Seizure disorders

Seizure Disorder

Case Studies

A 12-year-old boy began to complain of frequent headaches 4 months before his hospital

admission. On the day of his admission, he had a major motor seizure, which his parents

observed. During the seizure he lost bladder and bowel control. On physical examination he

appeared to be in deep postictal sleep. He had no focal neurologic signs. On examination of

the optic fundi, no evidence of papilledema was found.

Studies Results

Routine laboratory work Within normal limits (WNL)

Skull X-ray study, p. 1062 No evidence of skull fracture

Lumbar puncture, p. 651

Opening pressure 250 cm H2O (normal: <200 cm H2O)

Closing pressure 220 cm H2O (normal: <200 cm H2O)

Cerebrospinal fluid (CSF)

examination, p. 651

Blood Negative

Color Clear

Cells

Lymphocytes 0-2/mm3 (normal: <5/mm3)

Polymorphonuclear leukocytes None (normal: none)

Protein 120 mg/dL (normal: 15-45 mg/dL)

Glucose 50 mg/dL (normal: 50-75 mg/dL)

Cytology Questionably malignant cells

Serologic test for venereal disease Negative (normal: negative)

Electroencephalography (EEG), p. 549 Focal slowing of wave pattern in posterior aspect of

the cerebrum (normal: regular, rhythmic,

electrical waves)

Brain scan, p. 785 Increase in radioactivity in the posterior aspect of

the brain (normal: homogenous and minimal

uptake of radioactive material)

Cerebral angiography, p. 988 Neovascularity (tumor vessels) in the posterior

aspect of the brain, involving the cerebellum

and the occipital lobe of the cerebrum (normal:

normal carotid vessels and terminal branches)

Magnetic resonance imaging (MRI) of

the brain, p. 1106

Tumor of the cerebellum extending into the

posterior cerebrum

Computed tomography (CT) scan of

the brain, p. 1026

A soft tissue mass arising out of the cerebellum and

invading the occipital lobe of the cerebrum

Case Studies 2

Diagnostic Analysis

The skull X-ray study ruled out the possibility of a skull fracture as the cause of the boy’s

problem. Lumbar puncture excluded the possibility of meningitis or subarachnoid

hemorrhage; however, the high protein count and questionable positive cytology indicated a

possible neoplasm. An EEG located an area of nonspecific abnormality in the posterior

aspect of the brain. Brain scanning, cerebral angiography, and CT scanning indicated a

posterior fossa tumor. These tests are mentioned in this case study mostly for historical

interest. Under most circumstances, this young boy would have a MRI of the brain early in

the diagnostic period.

Because of these findings, the patient underwent a craniotomy. In many centers, this young

boy would have a nonoperative stereotactic brain biopsy instead of a craniotomy. An

invasive medulloblastoma was found to be arising from the patient’s cerebellum and

involving the occipital lobe of the cerebrum. The tumor was unresectable. Postoperatively,

the patient was given phenytoin (Dilantin) and radiation therapy to the involved area. A

chemotherapy regimen was administered. The patient’s tumor did not respond to the therapy,

and he died 4 months after the onset of disease.

Critical Thinking Questions

1. What are the major assessments that the nurse should make during seizure activity? 2. Why is the EEG a priority study for patients with seizure disorders?