My mom's fiance is having seizures and Headaches, could anybody give me any information on the two?

I know someone with partial complex frontal lobe seizures. There is a migraine-like headache prior to the seizures, and excessive sleeping and disorientation after the seizures. Only a neurologist could diagnose this.

There is also often an aura before the seizures (smelling smells that aren’t there, seeing things, feeling dizzy, etc), but not always. In my friend’s case, he smells bacon and gets dizzy.

The disorientation after a seizure is “normal”. The presence of headaches and seizures together is worrisome. It could range from an infection like meningitis/encephalitis to a tumor, to an aneurysm, to stroke, to a metabolic cause (i.e. changes in serum salts or low glucose) to a toxic process (i.e. a drug overdose or withdrawal). The CT scan will help, as will the thorough evaluation of the emergency room doctor (blood tests, urine tests, lumbar puncture, etc.).

If the CT scan is clean, the most likely next move to diagnose the problem will be an electroencephalogram (EEG) to uncover unusual electrical activity in the brain. I assumed when answering that the CT was clean since there is still a question of the cause. Absent a fever, nausea, elevated white blood count, or other signs of illness , etc, an infection is unlikely. With a clean CT, tumor is pretty well ruled out. I’d look for a seizure disorder, especially given the behavioral changes and disorientation following the episodes.

@Mensan, if you want something, message me personally.

@juwhite1@shilolo – thank you for taking time to help me out. I’m hoping that everything turns out fine.

@LeopardGecko – I’m also hoping it all works out. Those symptoms can be scary, especially when you’ve never seen this before. Best wishes to your mom’s fiance for a fast recovery!

@juwhite1 I disagree. The diagnosis of a seizure disorder after a new onset seizure occurs after all other common causes are excluded. Further, the disorientation after a seizure is called the post-ictal state, and is typical for seizures. Thus, he almost undoubtedly would need a lumbar puncture, because a slowly bleeding aneurysm is sometimes not visible by CT scan, but the blood in the CSF turns a dark color and can be seen in cerebrospinal fluid.

Fortunately, CT scans and EEGs are two of the most common ways to diagnose a bleeding cerebral aneurysms, so an EEG would give you two different diagnostic tools that are very good at finding bleeds, without the risks or pain of a lumbar puncture. Since there is already a CT scan, which is excellent at finding bleeds, that I am assuming resulted in no abnormal findings, I think it is safe to move on to the much more likely culprit being a seizure disorder. Since it is withing protocol to do an EEG for suspected bleeds that are accompanied by seizures, I feel doing so would be appropriate. It is both art and science, and I think that personal preferences for looking for the most common things first versus continuing to look for lethal things that are highly unlikely given the first results from the CT play in. Neither is really right or wrong, as each avenue carries different risks… different priorities and different experiences will produce different answers to the question of the best next test. I’d also consider the fact that it if is a slow bleed, the odds of being able to treat it are much lower than the odds of being able to successfully treat a seizure disorder.

In what protocol is EEG used for diagnosis of aneurysm? I’ve never seen it, and it would be unlikely to show the cause of the seizure, just the location and type.

I just now did a quick google search of “slow bleed aneurysm seizure” (leaving out any references to EEG’s so as not to bias the results) and clicked on the first result. Look under exams and tests:
http://www.nlm.nih.gov/medlineplus/ency/article/001414.htm

Since it is from the National Institutes of Health, I feel it is pretty reliable.

Yeah, it isn’t used for diagnosis. Having clinical experience with this, I can tell you that it is never used. Most ERs can’t do it, and so the algorithm is typically CT (or MRI). If negative, and suspicion is high, then LP. That is the standard of care.

Also, in this case, we are diagnosing a seizure precipitated by a headache, and while an aneurysm could be the culprit (although rare), and since the CT scan would have shown an aneurysm in 90% of cases (according to your source), and since in this particular case, there don’t seem to be other signs that it would be an aneurysm (vision problems, stiff neck, etc.) it seems wise to look for more likely culprits.

OK, you are right. My medical experience has been trumped by google. ~

@juwhite1 May I ask how you are qualified? We regulars all know how @shilolo is qualified, but nothing in your profile leads me to suspect that you have the experience to be able to answer this question definitively.

What hospital isn’t equipped with an EEG and a neurologist to use it? I’d be terrified if I was in a hospital without such basic equipment! While certainly the ER can’t do it themselves, they can and should send the patient over to another department within the hospital to get one! I just don’t see in this case that aneurysm would be high on the list of things to rule out at this point in the game.
Regarding the google comment, the source is reliable. If it were a blog, I’d agree with you, but it is the National Institutes of Health… where almost all medical research funding is hubbed. I doubt they’d list using an EEG as a diagnostic tool for suspected aneurysms if it had never been used before.

@pdworkin Thanks, but this is all moot anyway. It isn’t like either of us has any sway over what will happen. The ER will do what they think, and then admit for observation if everything is negative. A neurologist will then consult, and may or may not due an EEG depending on her history and physical examination. EEGs aren’t very useful tests, in the grand scheme of things anyway.

@juwhite1 They listed a bunch of tests that could be used, not what is actually done and in what priority. Regarding your comments, many community hospitals do not staff 24h EEG and neurologists, since it isn’t an emergency procedure. Precisely my point.

@shilolo I didn’t post in order to defend one of you and attack the other. I posted the question in order to learn what @juwhite1‘s qualifications are.

@pdworkin – I worked extensively with seizure disorders for about 7 years, and this has the ring of a seizure problem to me. While my work was on the treatment and control end for people with severe seizure disorders who were prone to status epilepticus, and not on the diagnostic end, it gave me a fair amount of experience in the area. While it could certainly hold another cause as well, the likelihood in this scenario is pretty high that there is a seizure disorder. As @shilolo points out, none of us will know until all the tests are run, in whichever order the doctors choose to run them, in order to diagnose him.

I recently called my mom, her fiance has been taken to CCU. He has had another convulsion and following this was a stroke.

@juwhite1 Thanks for answering the question, and thanks for understanding that it was not meant to be an attack.

@LeopardGecko I’m sorry to hear the bad news. I hope he recovers.

@LeopardGecko – I’m very sorry to hear that. Hope he has a strong recovery.
@pdworkin – It was a good question and I didn’t take it as an attack.