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A Brief History of Number Systems
Quiz by Madison Lucas
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A Brief History of Washingtonâs Crossing of the Delaware River, Christmas Night 1776... In the fall of 1776, General George Washington and his army had suffered a series of defeats at the hands of the British Army. The Continental Army had lost every battle with the British in the New York campaign: Long Island, Manhattan, Brooklyn Heights, Harlem and White Plains and had surrendered Fort Washington and Fort Lee. At Fort Lee, the army barely escaped and was forced to leave behind its store of provisions, ammunition, and many of its weapons. A sense of defeat had settled around Washington as he was forced to retreat across New Jersey in November and finally to Pennsylvania on December 8, 1776. The British, at least, considered the war over. By December 11th, the only reason the British had not taken Philadelphia, the seat of the Continental Congress, was that Washington had ordered every boat in the Delaware River on the New Jersey side to be brought to the Pennsylvania side, thus denying the British army transportation. Washington knew that the British would be capable of resuming an offensive by crossing the Delaware once it iced over. As the harsh winter set in, the morale of the American troops was at an all-time low. The soldiers were forced to deal with a lack of both food and warm clothing, while Washington watched his army shrink because of desertions and expiring enlistments. Now, more than ever, a victory was desperately needed. Washington devised a courageous plan to take the offensive and cross the Delaware River on Christmas night and attack the Hessian garrison at Trenton, New Jersey, nine miles south of his encampment near McConkey's Ferry. The original plan called for three divisions to cross the Delaware under the cover of darkness. Lt. Col. John Cadwalader's division was to cross at Bristol and engage the southern most contingent of British forces â Hessian troops under the command of Colonel von Donop. General James Ewing's division was to cross at Trenton Ferry and take a position south of Assunpink Creek below Trenton and hold the bridge over that stream. Washington's division was to cross at McConkey's Ferry and then divide into two corps under General Nathanael Greene and General John Sullivan. Their point of attack was Trenton and the Hessian troops quartered there under the command of Colonel Johann Gottlieb Rall. The boats to be used for the crossing were gathered earlier in the month in compliance with General Washington's orders, primarily as a defensive measure. Various types of boats had been collected, most notably the large Durham boats used to carry pig iron down the Delaware to the Philadelphia markets. There were a number of problems in moving a large number of men, cannons, and supplies in an age when overland transportation was by foot and animal power. The roads were rutted and winding. There were no bridges over major rivers because the technology did not exist to span great distances. A river like the Delaware was crossed by ferry, sometimes out of service because of ice floes or floods, and certainly not designed to carry masses of men and equipment across quickly. A river could be a formidable natural barrier to an army on the move. Washington had several logistical concerns for the crossing. In addition to the troops were the cannon; each of which required at least two horses to pull it. The heavier twelve pounders, and probably the eight pounders, had four horses. There would have been between four and six ammunitions wagons. Officers of the rank of colonel or higher may have had horses. In sum, Washington had to move 2,400 men, eighteen cannons, at least four ammunition wagons and fifty to seventy-five horses across the Delaware River the night of December 25, 1776. Fully expecting to be supported by Cadwalader's and Ewing's divisions south of Trenton, Washington assembled his own troops near McKonkey's Ferry in preparation for the crossing. By 6:00 pm, 2,400 men had begun crossing the ice-chocked river. There was an abrupt change in the weather, forcing the men to fight their way through sleet and a blinding snowstorm. The river was flooded with sheets of ice moving at eleven or twelve miles per hour. These obstacles proved to be too much for the two supporting divisions led by Generals Cadwalader and Ewing, who did not cross at their assigned