Epilepsy – Top USMLE Diseases

Hypertensive disorders of pregnancy include chronic hypertension, gestational hypertension, preeclampsia/eclampsia, and hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. These syndromes pose a significant risk to the pregnant woman and her fetus. Hypertension is defined as a BP > 140/90 mm Hg and can be diagnosed before (chronic) or after (gestational) the 20th week of gestation. Preeclampsia is gestational hypertension with proteinuria and/or end-organ damage. Eclampsia is preeclampsia with seizures. HELLP syndrome is a severe manifestation of preeclampsia leading to hemolysis, low platelets, and liver injury. Management is with antihypertensives and magnesium sulfate for seizure prophylaxis or treatment, depending on the presentation. The definitive treatment for all hypertensive disorders of pregnancy (aside from chronic hypertension) is delivery.

A seizure is abnormal electrical activity of the neurons in the cerebral cortex that can manifest in numerous ways depending on the region of the brain affected. Seizures consist of a sudden imbalance that occurs between the excitatory and inhibitory signals in cortical neurons, creating a net excitation. The 2 major classes of seizures are focal and generalized. Diagnosis is clinical, relying on history and physical exam, but also may use EEG and other tools. Management includes both abortive and preventive medications but may not be required in self-limited cases with no etiology found during workup.

Fever is defined as a higher-than-normal body temperature. In modern medicine, fever is defined as a temperature > 38°C (100.4°F). It is a common symptom in the pediatric population as an isolated symptom or accompanied by other findings that can help narrow the differential diagnosis. Fever is most commonly the body’s response to infectious processes; however, it can also be seen in other pathologic processes. In neonates and very young infants, the clinical presentation lacks specificity, so more diagnostic aids are deployed to rule out severe bacterial infection (SBI) and to begin treatment according to age and clinical evolution.

Hypertensive disorders of pregnancy include chronic hypertension, preeclampsia/eclampsia, gestational hypertension, and hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. These syndromes pose a significant risk to the pregnant woman and her fetus. Hypertension is defined as a BP > 140/90 mm Hg and can be diagnosed before (chronic) or after (gestational) the 20th week of gestation. Preeclampsia is gestational hypertension with proteinuria or end-organ damage. Eclampsia is preeclampsia with seizures. HELLP syndrome is a severe manifestation of preeclampsia leading to hemolysis, low platelets, and liver injury. Management is with antihypertensives and magnesium sulfate for seizure prophylaxis. The definitive treatment for all hypertensive disorders of pregnancy is delivery.

A seizure is abnormal electrical activity of the neurons in the cerebral cortex that can manifest in numerous ways depending on the region of the brain affected. Seizures consist of a sudden imbalance that occurs between the excitatory and inhibitory signals in cortical neurons, creating a net excitation. The 2 major classes of seizures are focal and generalized. Diagnosis is clinical, relying on history and physical exam, but also may use EEG and other tools. Management includes both abortive and preventive medications but may not be required in self-limited cases with no etiology found during workup.

Epilepsy is a chronic brain disorder marked by recurrent and unprovoked seizures. These seizures can be classified as focal or generalized and idiopathic or secondary to another condition. Clinical presentation correlates to the classification of the epileptic disorder. Diagnosis is confirmed with EEG. While some epileptic disorders resolve over time, many require lifelong antiepileptic medication for management or, in some refractory cases, surgical procedures.

Seizures occur when uncontrolled excessive synchronous neuronal activity in the brain causes sudden transient changes in motor function, sensation, behavior, or mental status. Seizures are classified primarily as generalized or focal and may occur once or be recurrent (epilepsy). Prolonged or recurrent seizures lasting > 30 minutes are called status epilepticus. Diagnosis depends on thorough history, physical exam, and EEG findings. Treatment is directed at the underlying trigger, and medications are administered as necessary. Most children that seize recover without any sequelae, but prognosis depends on the initial cause and the presence of underlying neurologic pathology.