Systemic and Metabolic Disorders Flashcards Preview

Neurology > Systemic and Metabolic Disorders > Flashcards

Flashcards in Systemic and Metabolic Disorders Deck (21):

What will an EEG typically show with a toxic-metabolic encephalopathy?

slowing of the background rhythm


What is the cardinal clinical feature of encephalopathy?

waxing and waning level of consciousness


What is a frequent physical exam finding in encephalopathy?

asterixis, which is an example of negative myoclonus


Sarcoidosis only affects the CNS in about 5% of cases. What is the most common presentation?

cranial neuropathy due to chronic basal meningitis with the facial and optic nerves most frequently affected

Facial neuropathy may occur due to parotid inflammation

visual changes are common due to direct involvement of the optic nerves


What is the typical pathology of sarcoidosis?

noncaseating granuloma


We usually don't like to do brain biopsies to confirm neurosarcoid, but what will CSF analysis show?

elevated protein and lymphocytic pleocytosis

(CSF ACE concentration is difficult to interpret, but serum ACE concentration will be high)


What is the most common neurological complication of diabetes?

peripheral neuropathy


Describe the typical presentation of peripheral neuropathy

distal symmetric sensory polyneuropathy affecting temperature and pinprick sensation first (2/2 predilection for small myelinated and unmyelinated fibers)


An associated autonomic neuropathy is common. What are some of the symptoms?

gustatory sweating, orthostatic hypotension, diarrhea and impotence

neurogenic bladder and gastroparesis occur less frequently


What are some acute neurological effects of hyperglycemia?

transient painful peripheral neuropathy that resolves with correction of the hyperglycemia


What is the clinical triad seen in Wernicke's encephalopathy?

truncal ataxia


Gait ataxia greater than limb ataxia and dysarthria in a long-time alcoholic usually is caused by what?

cerebellar degeneration


Describe the vision change that occurs with tobacco-alcohol amblyopia?

an insidious and painless loss of vision in a centrocecal scotoma pattern


Alcohol can cause a focal demyelination and necrosis of the corpus callosum leading to frontal-type dementia, seizures and pyramidal signs. What is this syndrome called?

Marchiafava-Bignami syndrome


Subacute combined degeneration of the spinal cord results from deficiency of what?

Vitamin B12


What happens in subacute combined degeneration of the spinal cord?

degeneration of the posterior and lateral white matter tracts of the spinal cord, so you get paresthesias in the hands and feet with eventual weakness and spasticity in the legs

often associated with a large-fiber peripehral neuropathy and macrocytic anemia


What lab tests should you do to check for B12 deficiency?

B12 levels may be normal, so you need to measure levels of serum homocysteine and methylmalonic acid (which are the precursors of B12 and will thus be elevated when B12 is deficiency as the body tries to compensate)


What are some of the CNS manifestations of SLE?

psychosis and depression are the most common

also seizures, stroke (bc of being hypercoagulable), transverse myelitis, headache and chorea


What is the most common PNS manifestation of SLE?

distal sensory polyneuropathy


What are the major features of antiphospholipid syndrome?

venous and arterial thrombosis (more often venous)
recurrent fetal loss


What is the management for antiphospholipid syndrome?

long-term warfarin to INR of 3-4