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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What are symptoms of a seizure?

Answered by
Dr. Dariush Saghafi


Practicing since :1988

Answered : 1629 Questions

Posted on Thu, 7 Aug 2014 in Brain and Spine
Question: Recently I wound up in the ER. Here's what happened:

I worked the night before and had 3 hrs of sleep and then made a 3 hr drive to meet friends.

We had a late dinner. I ate a full meal, appetizer and entree with 2 glasses of wine over the course of 1 1/2 to 2 hrs. We went to a club and had 1 shot of tequila and walked to another club and this took at least a half hour total. At the second club we were there for about 2 hours and had a total of two shots during this period. I did not feel intoxicated. I was dancing and felt hot and had a sharp pain in my neck but kept dancing. It got better then I felt a burning from my waist up to my neck about 30 minutes later and tried to keep dancing but had to sit down. Then I could not hold a conversation and laid down. My friend later told me that she saw a tremor and stiffening in my right hand. I was not aware of this. We were told to leave the club so they could clean up. I was worried about getting up but felt I had to make myself. I walked outside with my friends and sat down at the nearest place I could find which was a sidewalk. Soon after, I felt again that I had to lay down. I felt like I could not recover and assumed I was dehydrated and just overheated. I lost bowel control and told a friend that I needed to get to a bathroom and made myself get up yet again even though I felt very worried about being able to walk. We got about 15-20 feet away behind a concrete structure and I used the wall to slide down to complete the bowel movement. I then used the wall to slide back up for support. My friend told me that I said I was going to fall and then hit my knee, shoulder and then the left side of my face. She also witnessed a fixed stare to the right, right hand tremor and then hand stiffening. EMS was called and I wound up at the ER but was answering most questions accurately by the time EMS arrived. My friend said I only answered strangely once. The ER did a CT scan, no fractures but they found a meningioma in front of my left frontal lobe and started me on IV Keppra and said I had a seizure. I was told the meningioma looked calcified and therefore was not malignant but was told to f/u with a neurologist and was sent home with Norco for pain and Keppra po bid 500mg. The CT scan revealed a a meningioma 1.4 cm in size. The only abnormal lab was blood sugar 159.
Next I saw a neurosurgeon who did an mri. He told me that the meningioma was old, not touching my frontal lobe and he didn't believe it caused the seizure. I'm now scheduled to see a neurologist this week.
On reflection I had another event almost a year ago and ended up in the ER. I had dinner at a restaurant, two glasses of wine and became nauseated and felt that I needed to lay down in the car. I got up and fell but my brother and husband caught me. I thought I had fainted but my husband said no, you never fainted, your eyes were open, you were drenched with sweat but you were not unconscious but you were not responsive. I was brought to the ER and they thought it was a syncopal episode. No CT scan was done because I did not hit my head. They recommended that I see a cardiologist. I had an EKG, echo and XXXXXXX stress test all normal. My electrolytes were fine. My blood sugar was also normal at that time. Do these sound like seizures to you?
Answered by Dr. Dariush Saghafi 36 minutes later
Brief Answer:
I believe your episodes to be seizures

Detailed Answer:
Good afternoon. My name is Dr. Saghafi and I'm happy to answer your questions and opine on the matter to help find the next best step in the process of addressing your issues.

I have read your case thoroughly and believe that your presentations are consistent with that of convulsive or epileptic episodes. It sounds as if a cardiological workup has been performed and negative. I must disagree with the neurosurgeon's opinion on the meningioma not being a possible player in this clinical situation. I would not be so hasty with discarding that entity for the following reasons.

Meningiomas can and do have a predilection for initiating seizures and convulsive episodes whether or not they "appear" to be touching anything. If your study was not done with gadolinium contrast and/or was not done with what we refer to as a SEIZURE PROTOCOL then, I would definitely recommend that series to be done.

It certainly is true as well that the meningioma may not have anything to do with what happened to you and it could simply be a coincidence that it was found but for a 44 year old woman, otherwise healthy, to start having seizures out of the blue with the finding of a frontal meningioma....I find that the most likely suspect to the picture until proven otherwise.

The good news is that you have a neurology appointment scheduled and so hopefully your specialist will confirm these facts for you. What I believe you will undergo is a series of workups including at least one EEG or electroencephalogram. You may also receive a repeat MRI study and I would recommend one with a seizure protocol associated. This is when fine cuts are taken through the temporal lobes up to what is known as the optic chiasm. The radiologist will also look for something called mesial temporal lobe sclerosis which may be an unusual entity to find in someone your age but I've found this as a cause to people's seizures when they were in the 60's and even 70's so I leave nothing to chance simply based upon age.

