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Clinical Neuroscience weeks 1-3 > MetabEnceph > Flashcards

Flashcards in MetabEnceph Deck (37):
1

Definition of a metabolic encephalopathy

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

2

Pathophysiology of metabolic encephalopathy

diverese mechanisms lead to diffuse involvement of all brain structures

3

Signs and symptoms

- 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)

4

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

non- chemical: trauma, infxn, vascular, seizures

5

vitamins that lead to metabolic encephalopathy

B1
Niacin
B12

6

Wernicke Korsakoff syndrome often seen in what population

Alcoholics

7

Weinicke's triad

1) Opthalmoparesis
2) Gait Ataxia
3) Confused State

8

What is the Korsakoff part of Weirnicke Korsakoff?

Korsakoff syndrome is generally defined by amnesia

9

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

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

10

Tx of Wiernickes

Thiamine (IV) and then glucose

REMEMBER THIAMINE BEFORE GLUCOSE

11

Wiernicke Korsakoff is a deficiency of what?

B1

12

What are some other B1 deficiency syndromes

Wet Beriberi- high output CV failure
Dry Beriberi- polyneuropathy

13

Niacin deficiency causes

dementia and polyneuropathy.....rare

14

B6 deficiency

polyneuropathy in adults and seizures in kids

15

Vit B12 deficiency causes

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

16

Neurologic signs and symptoms of B12 deficiency

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

17

Pathology of B12

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

18

Lab for B12

look or macrocytic anemia

19

Treat B12 deficiency how

cyanocabalamin weekly, treat underlying etiology

20

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

homocysteine and methylmalonic acid

21

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

methylmalonic acid low

22

Vitamin B complex deficiencies cause

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

23

Hypoglycemia and Hyperglycemia can both cause encephalopathies

ok

24

Hypoglycemic encephalopathy shows what

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

25

Hyperglycemic encephalopathy

small pupils, no seizures, non-brisk reflexes,

26

Diabetic sensory neuropathy is often symmetrical

true

27

sensory neuropathy seen in upper or lower limbs

lower,,,,disturbs night sleep

28

Autonomic neuropathy in diabetics results in

atonic bladder

29

Hypoxic encephalopathy affects what parts of the brain

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

30

Clinical features of hypoxic encephalopathy

coma, seizures, myoclnus,

31

Cerebral hypoxia most commony caused by

cardiac arrest

32

CO poisoning will appear as

Cherry red skin with cyanotic hue

33

tx of CO poisoning

hyperbaric O2

34

"awake but unaware"

status of ppl recovering from hypoxia

35

Hepatic encephalopathy

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

36

Electrolytes that may cause encephalopathy

low sodium, calcium, magnesium or phosphate

37

Hyponatremia must be corrected....

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