Читать книгу Emergency Medical Services - Группа авторов - Страница 385

1 Seizures: from abnormal, excessive neuronal dischargesUnprovoked seizuresSymptomatic or secondary seizures

2 Nonepileptic seizures: appear to be seizures but do not result from abnormal excessive neuronal dischargesPsychogenic seizures (sometimes the term nonepileptic seizures is used synonymously with psychogenic seizures)Repetitive abnormal posturingInvoluntary movement disordersSyncope/convulsive syncopeConcussion/convulsive concussionSleep disorders

A person experiencing a blow to the head may have a brief episode of extremity stiffening at the time of impact that understandably may be confused with seizure activity. These events clinically resemble brief abnormal extensor posturing, though myoclonic and tonic‐clonic movements are also described. Return to consciousness following these events is usually prompt. These “convulsive concussions” are not associated with injury or neurologic sequelae and do not predict future seizures [8, 9]. Posttraumatic epilepsy may occur after head trauma but is associated with more severe head injuries. These late‐presenting seizures are typical in appearance and associated with a postictal confusional state.

In any series of stroke patients, seizures and postictal states are a significant source of diagnostic confusion [10, 11]. Seizure patients may have postictal weakness or confusion that mimics some stroke symptoms. Subarachnoid hemorrhage may cause fragmentary or repetitive extensor posturing that at times is confused with seizures [12, 13].

Nonepileptic seizures, also known as pseudoseizures, psychogenic, or hysterical seizures, often result in diagnostic uncertainty. Simply stated, the patient appears to be having a seizure, but subsequent observations prove that the apparent convulsion does not follow from the excessive neuronal discharges that characterize epileptic seizures. The usual descriptions of nonepileptic seizures include side‐to‐side head movements, out‐of‐phase limb movements, and pelvic thrusting [14]. Other reports indicate that simple unresponsiveness without motor movements is a frequent presentation [15].