points along the river. It was Washington's pure force of will and determination that led to his troops' successful crossing of the river. Increasing Washington's odds were the sailors of Marblehead, Massachusetts. This group of hardened seamen, led by Col. John Glover, were used to the Nor'easters of New England. Sheer determination and muscles conditioned to the demands of rowing under the weather conditions now facing the Continental army enabled the Marbleheaders to row back and forth across the Delaware countless times. During the time of the Revolution, American soldiers marched single file along the margins of the roads. They were only assembled into a battle line (three deep) when they reached the battlefield. The battle plan had Washington's army marching in two divisions... General Greene's and General Sullivan's. They made a night march in two columns on separate roads, a very tricky operation that was prone to failure since the columns needed to arrive at the battlefield at the same time to carry out the surprise attack planned by Washington. The American army carried out the march flawlessly. Against all odds, Washington and his men successfully completed the crossing and marched to Trenton on the morning of December 26th and, in the resulting battle, achieved a resounding victory over the Hessians. By moving ahead with his bold and daring plan, General Washington reignited the cause of freedom and gave new life to the American Revolution.Week 1 - A Brief History of PortugalA (very) brief history of catsContact with the Americas In 1001, Viking sailors led by Leif Erikson reached the eastern tip of North America. Archaeologists have found evidence of the Viking settlement of Vinland in present-day Newfoundland, Canada. The Vikings did not stay in Vinland long and no one is sure why they left. However, Viking stories describe fierce battles with Skraelings, the Viking name for the Inuit. Evidence suggests that Asians continued to cross the Bering Sea into North America after the last ice age ended. Some scholars believe that ancient seafarers from Polynesia may have traveled to the Americas using their knowledge of the stars and winds. Modern Polynesians have sailed canoes thousands of miles in this way. Still others think that fishing boats from China and Japan blew off course and landed on the western coast of North or South America. Perhaps such voyages occurred. If so, they were long forgotten. Before 1492, the peoples of Asia and Europe had no knowledge of the Americas and their remarkable civilizations. The Voyages of Columbus Portuguese sailors had pioneered new routes around Africa toward Asia in the late 1400s. Spain, too, wanted a share of the riches. King Ferdinand and Queen Isabella hoped to keep their rival, Portugal, from controlling trade with India, China, and Japan. They agreed to finance a voyage of exploration by Christopher Columbus. Columbus, an Italian sea captain, planned to reach the East Indies by sailing west across the Atlantic. Finding a sea route straight to Asia would give the Spanish direct access to the silks, spices, and precious metals of Asia. The spice trade was a major cause for European exploration and a reason the Spanish rulers supported Columbusâs voyage. They also wanted wealth from any source. âGet gold,â King Ferdinand said to Columbus. âHumanely if possible, but at all hazardsâget gold.â Crossing the Atlantic In August 1492, Columbus set out with three ships and about 90 sailors. As captain, he commanded the largest vessel, the Santa MarĂa. The other ships were the NiĂąa and the Pinta. After a brief stop at the Canary Islands, the little fleet continued west into unknown seas. Fair winds sped them along, but a month passed without the sight of land. Some sailors began to grumble. They had never been away from land for so long and feared being lost at sea. Still, Columbus sailed on. On October 7, sailors saw flocks of birds flying southwest. Columbus changed course to follow the birds. A few days later, crew members spotted tree branches and flowers floating in the water. At 2 a.m. on October 12, the lookout on the Pinta spotted white cliffs shining in the moonlight. âTierra! Tierra!â he shouted. âLand! Land!â At dawn, Columbus rowed ashore and planted the banner of Spain. He was convinced that he had reached the East Indies in Asia. He called the people he found there âIndians.