Clinical Clues to the Causes of Symptomatic Seizures
Finding | Possible Cause |
|---|---|
Fever and stiff neck | |
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. | |