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35 Cards in this Set

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

Metabolic encephalopathy

What are these all signs and symptoms of?

What are these all signs and symptoms of?

Metabolic encephalopthy

How is pupil light reactivity, ocular motility, and motor activity affected?

What are these all causes of?

What are these all causes of?

Chemical encephalopathy

What are these all causes of?

What are these all causes of?

Non-chemical encephalopathy

Which type of encephalopathy more commonly leads to permanent brain injury? Which are more likely to be completely reversible?

Trauma


Chemical

What water soluble vitamin deficiencies may cause metabolic encephalopathy?

What is the triad of Wernicke disease?



What is the component of Korsakoff syndrome?



What is the vitamin deficiency? Cause?



Treatment? What labs?

Ophthalmoparesis, gait ataxia, and a confused state



Amnesia



B1 => alcoholism



Give thiamine BEFORE glucose for proper glucose metabolism



Labs = transketolase decrease

What areas are damaged with Werkicke/Korsakoff encephalopathy?

Mamillary body atrophy

Mamillary body atrophy


What is the difference between wet and dry beriberi? What is the vitamin deficiency?



What are the components of niacin deficiency? (3Ds)



What does B6 deficiency cause in adults? In children?

What are some causes of B12 deficiency? (think about what is required to absorb B12).



What are these all components of?

What are these all components of?

B12 deficiency

What will laboratory evaluation of blood smear reveal in patient with B12 deficiency?

Macrocytic anemia


Hypersegmentation of neutrophils


B12 level low



If borderline low, check methylmalonic acid and homocysteine levels.

What are these all components of?

What are these all components of?

B12 deficiency



Top = subacute degeneration of spinal cord (lateral and posterior spinal lesions)


Right = demyelination from B12 deficiency


Bottom = lemon yellow complexion with paleness from anemia, and atrophy of papillae of tongue

Draw the pathway of B12 metabolism.



What is folate deficiency associated with?

What are all of these? 
 
These are more common when associated with what?

What are all of these?



These are more common when associated with what?

Deficiency (toxic) ambylopia: B complex deficiencies



Alcohol and tobacco abuse

Pupillary abnormalities with preserved accommodation reflex and absent light reflex is suggestive of what?

Argyll Robertson pupil

What are all of these associated with?

Hypoglycemia => INCREASED sympathetic response

What are all of these associated with?

What are all of these associated with?

Hyperglycemia

What are some symptoms of the nervous system associated with diabetes?



What do both hyperglycemia and hypoglycemia cause?

Encephalopathies

Encephalopathies

Identify each:


1. Symmetric, painful, more often seen in lower than in upper limbs initially, disturbs night sleep.


2. Results in neurogenic atonic bladder


3. Infarction of the nerve with vascular insufficiency and causes diplopia, pain, ocular muscle weakness (6th or 3rd cranial nerve)


4. Caused from simultaneous infarction and ischemic of different peripheral nerves.


5. From involvement of nerve roots with proximal weakness seen in lower limbs.

1. Diabetic (sensory) neuropathy


2. Autonomic neuropathy.


3. Diabetic ophthalmoplegia


4. Mononeuritis multiplex


5. Diabetic amyotrophy

What are these all causes of?

What are these all causes of?

Hypoxia

What are the three components of posthypoxic syndrome?

What parts of the brain are most affected by hypoxic encephalopathy?



What are some of the clinical features?

Hippocampus


Watershed areas between vascular territories of major arteries


Deep folia of cerebellum



Stupor or coma, seizures, myoclonus


Amnesia if patient recovers due to hippocampal damage



What is cerebral hypoxia most commonly caused by?

Cardiac arrest

What does chronic bronchitis result in?

Chronic hypoxia and hypercarbia

What are these all causes of? 
 
What are some resulting symptoms?

What are these all causes of?



What are some resulting symptoms?

Confusion, seizures, slow EEG with triphasic waves, peripheral asterixis, and myoclonus



Polyneuropathy seen in hepatic disease is often associated with what?



Are reflexes brisk with hepatic failure? Uremic encephalopathy?

Alcoholic liver failure


No


Yes

What are some complications of ureic encephalopathy?

Proximal muscle weakness associated with low calcium levels seen with chronic renal disease

Proximal muscle weakness associated with low calcium levels seen with chronic renal disease

These are all causes of what?

These are all causes of what?

Metabolic encephalopathy

What can call of these disorders cause?

What can call of these disorders cause?

Metabolic encephalopathy

What can all of these cause? 
 
Should you correct hyponatremia slowly or quickly? What could if cause if not corrected properly?

What can all of these cause?



Should you correct hyponatremia slowly or quickly? What could if cause if not corrected properly?

Metabolic encephalopathy



SLOWLY (8mEq/day)


Faster => central pontine myelinolysis => severe brainstem injury

What can all of these cause?

What can all of these cause?

Metabolic encephalopathy