â In fact, he had reached islands off the coasts of North America and South America in the Caribbean Sea. These islands later became known as the West Indies. For three months, Columbus explored the West Indies. To his delight, he found signs of gold on the islands. Eager to report his success, he returned to Spain. Columbus Claims Lands for Spain In Spain, Columbus presented Queen Isabella and King Ferdinand with gifts of pink pearls and brilliantly colored parrots. Columbus brought with him many things that Europeans had never seen before: tobacco, pineapples, and hammocks used for sleeping. Columbus also described the âIndiansâ he had met, the Taino (ty noh). The Taino, he promised, could easily be converted to Christianity and could also be used as slaves. The Spanish monarchs were impressed. They gave Columbus the title Admiral of the Ocean Sea. They also agreed to finance future voyages. The promise of great wealth, and the chance to spread Christianity, gave them a reason to explore further. Columbus made three more voyages across the Atlantic. In 1493, he founded the first Spanish colony in the Americas, Santo Domingo, on an island he called Hispaniola (present-day Haiti and the Dominican Republic). A colony is an area settled and ruled by the government of a distant land. Columbus also explored present-day Cuba and Jamaica. He sailed along the coasts of Central America and northern South America. He claimed all of these lands for Queen Isabella of Spain. Columbus proved to be a better explorer than governor. During his third expedition, settlers on Hispaniola complained of his harsh rule. Queen Isabella appointed an investigator, who sent Columbus back to Spain in chains. In the end, the queen pardoned Columbus, but he never regained the honors he had won earlier. He died in 1506, still convinced that he had reached Asia. The Impact of Columbusâs Voyages Columbus has long been honored as the bold sea captain who âdiscovered America.â Today, we recognize that American Indians had discovered and settled these lands long before 1492. We also recognize that Columbus and the Europeans who followed him treated the ancient inhabitants of the Americas brutally. Still, Columbusâs voyages did change history. They marked the beginning of lasting contact among the peoples of Europe, Africa, and the Americas. For a great many American Indians, contact had tragic results. Columbus and those who followed were convinced that European culture was superior to that of the Indians. The Spanish claimed Taino lands and forced the Taino to work in gold mines, on ranches, or in Spanish households. Many Taino died from harsh conditions or European diseases. The Taino population was wiped out. Still, the voyages of Columbus signaled a turning point for the Americas. A turning point is a moment in history that marks a decisive change. Curious Europeans saw the new lands as a place where they could settle, trade, and grow rich. Spanish Exploration Continues After the voyages of Columbus, the Spanish explored and settled other Caribbean islands that Columbus had found. They sought gold, land for crops, people to enslave, and converts to Christianity for the Spanish crown. By 1511, they had conquered Puerto Rico, Jamaica, and Cuba. They also explored the eastern coasts of North America and South America in search of a western route to Asia. In 1513, Vasco Núùez de Balboa (bal boh uh) crossed the Isthmus of Panama. American Indians had told him that a large body of water lay to the west. With a party of Spanish soldiers and Indians, Balboa reached the Pacific Ocean and claimed the ocean for Spain. The Spanish had no idea how wide the Pacific was until a sea captain named Ferdinand Magellan (muh jel un) sailed across it. The expeditionâmade up of five ships and about 250 crew membersâleft Spain in 1519. Fifteen months later, it cut through the stormy southern tip of South America by way of what is now known as the Strait of Magellan and entered the Pacific Ocean. Crossing the vast Pacific, the sailors ran out of food: Primary Source âWe remained 3 months and 20 days without taking in provisions or other refreshments and ate only old biscuit reduced to powder, full of grubs and stinking from the dirt which rats had made on it. We drank water that was yellow and stinking.