I would also recommend you keep a SEIZURE DIARY or log in case you should have more events. Be sure to document as much information as possible especially if you are alone. Try to always do things out of doors with a friend or companion. Do not climb ladders for the time being, involve yourself with hazardous activities such as going into isolated or wooded areas alone without telling someone where you're going and when you expect to be back. No driving of a vehicle until your neurologist clears you, and do not drink alcohol in the least as this will reduce the efficiency of your medication controlling your seizures right now. Stay well hydrated, don't skip meals, and for sure don't miss your meds.

All of these things can provoke more seizures.

I would ask the neurologist if they had a recommendation for another pain medication as opiate drugs can also lower seizure thresh holds and cause events.

I don't quite understand why simple analgesics wouldn't just as well serve your pain. ER's have a habit of just overdoing things for some reason I suppose.

I hope this information allows you to make good forthcoming decisions until you see your neurologist. If you agree that this consultation has been of value then, your feedback would be greatly appreciated as well as your CLOSING THE QUERY so that the interaction can be logged in as satisfactorily completed.

This case review and response utilized 25 minutes of physician dedicated time and documentation.

Once again, I wish you well and for you to take care of yourself. Follow the rules of the road (i.e. suggestions I've given you) and you'll be just fine.
Above answer was peer-reviewed by : Dr. Raju A.T
Follow up: Dr. Dariush Saghafi 3 hours later
What type of seizures do you think these are? Thank you for your prior answer.
Answered by Dr. Dariush Saghafi 3 hours later
Brief Answer:
Focal left frontal with secondary generalization

Detailed Answer:
Glad you were able to find my previous answer useful.

People can often have more than 1 seizure type at the same time so please understand that making a perfectly sealed ready to package diagnosis is not possible to promise in such as short amount of time knowing your case.

However, from the description of your events and especially with the right upper limb involved with your gaze (and possibly your head?) turning toward the right then, a change in mental status, I would say you were suffering from a type of frontal lobe seizure emanating from the left side of the brain. Your description is somewhat reminiscent of something referred to as the "fencing posture" but without some of the other postural peculiarities. No matter, it is said that real people's diseases rarely read medical textbooks. These form of seizure basically initiate from the frontal lobes of the brain on the side opposite from where the direction of gaze is pointed.

Now, it just so happens that the meningioma is also on the left side and in the frontal area....Coincidence? Or related? My vote is "related" until otherwise proven not. And by the way, calcified meningiomas are typically worse players when it comes to seizure precipitation than noncalcified so again I'm not sure what the neurosurgeon was trying to say when he implied that calcification somehow made it less likely that there could be any involvement from the meningioma. For me that's a bigger red flag when I discover that the entity is calcified.

EEG studies would be very worthwhile to obtain in addition to the MRI as I mentioned in my previous note with gadolinium contrast and a seizure protocol which utilizes fine cuts through the temporal lobes. I really DON'T THINK these are temporal lobe events because the description of the posture and how it initiates is all wrong for that type.

The sudden urge to defecate is a premonitory symptom of an impending major discharge in the brain.

All the best and please don't hesitate to send more questions if they should arise. Don't forget about keeping the seizure diary I mentioned. You should be able to find examples that you can download and fill out either on your smart phone/ipad or PC if you have either.

This response required 30 minutes of physician specific case review, revision, and final draft revision.

Once again, thank you for the opportunity to answer your questions and if you feel that the information was of benefit your feedback on our interaction would be much appreciated. In addition, being sure that you CLOSE THE QUERY on your end will guarantee that this interaction becomes fully registered as satisfactorily terminated.

Dr D.

Above answer was peer-reviewed by : Dr. Yogesh D
Follow up: Dr. Dariush Saghafi 12 hours later
Thanks again, this was very helpful!
Answered by Dr. Dariush Saghafi 21 minutes later
Brief Answer:
You are very welcome.

Detailed Answer:
I would like to verify that there is no question here for me to answer because the server alerted me to a follow-up question but I suspect it was simply your comment of thanks.

if that is the case then a rating of the transaction from your end would be greatly appreciated by way of whatever the formal means is that they document these things and then, if you could also please close the query from your end so that we get credited with having completed the case.

otherwise, keep in mind everything I mentioned, take extra precautions until you see your neurologist and start keeping track of things in detail. Everything should work out fine.
Above answer was peer-reviewed by : Dr. Ashwin Bhandari

The User accepted the expert's answer

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