain lesions cause focal seizures and, at times, generalized seizures. Inspection reveals café-au-lait spots, multiple skin tumors, scoliosis, and kyphoscoliosis. Related findings include dizziness, ataxia, progressive monocular blindness, nystagmus, and endocrine abnormalities.

Stroke

A major cause of seizures in patients older than age 50, a stroke may induce focal seizures up to 6 months after its onset. Related effects depend on the type and extent of the stroke but may include decreased LOC, contralateral hemiplegia, dysarthria, dysphagia, ataxia, unilateral sensory loss, apraxia, agnosia, and aphasia. A stroke may also cause vision deficits, memory loss, poor judgment, personality changes, emotional lability, headache, urinary incontinence or retention, and vomiting. It may result in generalized seizures.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Seizures: Principal Causes of Seizures
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)

Febrileseizures
Hypoxic-ischemic encephalopathy
Brain disorders
1. Cerebralmalformations
2. Intracranial infection
3. Intracranial hemorrhage
4. Other
Hypertensive encephalopathy
Drugs and toxins
Metabolic disorders
1. Hypoglycemia
2. Hypocalcemia
3. Hypomagnesemia
4. Hyponatremia
5. Hypernatremia
6. Uremia
7. Bilirubin encephalopathy (kernicterus)
8. Pyridoxine dependency
9. Inborn errors of metabolism
Selected epileptic syndromes
1. Neonatalseizures
2. Benign neonatal epilepsy
3. Infantile spasms (West syndrome)
4. Lennox-Gastaut syndrome
5. Benign focal epilepsy with centrotemporalspikes
6. Temporal lobe epilepsy
7. Juvenile myoclonic epilepsy
8. Posttraumatic epilepsy
9. Childhood absence epilepsy
Unknown

» READ BOOK EXCERPT ONLINE »

Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006

Myoclonus: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Alzheimer's disease.Generalized myoclonus may occur in advanced stages of Alzheimer's disease, a slowly progressive dementia. Other late findings include mild choreoathetoid movements, muscle rigidity, bowel and bladder incontinence, delusions, and hallucinations.

Creutzfeldt-Jakob disease.Diffuse myoclonic jerks appear early in Creutzfeldt-Jakob disease. Initially random, they gradually become more rhythmic and symmetrical, usually occurring in response to sensory stimuli. Associated effects include ataxia, aphasia, hearing loss, muscle rigidity and wasting, fasciculations, hemiplegia, and vision disturbances, or possibly, blindness.

Encephalitis (viral).With viral encephalitis, myoclonus is usually intermittent and either localized or generalized. Associated findings vary, but may include rapidlydecreasing LOC, fever, headache, irritability, nuchal rigidity, vomiting, seizures, aphasia, ataxia, hemiparesis, facial muscle weakness, nystagmus, ocular palsies, and dysphagia.

Encephalopathy.Hepatic encephalopathy occasionally produces myoclonic jerks in association with asterixis and focal or generalized seizures.

Hypoxic encephalopathy may produce generalized myoclonus or seizures almost immediately after restoration of cardiopulmonary function. The patient may also have a residual intention myoclonus.

Uremic encephalopathy commonly produces myoclonic jerks and seizures. Other signs and symptoms include apathy, fatigue, irritability, headache, confusion, gradually decreasing LOC, nausea, vomiting, oliguria, edema, and papilledema. The patient may also exhibit elevated blood pressure, dyspnea, arrhythmias, and abnormal respirations.

Epilepsy.With idiopathic epilepsy, localized myoclonus is usually confined to an arm or leg and occurs singly or in short bursts, usually upon awakening. It's usually more frequent and severe during the prodromal stage of a major generalized seizure, after which it diminishes in frequency and intensity.

Other causes

Drug withdrawal.Myoclonus may be seen in patients with alcohol, opioid, or sedative withdrawal or delirium tremens.