â âAntonio Pigafetta, The Diary of Antonio Pigafetta Magellan himself was killed in a battle with the local people of the Philippine Islands off the coast of Asia. In 1522, only one ship and 18 sailors returned to Spain. They were the first people to circumnavigate, or sail completely around, the world. In doing so, they had found an all-water western route to Asia. Europeans became aware of the true size of the Earth. How Did the Columbian Exchange Affect the Rest of the World? The encounter between the peoples of the Eastern and Western Hemispheres sparked a global exchange of goods and ideas. Because it started with the voyages of Columbus, this transfer is known as the Columbian Exchange. The Columbian Exchange refers to a biological and cultural exchange of animals, plants, human populations, diseases, food, government, technology, the arts, and languages. The exchange went in both directions. Europeans learned much from American Indians. At the same time, Europeans contributed in many ways to the culture of the Americas. This exchange also brought about many modifications, or changes, to the physical environment of the Americas, with both positive and negative results. Changing Environments Europeans introduced domestic animals such as chickens from Europe and Africa. European pigs, cattle, and horses often escaped into the wild and multiplied rapidly. Forests and grasslands were converted to pastures. As horses spread through what would become the United States, Indians learned to ride them and used them to carry heavy loads. Plants from Europe and Africa changed the way American Indians lived. The first bananas came from the Canary Islands. By 1520, one Spaniard reported that banana trees had spread âso greatly that it is marvelous to see the great abundance of them.â Oranges, lemons, and figs were also new to the Americas. In North America, explorers also brought such plants as bluegrass, the daisy, and the dandelion. These plants spread quickly in American soil and modified American grasslands. Tragically, Europeans also brought new diseases, such as smallpox and influenza. American Indians had no resistance to these diseases. Historians estimate that within 75 years, diseases from Europe had killed almost 90 percent of the people in the Caribbean Islands and in Mexico. American Indian Influences on Europe, Africa and Asia American Indians introduced Europeans to valuable food crops such as corn, potatoes, sweet potatoes, beans, tomatoes, manioc, squash, peanuts, pineapples, and blueberries. Today, almost half the worldâs food crops come from plants that were first grown in the Americas. Europeans carried the new foods with them as they sailed around the world. Everywhere, peopleâs diets changed and populations increased. In South Asia, people used American hot peppers and chilies to spice stews. Chinese peasants began growing corn and sweet potatoes. Italians made sauces from tomatoes. People in West Africa grew manioc and corn. European settlers often adopted American Indian skills. In the North, Indians showed Europeans how to use snowshoes and trap beavers and other fur-bearing animals. European explorers learned how to paddle Indian canoes. Some leaders studied American Indian political structures. In the 1700s, Benjamin Franklin admired the Iroquois League and urged American colonists to unite in a similar way. Positive and Negative Consequences Through the Columbian Exchange, Europeans and American Indians modified their environments and gained new resources and skills. At the same time, warfare and disease killed many on both sides. Europeans viewed expansion positively. They gained great wealth, explored trade routes, and spread Christianity. Yet their farming, mining, and diseases took a toll on the physical environment and left many American Indians dead. Despite these negatives, the Columbian Exchange shaped the modern world, including what would become the United States.Honduras is a Central American nation bordered by Nicaragua, Guatemala, and El Salvador. The Caribbean Sea forms its northern coastline. The Pacific Ocean borders a small southern strip of land. Almanaque Nombre oficial: RepĂşblica de Honduras Ărea total: 112.090 km2 PoblaciĂłn: 9.038.741 Ciudad capital: Tegucigalpa Moneda: lempira Lenguas: espaĂąol, dialectos amerindios Early History Explorer Christopher Columbus came to Honduras in 1502 on his fourth trip to the New World. As was the case in North America, Honduras, in Central America, had been home to many native indigenous groups including the Sumu and Lenca. Some estimates suggest an indigenous population of up to 2,000,000 before the Europeans arrived. Among these indigenous groups were the Maya. Their civilization spread from the YucatĂĄn area of Mexico to Hondurasâ ancient city of CopĂĄn. Spainâs conquest of