Delirium/LOC - Neuro Flashcards
1
Q
Delirium
A
- Usually acute event hours to days
- Often reversible, metabolic state
- May be rapidly changing-LOC, Orientation, Hallucinations
- History and signs of medical condition
- Infection-fever, neurologic infection-(herpes simplex most common cause for delirium in encephalitis)
- Metabolic condition-Nutritional state
- Wernickes encephalopathy-acute Thiamine def-triad=ocular abn, gait ataxia,mental status changes
- Drug toxicity-prescription or other
- Withdrawal of drug or toxin-alcohol, barbs, opiates
2
Q
Evaluation for Delirium
A
- H+P (history from someone who knows the patient)
- Labs-CBC, Metabolic Panel, UA/UC, Blood Glucose
- Other tests-as the history or exam indicates
3
Q
Head Trauma
A
- Mimic dementia/delirium
- May predispose to dementia
- Acute change in LOC-concussion
- Delayed change in LOC-subarachnoid bleeding
- Permanent change in functioning-traumatic brain injury
- Body trauma with LOC-shock-blood or fluid loss also possible
4
Q
Dementia
A
- Insidious onset
- Slow progression
- Social withdrawal
- Paranoia
- Anxiety
- Loss of short term memory
- Hallucinations
- Alzheimer’s
- Vascular
- Lewy Body
- Frontal Temporal Lobe
5
Q
ETIOLOGIES of dementia
A
D-Depression E-Ethanol, withdrawal, nutritional M-Medications E-Electrolytes, labs, ammonia N-Nutrition T-Trauma, Tumors, Ticks I-Infection-urine, lungs, neuro A-Alzheimer’s, age
6
Q
Alzheimer’s Dementia
A
- Insidious onset-cause unknown
- Slow progression
- Social withdrawal
- Paranoia
- Anxiety
- CT/MRI=shrinking of hippocampus, medial temporal lobe, posterior cortical atrophy
- EEG-slowing of background rhythm
7
Q
Vascular Dementia
A
- step wise also slow changes
- multiple infarcts often leading to cog decline
- other stroke sx noted-incontinent, hemiparesis, other cardiovascular sx
- CT/MRI-ischemic infarcts, hippocampal volume loss
8
Q
Lewy Body Dementia
A
- Fluctuating cognitive performance
- Well formed visual hallucinations
- Often sx of Parkinson’s emerging along with cognitive loss
- CT/MRI-Hippocampal volume loss
- EEG-slowing of background rhythm
- R/o sleep apnea
9
Q
Frontal Temporal Lobe Dementia
A
- Disinhibition
- Impulsiveness
- Social inappropriateness
- Apathy
- Withdrawal
- MRI/CT scan -frontal and temporal lobe atrophy
10
Q
Depression Quick test
A
Sig Energy Caps S=sleep I=interests G=guilt Energy-changes C=concentration A=appetite P=Psychomotor S=suicidal thoughts or ideation.
11
Q
Decorticate Posturing
A
- Upper extremities flexed toward the heart,
- Lower extremities extended and rotated inward-if progressing to Decerebrate then brainstem herniation likely.
- Head may be hyperextended as well as back =opisthotonus.
- may be damage to areas including the cerebral hemispheres, the internal capsule, and the thalamus It may also indicate damage to the midbrain
12
Q
Decerebrate
A
- a posture with lesions of the upper part of the brainstem or severe bilateral lesions of the cerebrum
- arms extended with wrists rotated and fingers out
- legs extended with feet internally rotated
13
Q
Nystagmus
A
rhythmic oscillation of the eyes-horizontal, vertical, rotary, right or left lateral gaze
14
Q
Fasciculations
A
visible twitching of muscle bundles(with atrophy=>lower motor neuron disease)
15
Q
Tremors
A
at rest(pill rolling/Parkinsons), postural(in sustained position/hyperthyroid or anxiety) or intention(active movement/cerbellar ataxia)
