MetabEnceph

Question 1

Definition of a metabolic encephalopathy

Answer 1

subacute onset of a confusional state marked by fluctuating alterations of consciousness that progressively worsens if untreated

Question 2

Pathophysiology of metabolic encephalopathy

Answer 2

diverese mechanisms lead to diffuse involvement of all brain structures

Question 3

Signs and symptoms

Answer 3

• Altered mental status
• Seizures
• Altered respiration
• Altered pupil light reactivity- usually symmetric and sluggishly reactive, asymmetric or nonreactive pupils
  Altered ocular motility- may be roving, dysconjugate, absent
  Altered motor activity- diffuse alteration of strength, tone and reflexes. Tremor, asterixis (flapping of hands), multifocal myoclonus (rapid jerking of a limb)

Question 4

Non-chemical or chemical more commonly lead to permanent brain injury

Answer 4

non- chemical: trauma, infxn, vascular, seizures

Question 5

vitamins that lead to metabolic encephalopathy

Answer 5

B1
Niacin
B12

Question 6

Wernicke Korsakoff syndrome often seen in what population

Answer 6

Alcoholics

Question 7

Weinicke’s triad

Answer 7

1) Opthalmoparesis
2) Gait Ataxia
3) Confused State

Question 8

What is the Korsakoff part of Weirnicke Korsakoff?

Answer 8

Korsakoff syndrome is generally defined by amnesia

Question 9

Inappropriate treatment or repeated episodes leads to petechial hemorhage and atrophy to which brain areas

Answer 9

• Dorsomedial Thalamus atrophy and hemorrhage
• Mamillary body atrophy and hemorrhage
• Periaqueductal gray atrophy and hemorrhage

Question 10

Tx of Wiernickes

Answer 10

Thiamine (IV) and then glucose

REMEMBER THIAMINE BEFORE GLUCOSE

Question 11

Wiernicke Korsakoff is a deficiency of what?

Answer 11

B1

Question 12

What are some other B1 deficiency syndromes

Answer 12

Wet Beriberi- high output CV failure

Dry Beriberi- polyneuropathy

Question 13

Niacin deficiency causes

Answer 13

dementia and polyneuropathy…..rare

Question 14

B6 deficiency

Answer 14

polyneuropathy in adults and seizures in kids

Question 15

Vit B12 deficiency causes

Answer 15

pernicious anemia, fish tapeworm, gastric cancer, vegetarian diet, N20 abuse

Question 16

Neurologic signs and symptoms of B12 deficiency

Answer 16

decreased vibration or position sense
distal paresthesis
weakness
spastic gait
visual impairment
confusion, dementia, depression

Question 17

Pathology of B12

Answer 17

demyelination of the dorsal columns, corticospinal tract, cerebral white matter, optic and peripheral nerves

Question 18

Lab for B12

Answer 18

look or macrocytic anemia

Question 19

Treat B12 deficiency how

Answer 19

cyanocabalamin weekly, treat underlying etiology

Question 20

In B12 deficiency levels of what rise and are useful as tests to confirm thediagnosis

Answer 20

homocysteine and methylmalonic acid

Question 21

In folate deficiency homocysteine will be normal but methylmalonic acid will be low

Answer 21

methylmalonic acid low

Question 22

Vitamin B complex deficiencies cause

Answer 22

optic nerve disease:
- decreased visual acuity and central scotoma (blind spots). SOmetimes the central scotoma merges with physiological blind spot to causecentrocecal scotoma. More common when assoc with alc abuse

Question 23

Hypoglycemia and Hyperglycemia can both cause encephalopathies

Answer 23

ok

Question 24

Hypoglycemic encephalopathy shows what

Answer 24

confusion, seizures, dilated pupils, brisk reflexes, extensor plantar responses

Question 25

Hyperglycemic encephalopathy

Answer 25

small pupils, no seizures, non-brisk reflexes,

Question 26

Diabetic sensory neuropathy is often symmetrical

Answer 26

true

Question 27

sensory neuropathy seen in upper or lower limbs

Answer 27

lower,,,,disturbs night sleep

Question 28

Autonomic neuropathy in diabetics results in

Answer 28

atonic bladder

Question 29

Hypoxic encephalopathy affects what parts of the brain

Answer 29

hippocampus, areas between vascular territories of major arteries, deep folia of cerebellum

Question 30

Clinical features of hypoxic encephalopathy

Answer 30

coma, seizures, myoclnus,

Question 31

Cerebral hypoxia most commony caused by

Answer 31

cardiac arrest

Question 32

CO poisoning will appear as

Answer 32

Cherry red skin with cyanotic hue

Question 33

tx of CO poisoning

Answer 33

hyperbaric O2

Question 34

“awake but unaware”

Answer 34

status of ppl recovering from hypoxia

Question 35

Hepatic encephalopathy

Answer 35

confusion, seizures, slow EEG with triphasic waves, asterixis, myoclonus, BRISK REFLEXES

Question 36

Electrolytes that may cause encephalopathy

Answer 36

low sodium, calcium, magnesium or phosphate

Question 37

Hyponatremia must be corrected….

Answer 37

SLOWLY- 8mEq per 24 hours otherwise you can get central pontine myelinolysis resulting in severe brainstem injury with impaired cognition or coma