Honduras began in 1525, but it was not easy. It took until 1539 to fully conquer it. There were conflicts with the native population, who were forced into labor. Many died from disease and abuse. Others were enslaved and sent to the Caribbean islands. In addition, there were pirate attacks and in-fighting among the Spaniards. Phawat/Shutterstock Gold and silver deposits were discovered in Honduras in the 1530s, attracting more settlers. By the mid-16th century, mining was an important industry, mainly in the towns of Gracias and Comayagua. More native labor was needed, taking its toll on the dwindling indigenous population. As a solution, enslaved Africans were introduced in the 1540s. This was well before 1619, when enslaved Africans first arrived in Jamestown in the American colonies. The 17th century was filled with conflicts, primarily between the Spanish and the British. Britain wanted to establish colonies on the Caribbean coast of Honduras. They eventually seized the coast with help from the native Sambo and Miskito peoples. However, Spain later regained control. Independence In the early 1800s in Honduras, resentment toward Spain grew. One reason was that Honduras was subject to more taxes to help pay for conflicts that were happening between Spain and France. Other Spanish colonies were also increasingly resentful toward Spain. In 1776 in North America, the 13 colonies banded together to declare their independence from Britain. Similarly, Honduras joined other Central American provinces. Together, they declared independence from Spain on September 15, 1821. Honduras briefly became a part of Mexico, but in 1823, it became independent from Mexico. It then joined the United Provinces of Central America. This included other former Spanish colonies: Costa Rica, El Salvador, Guatemala, and Nicaragua. But the federation did not last, partially due to divisions in political beliefs. In 1838, Honduras declared its independence from the federation. By the early 1900s, the United States had economic interests in Honduras. American fruit corporations like the Standard Fruit Company and United Fruit Company began investing in Honduras to export bananas. To protect American investments, the United States became more involved in Hondurasâ political affairs. When Nicaragua appeared to threaten the stability in Honduras, US President Taft sent forces to Honduras to protect American interests. The Great Depression caused economic havoc in the United States and elsewhere. In Honduras, this meant economic problems and political turmoil. During this time, General Tiburcio CarĂas Andino was elected president, in 1932. He worked to strengthen the military and pay off Honduran debt. Yet he also worked to gather and maintain his own power. He changed the constitution so that he could extend his term in office as president until 1949. His advanced age and pressure from the United States forced him to allow free elections in 1948. General Francisco MorazĂĄn In 1823, Honduras joined the United Provinces of Central America. In 1830, Tegucigalpa-born General JosĂŠ Francisco MorazĂĄn was elected president of the federation. He remained president until just before the federation disbanded in 1840. aalezk/Shutterstock MorazĂĄn favored liberal policies and the reduced power of the church. MorazĂĄn was a self-educated man. He recognized the importance of education and the need for schools in Honduras. He believed that girls and boys should have an equal opportunity for education. During his presidency, he tried to make improvements in education. He opened schools that were free to attend. In addition to improving education, he established a system of trial by jury. It was based on the Livingston Code, created in Louisiana. This was a set of reforms to the system of legal punishment. Today, Honduras celebrates the Day of the Honduran Soldier on October 3, MorazĂĄnâs birthday. This holiday honors MorazĂĄn for his fight for democracy, liberalism, and the nation. Modern Honduras The last half of the 20th century was a political rollercoaster. There were various coups (government takeovers), conflicts, and changing leaders. Starting in 1963, Honduras was primarily led by military governments. This continued for almost 20 years. In 1969, Honduras fought a four-day war with El Salvador. The conflict was over immigration and the shared border. Though the war was brief, the two nations didnât sign a peace treaty until 1980. With the election of president Roberto Suazo CĂłrdova in 