الفهرس 
Anatomy and Physiology of Cereberal circulation
Clinical Manifestations and Diagnosis of EpilepsyOnly 14 pages are availabe for public view
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Abstract
The brain blood supply consists of right and left internal arteries and right and left vertebral
arteries.the venous drainage is via superior sagittal sinuses to sigmoid sinuses then to jugular
vein.
The three regulatory mechanisms involved in regulation of cerebral circulation are cerebral
autoregulation, flow metabolism coupling and neurogenic regulation.
Pathophysiology of epilepsy can be explained by ictogenesis caused by hyperexcitation of neurons,
neuronal networks or neuronal environment, then epileptogenesis by synaptic and nonsynaptic
mechanisms.
Types of epilepsy are partial, generalized and unclassified seizures .key role in epilepsy
diagnosis is detailed medical history then medical examination, C.T brain and electro-
encephalogram .
Anesthetic management of epileptic patient undergoing an operation includes preoperative assessment
by laboratory tests to detect antiepileptic drugs side effects and measurement of plasma level of
antiepileptic druds to be optimizd, patient with cardiac diseases should have
echocardiograph.Antiepileptic drugs should be continued up to time of surgery.
Intraoperative monitoring by electrocardiograph ,non invasive blood pressure measurement, pulse
oximetery, end tidal carbon dioxide, temperature and urine output.
Induction of anesthesia is by sevoflurane and nitrous oxide (in children) or if established
intravenous access induction os by propofol (3-5mg\kg) or thiopental (5-8mg\kg).
Neuromuscular blockade is recommended to be monitored
by prefphiral nerve stimulator as antiepileptic drugs are enzyme inducers.
Maintenance of anesthesia is by volatile agents with or without nitrous oxide and opioids. Total
intravenous anesthesia (TIVA) is less frequently used .
Anesthetic agents with epileptogenic potential (ketamine and alfentanil) or wilth epileptogenic
metabolites (meperidine) should be avoided.
Regional anesthesia is safe as long as epilepsy is controlled and factors known to
cause seizures are avoided.
Postoperative restart of antiepileptic drug as soon as possible is mandatory, plasma level of
antiepileptic drug must be checked. Pain control with opiates as mainstay or
intravenous patient control analgesia or nonsteroidal anti inflamatory drugs.