Poisoning.Acute intoxication with methyl bromide, bismuth, or strychnine may produce an acute onset of myoclonus and confusion.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Seizures, generalized tonic-clonic: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Brain abscess.Generalized seizures may occur in the acute stage of a brain abscess formation or after the abscess disappears. Depending on the size and location of the abscess, a decreased LOC varies from drowsiness to deep stupor. Early signs and symptoms reflect increased intracranial pressure (ICP) and include a constant headache, nausea, vomiting, and focal seizures. Typical later features include ocular disturbances, such as nystagmus, impaired vision, and unequal pupils. Other findings vary with the abscess site but may include aphasia, hemiparesis, abnormal behavior, and personality changes.

Brain tumor.Generalized seizures may occur with a brain tumor, depending on it's location and type. Other findings include a slowly decreasing LOC, a morning headache, dizziness, confusion, focal seizures, vision loss, motor and sensory disturbances, aphasia, and ataxia. Later findings include papilledema, vomiting, increased systolic blood pressure, widening pulse pressure and, eventually, a decorticate posture.

Chronic renal failure.End-stage renal failure produces the rapid onset of twitching, trembling, myoclonic jerks, and generalized seizures. Related signs and symptoms include anuria or oliguria, fatigue, malaise, irritability, decreased mental acuity, muscle cramps, peripheral neuropathies, anorexia, and constipation or diarrhea. Integumentary effects include skin color changes (yellow, brown, or bronze), pruritus, and uremic frost. Other effects include an ammonia breath odor, nausea and vomiting, ecchymoses, petechiae, GI bleeding, mouth and gum ulcers, hypertension, and Kussmaul's respirations.

Eclampsia.Generalized seizures are a hallmark of eclampsia. Related findings include a severe frontal headache, nausea and vomiting, vision disturbances, increased blood pressure, a fever of up to 104° F (40° C), peripheral edema, and sudden weight gain. The patient may also exhibit oliguria, irritability, hyperactive deep tendon reflexes (DTRs), and decreased LOC.

Encephalitis.Seizures are an early sign of encephalitis, indicating a poor prognosis; they may also occur after recovery as a result of residual damage. Other findings include fever, headache, photophobia, nuchal rigidity, neck pain, vomiting, aphasia, ataxia, hemiparesis, nystagmus, irritability, cranial nerve palsies (causing facial weakness, ptosis, and dysphagia), and myoclonic jerks.

Epilepsy (idiopathic).In most cases, the cause of recurrent seizures is unknown.

Head trauma.With severe head trauma, generalized seizures may occur at the time of injury. (Months later, focal seizures may occur.) Severe head trauma may also cause decreased LOC, leading to coma; soft-tissue injury of the face, head, or neck; clear or bloody drainage from the mouth, nose, or ears; facial edema; bony deformity of the face, head, or neck; Battle's sign; and a lack of response to oculocephalic and oculovestibular stimulation. Motor and sensory deficits may occur along with altered respirations. Examination may reveal signs of increasing ICP, such as a decreased response to painful stimuli, nonreactive pupils, bradycardia, increased systolic pressure, and widening pulse pressure. If the patient is conscious, he may exhibit visual deficits, behavioral changes, and headache.

Hepatic encephalopathy.Generalized seizures may occur latein hepatic encephalopathy. Associated late-stage findings in the comatose patient include fetor hepaticus, asterixis, hyperactive DTRs, and a positive Babinski's sign.

Hypoglycemia.Generalized seizures usually occur with severe hypoglycemia, accompanied by blurred or double vision, motor weakness, hemiplegia, trembling, excessive diaphoresis, tachycardia, myoclonic twitching, and decreased LOC.

Hyponatremia.Seizures may develop when the serum sodium level falls below 125 mEq/L, especially if the sodium loss is rapid. Hyponatremia also causes orthostatic hypotension, headache, muscle twitching and weakness, fatigue, oliguria or anuria, cold and clammy skin, decreased skin turgor, irritability, lethargy, confusion, and stupor or coma. Excessive thirst, tachycardia, nausea, vomiting, and abdominal cramps may also occur. Severe hyponatremia may cause cyanosis and vasomotor collapse, with a thready pulse.

Hypoparathyroidism.Chronic hypoparathyroidism produces neuromuscular irritability and hyperactive DTRs. Worsening tetany causes generalized seizures.