1981, Honduras returned to a civilian government. In the 1980s Honduras was tangled in conflicts of Nicaragua and El Salvador, partly because of the United States. Nicaraguan Contras, who wanted to overthrow the Sandinista government in Nicaragua, were using US-approved bases in Honduras. The United States was also running training camps in Honduras for Salvadoran forces facing their own civil war. This sparked anti-American protests and a desire to reduce the US presence in Honduras. Over the next few decades, Honduras continued to experience political instability. In 2009, President Manuel Zelaya was removed from power by a military coup. People were upset because he called for a referendum to change the constitution. The international community condemned this coup. As a result, Honduras cut diplomatic ties with several countries. In 2010, the United States recognized President Porfirio Lobo Sosa as a democratically elected leader. He was followed by Juan Orlando HernĂĄndez in 2014. However, protests in 2015 called for his resignation over claims of campaign fraud. In 2017, Orlando HernĂĄndez was re-elected in a disputed election. [t comes from the GREEK name "Epilepsia" which means "taking hold of or seizing". - It is a disorder characterized by: recurrent seizures. SEIZURES R ectment transient attacks of: R epresent: R esult from: ASSOCIATED WITH: somatic, psychic, or, autonomic clinical featmes. clinical features of abnormally hyperexcitable cortical neurons. paroxvsmal and excessive electrical neuronal discharges. EEG changes & may be disturbance of consciousness. same causes of convulsions 1. Idiopathic epile~ ⢠It is the commonest cause. no cause can be detected ( 65 % ) ⢠It may be associated with positive family history in some cases. ⢠It starts in the l st & 2nd decades in the form of: -- Grand ma! epilepsy. Petit mal epilepsy. Myoclonic epilepsy. Atonic seizures. 2. Secondary epilepsy A. Local causes in the brain: l. Congenital: 2. Traumatic: cerebral palsy. a cause can be detected cerebral contusion or laceration. 3. Inflammatory: 4. Neoplastic: 5. Degenerative: 6. Vascular: encephalitis, brain tumours. mening1t1s, presenile dementia. brain abscess. stroke (especially hemon-hagic), hypertensive encephalopathy. B. General causes with secondary effects on the brain: I. Toxic: 2. Iatrogenic: 3. Metabolic: 4. Endocrinal: 5. Organ failure: 6. Heart disease: 7. Nutritional: - Alcohol, cocaine, lead. - Lidocaine, INH. - j glucose & ! glucose. - Hypoparathyroidism. - Hepatic failme. - Adam's Stoke's attacks. - Pellagra. - Botulism, tetanus. - Ambilhar, Amphetamine, Aminophylline. - j Ca & ! Ca. - Hype1thyroid crisis. - Renal failure. - Fallot's tetralogy. - j Na & ! Na. - Vitamin B6 deficiency. 8. Physical: 9. HYSTERICAL. - High fevers. - Heat stroke. 136 137 CLINICAL PICTURE 1. GENERALISED SEIZURES " Excessive electrical discharges from cortical neurons in BOTH hemispheres simultaneously " I. II. 1. Grand Mal Epile~: 1. Pre-ictal stage "attacks of tonic-clonic convulsions " (aura) It is a warning sign of a coming attack. It may be: ⢠Somatic: ⢠Psychic: ⢠Autonomic: 2. Ictal stage Myoclonus, Hallucinations. Tachycardia, (seizure) Sudden loss of consciousness: Parasthesias. Sweating. for seconds to minutes. -- Tonic phase (few seconds) o The UL & LL: o o o o The HEAD: The JAWS: CYANOSIS: are extended. is retracted to one side & the eye balls rolled up. are firmly clenched, with biting of the TONGUE. due to impaired respiration. There may be incontinence of urine. Clonic phase (few minutes) o The UL & LL: o The HEAD: 3. Post-ictal stage - It may be: ⢠Somatic: ⢠Psychic: ⢠Autonomic: Drug of choice: contract & relax repeatedly & rapidly. jerks forcibly. (sequelae) Todd's paralysis(< 24 hours, due to neuronal exhaustion). Confusion. Vomiting. Carbamazepine (Tegretol) or Phenytoin (Epanutin) Petit Mal Epilepsy: "attacks of loss of consciousness " " Absence " It starts in childhood & improves at puberty & usually disappears at the age of 20. 2. It is NOT PRECEEDED by aura & NOT FOLLOWED by sequelae. 3. It is usually PRECIPITATED by: hyperventilation 4. It is characterized by: or photic stimulation. sudden loss of consciousness of short duration (few seconds). 