Question

Elsie is a 76-year old female in reasonably good health. Her only health problems are

hypertension, diabetes type 2, and atrial fibrillation. She takes Coumadin (a blood thinner) for her atrial

fibrillation, Prinivil (antihypertensive) for her high blood pressure, and her diabetes is diet-controlled.

This morning, Elsie didn’t feel well complaining of a headache. As she ate her breakfast, she noted the

food seemed to make her cough often. She ate about half of it and took all her medications, including an

ibuprofen for headache. Afterwards, she decided she wanted to lie down for a little while. As she was

walking back to her bedroom, her husband commented that she seemed “wobbly” on her feet. She

replied it was only because she wasn’t feeling her best today.

About an hour later, the husband heard a noise in the bedroom. When he entered the room, Elise was

leaning on the side of the bed vomiting. She said it came on so quickly that she couldn’t make it to the

bathroom. The husband reassured her and told her to continue to rest and he would clean everything

up. As she thanked him, the husband questioned her slurred speech. She replied that it was only

because she was so sleepy.

As the husband returned to the room with towels, he noted Elsie was making jerking movements. By the

time he got to her bedside, he couldn’t wake her up. He immediately called 911. Since she was

breathing and had a pulse, all he could do was wait and watch over her. Thankfully, the ambulance

arrived quickly.

Q1: What do you think is going on here? Include risk factors, signs/symptoms/Pathophysiology.

Q2: What can you say about the jerking movements Elsie had? (medical term)

Q2a. What if she experienced a visual or hearing disturbance before the jerking movements?

What would that be called?

Q2b. After the jerking movements stopped, her husband couldn’t wake her. What is that

period called?

Q2c. If the jerking movements had not stopped, what would that be called

Answer 1

1. Seizures - Paroxysmal time-limited events that result from abnormal or involuntary rhythmic neuronal discharges in the cerebral cortex.

#. Signs and Symptoms of a seizure are:

almost imperceptible alteration in conscousness to a dramatic loss of consciousness (day dreaming), a cry, falling, tonic-clonic convulsions of all the extremities (stiff), urinary and fecal incontinence, staring spells, amnesia for the event, audden brief muscular jerks or spasms of one side of the body, abnormal sensations of smell taste or touch, person may appear drunk, drugged or mentally ill

#. Pathophysiology :-

Normal cortex – recurrent and collateral inhibitory circuits that limit synchronised discharge GABA – inhibitory neurotransmitter, GABA receptor drugs cause seizures Acetylcholine, glutamate & aspartate - excitatory neurotransmitters Epileptic cortex - reduced inhibitory signals or increased excitatory signals

2. The medical term for the jerking movements Elsie had is called seizures .

2a) If she experienced a visual or hearing disturbance before the jerking movements is called Aura ,the warnng sign of seizures.

2b) After the jerking movements stopped, her husband couldn’t wake her. This period is called postictal state