Hypoxic encephalopathy.Besidesgeneralized seizures, hypoxic encephalopathy may produce myoclonic jerks and coma. Later, if the patient has recovered, dementia, visual agnosia, choreoathetosis, and ataxia may occur.

Neurofibromatosis.Multiple brain lesions from neurofibromatosis cause focal and generalized seizures. Inspection reveals café-au-lait spots, multiple skin tumors, scoliosis, and kyphoscoliosis. Related findings include dizziness, ataxia, monocular blindness, and nystagmus.

Stroke.Seizures (focal more commonly than generalized) may occur within 6 months of an ischemic stroke. Associated signs and symptoms vary with the location and extent of brain damage. They include decreased LOC, contralateral hemiplegia, dysarthria, dysphagia, ataxia, unilateral sensory loss, apraxia, agnosia, and aphasia. The patient may also develop visual deficits, memory loss, poor judgment, personality changes, emotional lability, urine retention or urinary incontinence, constipation, headache, and vomiting.

Other causes

Arsenic poisoning.Besides generalized seizures, arsenic poisoning may cause a garlicky breath odor, increased salivation, and generalized pruritus. GI effects include diarrhea, nausea, vomiting, and severe abdominal pain. Related effects include diffuse hyperpigmentation; sharply defined edema of the eyelids, face, and ankles; paresthesia of the extremities; alopecia; irritated mucous membranes; weakness; muscle aches; and peripheral neuropathy.

Barbiturate withdrawal.In chronically intoxicated patients, barbiturate withdrawal may produce generalized seizures 2 to 4 days after the last dose. Status epilepticus is possible.

Diagnostic tests.Contrast agents used in radiologic tests may cause generalized seizures.

Drugs.Toxic blood levels of some drugs, such as theophylline, lidocaine, meperidine, penicillins, and cimetidine, may cause generalized seizures. Phenothiazines, tricyclic antidepressants, amphetamines, isoniazid, and vincristine may cause seizures in patients with preexisting epilepsy.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Seizures, absence: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Idiopathic epilepsy.Some forms of absence seizure are accompanied by learning disabilities.

Other causes

Drugs.Drugs that lower the threshold for seizures, such as alcohol, cocaine, penicillin in high doses, isoniazid, and phenothiazines may trigger seizures in patients with preexisting epilepsy.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Seizures, complex partial: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Brain abscess.If the brain abscess is in the temporal lobe, complex partial seizures commonly occur after the abscess disappears. Related problems may include headache, nausea, vomiting, generalized seizures, and decreased level of consciousness (LOC). The patient may also develop central facial weakness, auditory receptive aphasia, hemiparesis, and ocular disturbances.

Head trauma.Severe trauma to the temporal lobe (especially from a penetrating injury) can produce complex partial seizures months or years later. The seizures may decrease in frequency and eventually stop. Head trauma also causes generalized seizures and behavior and personality changes.

Herpes simplex encephalitis.Herpes simplex virus commonly attacks the temporal lobe, resulting in complex partial seizures. Other features include fever, headache, coma, and generalized seizures.

Temporal lobe tumor.Complex partial seizures may be the first sign of a temporal lobe tumor. Other signs and symptoms include headache, pupillary changes, and mental dullness. Increased intracranial pressure may cause decreased LOC, vomiting and, possibly, papilledema.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Seizures, simple partial: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Brain abscess.Seizures can occur in the acute stage of a brain abscess formation or after resolution of the abscess. A decreased LOC varies from drowsiness to deep stupor. Early signs and symptoms reflect increased intracranial pressure and include a constant, intractable headache; nausea; and vomiting. Later signs and symptoms include ocular disturbances, such as nystagmus, decreased visual acuity, and unequal pupils. Other findings vary according to the abscess site and may include aphasia, hemiparesis, and personality changes.

Brain tumor.Focal seizures are commonly the earliest indicators of a brain tumor. The patient may report a morning headache, dizziness, confusion, vision loss, and motor and sensory disturbances. He may also develop aphasia, generalized seizures, ataxia, decreased LOC, papilledema, vomiting, increased systolic blood pressure, and widening pulse pressure. Eventually, he may assume a decorticate posture.