5. It may be associated with: ⢠High frequency ( 50 attacks / day). ⢠Falling to the ground without warning. ⢠Jerky movements of the head & UL Drug of choice: (myoclonic petit mal). Valproate (Depakine) or Succinimide (Zarontin) 137 138 Ill. M oclonic Seizures: "attacks of involuntary clonic movements " - It is characterized by: sudden, jerky, shock-like INVOLUNTARY muscle contraction. ⢠The jerks are bilateral contractions, mainly of the shoulders and arms. ⢠However, some patients repmtjerking in the lower limbs, trunk, or head. - It may be of 2 types: - Occurs singly ⢠Simple: ⢠As a pait of: I Drug of choice: IV. Atonic seizures: (no loss of consciousness). - Grand mal epilepsy (aura). - Petit mal epilepsy. Valproate (Depakine) or Clonazepam (Rivotril) I - Transient attacks of brief loss of postural tone, often resulting in falls and injuries. 2. PARTIAL SEIZURES "Excessive electrical discharges from cmtical neurons in a ce1tain area in ONE hemisphere" A. Simple seizures: " No disturbance in consciousness " - The CP depends on the site of the hyperexcitable neurones in the cerebral cortex, whether in: "Motor area or Senso,y areas". 1. Motor fits: ⢠Focal fits: ⢠Motor jacksonian fits: 2. General Sensory fits: ⢠Focal fits: ⢠Sensory jacksonian fits: 3. Special Senso1y fits: ⢠Visual hallucinations: ⢠Auditory hallucinations: ⢠Olfactory hallucinations: B. Complex seizures: - SITE: movement of part of a limb or the whole limb. movement of one side of the body (see before). parasthesia of part of a limb or the whole limb. parasthesia of one side of the body (see before). irritation of the visual sensory area. irritation of the auditory sensory area. initation of the uncus. " disturbance in consciousness " The hyperexcitable neurons are in the Temporal lobe "Temporal lobe epilepsy". - DURATION: The seizure lasts few seconds to few minutes. - The seizure starts with A ura, followed by A bsence, Automatism, Amnesia: 1. 2. 3. 4. A ura: A bsence: Automatism: A mnesia: Olfactory hallucinations, Deja-vu phenomenon, Sensation of fear. Absent patient with staring eyes (with no response to conversation). Involuntary Purposeless acts: motor ( eg, lip smacking, chewing) or verbal. No recalling of the seizure. 138 139 3. PARTIAL SEIZURES ~ GENERALISED SEIZURES " Partial seizures may spread to involve the whole brain .- secondarily generalised seizures " . HY-sterical epilepsY ⢠Usually: ⢠The cause: ⢠Incidence: young neurotic Sj2 . psychological & there is no organic lesion. usually occurs in the presence of people. ⢠It is associated with: ⢠EEG: ⢠It is not associated with: normal. ⢠Missed ttt. ⢠Menses. ⢠Alkalosis. anxiety, palpitaion & hyperventilation. tongue biting or incontinence of urine. ⢠Alcohol use & Drug abuse ( e.g. cocaine ). ⢠S timulation by photons & Hyperventilation. ⢠S leep deprivation & Stress & sudden withdrawal of antiepileptic drngs. INVESTIGATIONS 1. EEG: ⢠It is the most specific test for epilepsy because it records the electrical activity of the brain. ⢠It shows specific pattern: 2. LOCAL INVESTIGATIONS: "Epilepsy waves". "CT & MRI of the brain" ⢠To identify or exclude a LOCAL CAUSE of seizures in the brain. 3. GENERAL INVESTIGATIONS: "Laboratory investigations" ⢠To search for a GENERAL CAUSE of seizures, e.g. blood glucose. 139 140 TREATMENT A. General Measures: 1. 2. Moderation of the patient's physical activity. A void the precipitating factors ( Alcohol, hyperventilation, photic stimulation ...... ). 3. A ketogenic diet is encouraged because it will induce acidosis: - Acidosis is beneficial as it raises the threshold of stimulation of the brain cells. B. Specific Treatment: 2. 1. Treatment of the cause in secondary epilepsy. Anti-epileptic drugs: a) Always sta1t with one drug, then add another drug if there is no response. b) Always stop the drugs ONLY if: ⢠The patient stays free of symptoms for at least 2 years. ⢠The patient has a normal EEG. 3. Side effects of Anti-epileptic drugs: I . Skin rash. 2. 3. Bone marrow depression. Ataxia. Drug 1. Barbiturates (Pbenonobarbitone) 2. Hydantoin (Epanutin) 3. Carbamazepine 4. Clonazepam 5. Valproate 6. Succinamide ANTI-EPILEPTIC DRUGS NEW ANTI-EPILEPTIC DRUGS - These drugs are new dtugs that may be used in resistant seizures. 1. Lamotrigine: 200 - 400 mg/ day. 2. Felbamate: 3. Gabapentin: 400- 800 mg/ day. 600 - 1200 mg/ day. \ " General rules for use ": Dose 100-600 mg I day 100-600 mg / day 200-600 mg I day 2-6 mg I day 500-1500 mg I day 500-1000 mg / day Best indicated - Broad spectrum. - Not for petit mal. - Grand mal. - Motor Jacksonian fits. - Grand mal. - Motor Jacksonian fits. - Complex seizures. - Not for petit ma!. - Myoclonic. - Grand mat. - Broad spectrum. - Petit mat. 140 141 STATUS EPILEPTICUS DEFINITION - A medical emergency: 1. Repeated attacks of generalized convulsions, with lack of recove,y of consciousness, 2. Persistent attack of seizure lasting for at least 30 minutes. OR, - If the convulsions are not stopped rapidly, coma deepens & death may occur due to: heart failure or respiratory failure or brain damage or hyperpyrexia. - The most common causes are: sudden withdrawal of anti-epileptic drugs & stroke. TREATMENT A. General Measures: l. Take care of: " ABC " ⢠Place the patient on the ground, to guard against falling from bed. ⢠Mouth gag & 02 inhalation ( endo-tracheal intubation may be needed). ⢠Record the vital signs regularly. 