Seizures and Meningitis

Seizure types, status epilepticus, and CNS infection

Med-Surg · Neuro

Seizure types

Focal aware	Patient stays conscious; twitching, odd sensations
Focal impaired awareness	Staring, lip smacking, picking at clothes; confused afterwards
Generalized tonic-clonic	Stiffening (tonic) then jerking (clonic); possible incontinence, tongue biting; postictal confusion and sleepiness
Absence	Brief staring spells (seconds), mostly children
Myoclonic / atonic	Sudden jerks / sudden loss of tone ("drop attacks": helmet)

Triggers: missed medications, sleep loss, alcohol or withdrawal, fever, low glucose or sodium, flashing lights.

Status epilepticus (seizure ≥5 min, or repeated without recovery)

Airway, oxygen, side-lying, suction; check glucose.
Benzodiazepine first: IV lorazepam, or IM midazolam (or intranasal/rectal options) if no IV.
Then a second-line IV drug: levetiracetam, fosphenytoin, or valproate.
Still seizing: anesthesia and intubation.

Teaching

Take medications on time, never stop suddenly; medical ID; no driving until cleared under state law; don't swim or bathe alone; folic acid if planning pregnancy; seizure diary.

Bacterial meningitis

Fever, severe headache, stiff neck, light sensitivity, confusion, vomiting.
Kernig's sign: pain when straightening the knee with the hip flexed. Brudzinski's sign: bending the neck makes hips and knees flex.
Petechial or purple rash → meningococcal: emergency.
Lumbar puncture: bacterial = cloudy CSF, high protein, low glucose, high WBCs. Viral = clear, normal glucose.

Antibiotics immediately after blood cultures: don't delay for imaging or LP. Dexamethasone with or just before the first dose (pneumococcal).
Droplet precautions until 24 h of effective antibiotics (meningococcal).
Close contacts get preventive antibiotics.
Quiet, dark room; HOB 30°; seizure precautions; watch for ↑ICP, SIADH, septic shock, hearing loss.
Prevention: MenACWY, MenB, pneumococcal and Hib vaccines.

After lumbar puncture

Position side-lying, knees to chest (or sitting leaning forward) during the procedure. Afterwards: encourage fluids; report a headache that's worse when upright (CSF leak). Bed rest afterward is a facility preference, not proven to prevent headache.

Memory hook Kernig = Knee. Brudzinski = Bend the neck.