Head trauma.Any head injury can cause seizures, but penetrating wounds are characteristically associated with focal seizures. The seizures usually begin 3 to 15 months after injury, decrease in frequency after several years, and eventually stop. The patient may develop generalized seizures and decreased LOC that may progress to coma.

Stroke.A major cause of seizures, a stroke may induce focal seizures up to 6 months after its onset. Related effects depend on the type and extent of the stroke, but may include decreased LOC, contralateral hemiplegia, dysarthria, dysphagia, ataxia, unilateral sensory loss, apraxia, agnosia, and aphasia. A stroke may also cause visual deficits, memory loss, poor judgment, personality changes, emotional lability, headache, urinary incontinence or urine retention, and vomiting. It may result in generalized seizures.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

» Next page: Symptoms of Temporal lobe epilepsy

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Causes of Temporal lobe epilepsy

Temporal lobe epilepsy Causes: Book Excerpts

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Causes of Temporal lobe epilepsy: Online Medical Books

Chorea: Differential Diagnosis (In a Page: Signs and Symptoms)

Seizures/Convulsions: Differential Diagnosis (In a Page: Signs and Symptoms)

Chorea: Differential Diagnosis (In A Page: Pediatric Signs and Symptoms)

Seizures – Childhood: Differential Diagnosis (In A Page: Pediatric Signs and Symptoms)

Seizures – Neonatal: Differential Diagnosis (In A Page: Pediatric Signs and Symptoms)

Myoclonus: Medical causes (Handbook of Signs & Symptoms (Third Edition))

Alzheimer’s disease

Creutzfeldt-Jakob disease

Encephalitis (viral)

Encephalopathy

Epilepsy

Other causes

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Poisoning

Seizures, generalized tonic-clonic: Medical causes (Handbook of Signs & Symptoms (Third Edition))

Brain abscess

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Stroke

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Diagnostic tests

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Seizures, absence: Medical causes (Handbook of Signs & Symptoms (Third Edition))

Idiopathic epilepsy

Seizures, complex partial: Medical causes (Handbook of Signs & Symptoms (Third Edition))

Brain abscess

Head trauma

Herpes simplex encephalitis

Temporal lobe tumor

Seizures, simple partial: Medical causes (Handbook of Signs & Symptoms (Third Edition))

Brain abscess

Brain tumor

Head trauma

Stroke

Myoclonus: Medical causes (Professional Guide to Signs & Symptoms (Fifth Edition))

Alzheimer’s disease

Creutzfeldt-Jakob disease

Encephalitis (viral)

Encephalopathy

Epilepsy

Other causes

Drug withdrawal

Poisoning

Seizures, generalized tonic-clonic: Medical causes (Professional Guide to Signs & Symptoms (Fifth Edition))

Alcohol withdrawal syndrome

Brain abscess

Brain tumor

Cerebral aneurysm

Chronic renal failure

Eclampsia

Encephalitis

Epilepsy (idiopathic)

Head trauma

Hepatic encephalopathy

Hypertensive encephalopathy

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Hypoparathyroidism

Hypoxic encephalopathy

Multiple sclerosis

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Porphyria (intermittent acute)

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Chorea: Differential Diagnosis
(In a Page: Signs and Symptoms)

Seizures/Convulsions: Differential Diagnosis
(In a Page: Signs and Symptoms)

Chorea: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

Seizures – Childhood: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

Seizures – Neonatal: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

Myoclonus: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Seizures, generalized tonic-clonic: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Seizures, absence: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Seizures, complex partial: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Seizures, simple partial: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Myoclonus: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Seizures, generalized tonic-clonic: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Chorea [Choreiform movements]: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Seizures, absence: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Seizures, complex partial: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Seizures, simple partial: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Seizures: Differential Overview

(Field Guide to Bedside Diagnosis)

Myoclonus: Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

Seizures, generalized tonic-clonic: Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

Chorea: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)