2. Take a sample of: - Venous blood: for the level of: - A.tierial blood: for the level of: 3. a nti-epileptic drugs, a lcohol. pH, p0 2, pC02, HC0 3. Give cerebral dehydrating measures: e.g. Frusemide, cone. Mannitol, Dexamethazone. B. Specific Treatment: - Phenytoin with diazepam (or clonazepam) immediately: 1. Phenytoin: 2. Diazepam: Clonazepam: seizures recur: 15 mg I Kg slow infusion. 5 mg slowly IV, to be repeated after 5 minutes if seizures recur: maximum dose: 20 mg. OR: 2 mg slowly IV, to be repeated after 5 minutes if maximum dose: 6 mg. - If seizures persist after 20 min. of Phenytoin & diazepam: 3. PHENOBARBITONE: - In resistant cases: 200 mg infusion. 4. GENERAL ANAESTHESIA: may be used.Annotation/ A brief explanation, summary, or evaluation of a text or work of literature Theoretical/ Based on theory, principles, or concepts Conviction/ A strong belief or opinion. Tenacious/Determined and persistent. Valiantly/ In a brave and determined manner. Personable/exhibits warmth, charm, and genuine interest in others, creating an inviting and comfortable atmosphere in social or professional settings Sincerity/ being genuine and authentic Eminent/ famous and respected within a particular sphere or profession Discreet/ careful and circumspect in one's speech or actions Diligent / a word that means hardworking and careful. Sundry / a word that means including many things of different kinds. Apparel/ refers to clothing or attire. Pilgrim/ a person who journeys to a sacred place for religious reasons. boorish/rough and bad-mannered embarked/go on board a ship, aircraft, or other vehicle sovereign/a supreme ruler, especially a monarch chivalry/the medieval knightly system with its religious, moral, and social code. Cadet/ One training to be a military officer. Yeoman/ A person who performs menial or low-level work. Saucy/Speaking in a rude or impertinent manner Memory updated Here's a brief description of each category of gastrointestinal (GI) drugs along with their trade and generic names: Electrolyte Modifiers Description: These agents help maintain electrolyte balance in the body. Trade/Generic Names: Calcium Carbonate (Tums, Caltrate) Calcium Gluconate (Kalcinate) Potassium Chloride (Klor-Con, Micro-K) Sodium Bicarbonate (Baking Soda, Alka-Seltzer) Sodium Polystyrene Sulfonate (Kayexalate) Gastric Mucosa Protectors Description: These drugs protect the stomach lining and reduce acid production. Trade/Generic Names: Famotidine (Pepcid) Ranitidine (Zantac) Cimetidine (Tagamet) Nizatidine (Axid) Esomeprazole (Nexium) Omeprazole (Prilosec) Pantoprazole (Protonix) Lansoprazole (Prevacid) Misoprostol (Cytotec) Sucralfate (Carafate) Antidiarrheals Description: These medications help reduce diarrhea. Trade/Generic Names: Bismuth Subsalicylate (Pepto-Bismol) Atropine (Atropen) Hyoscyamine (Levsin) Diphenoxylate/Atropine (Lomotil) Loperamide (Imodium) Codeine (Various) Irritable Bowel Syndrome (IBS) Treatments Description: Medications specifically aimed at treating symptoms of IBS. Trade/Generic Names: Alosetron (Lotronex) Laxatives/Bowel Preps/Antiflatulents Description: These drugs aid in relieving constipation, preparing the bowel for procedures, or reducing gas. Trade/Generic Names: Psyllium (Metamucil) Methylcellulose (Citrucel) Polyethylene Glycol/Electrolyte (MiraLAX, GoLYTELY) Simethicone (Gas-X) Sennoside (Senokot) Bisacodyl (Dulcolax) Lactulose (Enulose) Docusate Calcium/Docusate Sodium (Surfak/Colace) Magnesium Oxide/Magnesium Sulfate/Magnesium Hydroxide (Mag-Ox/Epsom Salt/Milk of Magnesia) Antiemetics Description: Medications used to prevent or treat nausea and vomiting. Trade/Generic Names: Scopolamine (Transderm Scop) Meclizine (Antivert) Prochlorperazine (Compazine) Metoclopramide (Reglan) Ondansetron (Zofran) Appetite Stimulants Description: These drugs are used to stimulate appetite, often in conditions like cancer or AIDS. Trade/Generic Names: Dronabinol (Marinol) Nabilone (Cesamet)