Клінічні підказки щодо причин симптоматичних судом

Finding

Possible Cause

Fever and stiff neck

Meningitis

Subarachnoid hemorrhage

Meningoencephalitis

Papilledema

Increased intracranial pressure

Loss of spontaneous venous pulsations (noted during funduscopy)

Increased intracranial pressure (specificity is 80–90%*)

Focal neurologic defects (eg, asymmetry of reflexes or muscle strength)

Structural brain abnormality (eg, tumor, stroke)

Postictal paralysis

Generalized neuromuscular irritability (eg, tremulousness, hyperreflexia)

Medication toxicity (eg, sympathomimetics)

Withdrawal syndromes (eg, of alcohol or sedatives)

Certain metabolic disorders (eg, hypocalcemia, hypomagnesemia)

Skin lesions (eg, axillary freckling or café-au-lait spots, hypomelanotic skin macules, shagreen patches)

Neurocutaneous disorders (eg, neurofibromatosis, tuberous sclerosis)

* Spontaneous venous pulsations are absent in all patients with increased intracranial pressure; these pulsations are also absent in 10‒20% of people with normal intracranial pressure, but sometimes only temporarily.

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