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14 Cards in this Set

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  • Back
Key History -
Hx from family members/caregivers

time course of cognitive deficits

associated Sxs -
constitutional
incontinence
ataxia
hypothyroid Sxs
depression

screen for delirium -
waxing/waning level of alertness

ADL/IADL staus
falls
meds & recent med changes
h/o stroke
atherosclerotic vascular dis.
syphilis
HIV risk factors
alcohol use
vitamn B12 deficiency
family h/o Alzheimer's
Key PE -
VS
complete neuro exam -
include mini-mental & gait
ENT
heart
lungs
abdomen
extremities
81 y/o M
presents with progressive confusion over the past several years together with forgetfulness and clumsiness.
He has a h/o HTN, DM and 2 strokes with residual left hemiparesis.
Mental status has clearly worsened after each stroke.

What is Differential?
Vascular ("multi-infarct") dementia
alzheimer's
normal pressure hydrocephalus
chronic subdural hematoma
intracranial tumor
depression
B12 deficiency
neurosyphilis
hypothyroidism
81 y/o M
presents with progressive confusion over the past several years together with forgetfulness and clumsiness.
He has a h/o HTN, DM and 2 strokes with residual left hemiparesis.
Mental status has clearly worsened after each stroke.

What is Workup?
CBC
RPR/VDRL
serum B12
TSH
MRI - brain
CT - head
LP - CSF analysis
84 y/o F
brought by her son c/o forgetfulness (e.g., forgets phone nos., loses her way back home) along with difficulty performing some of her daily activities (e.g., bathing, dressing, managing money, using the phone).
The problem has gradually progressed over the past few years.

What is Differential?
Alzheimer's
vascular dementia
depression
hypothyroidism
chronic subdural hematoma
normal pressure hydrocephalus
intracranial tumor
B12 deficiency
neurosyphilis
84 y/o F
brought by her son c/o forgetfulness (e.g., forgets phone nos., loses her way back home) along with difficulty performing some of her daily activities (e.g., bathing, dressing, managing money, using the phone).
The problem has gradually progressed over the past few years.

What is Workup?
CBC
RPR/VDRL
serum B12
TSH
MRI - brain
CT - head
LP - CSF analysis
72 y/o M
presents with memory loss, gait disturbance and urinary incontinence for the past six months.

What is Differential?
Normal pressure hydrocephalus
alzheimer's
vascular dementia
chronic subdural hematoma
intracranial tumor
depression
B12 deficiency
neurosyphilis
hypothyroidism
72 y/o M
presents with memory loss, gait disturbance and urinary incontinence for the past six months.

What is Workup?
CT - head
LP - opening pressure and
CSF analysis
serum B12
RPR/VDRL
TSH
55 y/o M
presents with a rapidly progressive change in mental status, inability to concentrate and memory impairment for the past 2 mos.
His Sxs are associated with myoclonus and ataxia.

What is Differential?
Creutzfeldt-Jakob disease
vascular dementia
lewy body dementia
wernicke's encephalopathy
normal pressure hydrocephalus
chronic subdural hematoma
intracranial tumor
depression
delirium
B12 deficiency
neurosyphilis
55 y/o M
presents with a rapidly progressive change in mental status, inability to concentrate and memory impairment for the past 2 mos.
His Sxs are associated with myoclonus and ataxia.

What is Workup?
CBC, electrolytes, calcium
serum B12
RPR/VDRL
MRI - brain (preferred)
CT - head
EEG
LP - CSF analysis
brain Bx
70 y/o IDDM M
presents with episodes of confusion, dizziness, palpitation, diaphoresis and weakness.

What is Differential?
Hypoglycemia
TIA
arrhythmia
delirium
angina
70 y/o IDDM M
presents with episodes of confusion, dizziness, palpitation, diaphoresis and weakness.

What is Workup?
Glucose
CBC, electrolytes
echocardiography
ECG
MRI - brain
doppler US - carotid
55 y/o F
presents with gradual altered mental status and headache.
Two weeks ago, she slipped, hit her head on the ground and lost consciousness for two minutes.

What is Differential?
Subdural hematoma
SIADH (causing hyponatremia)
creutzfeldt-jakob
intracranial tumor
55 y/o F
presents with gradual altered mental status and headache.
Two weeks ago, she slipped, hit her head on the ground and lost consciousness for two minutes.

What is Workup?
Electrolytes
CT - head
MRI - brain
LP