דליריום חדש Flashcards

Question

B12 clinical findings

Answer 1

Distal paresthesias, gait ataxia, a bandlike sensation of tightness around the trunk or limbs, and Lhermitte sign (an electric shock–like sensation along the spine precipitated by neck flexion) low-grade fever, glossitis, lemon-yellow discoloration of the skin, and cutaneous hyperpigmentation. Associated peripheral nerve involvement may cause loss of tendon reflexes in the legs and urinary retention.

Answer 2

macrocytic anemia leukopenia hypersegmented neutrophils thrombocytopenia

Answer 3

determines whether defective intestinal absorption of vitamin B 12 (as in pernicious anemia) is the cause of B12 deficiency

Answer 4

complication of cirrhosis, portosystemic shunting, chronic active hepatitis, hepatic necrosis after viral hepatitis. ammonia and other toxins diffuse into the brain Symptoms - nausea, anorexia, and weight loss. GI bleeding, agitation, and coma. asterixis - a flapping tremor of the outstretched, dorsiflexed hands or feet LAB - elevated bilirubin, transaminsae, PT, PTT, respiratory alkalosis CSF - elevated glutamine - most specific!!!

Answer 5

``` underlying cause vitamin E FFP rifaxamin - antibiotic that reduces ammonia-forming bacteria in the colon lactulose ```

Answer 6

may produce encephalopathy hyperventilation motor manifestations. seizures and focal neurologic signs are common, Laboratory - elevated urea, creatinine, and potassium, and metabolic acidosis, EEG - diffusely slow and may show triphasic waves or paroxysmal spikes or sharp waves. management - treat the cause. hydration, protein and salt restriction, and treatment of complications such as seizures. Dialysis itself can produce an encephalopathy

Answer 7

immune-mediated demyelinating disorder 1 month after a bacterial or viral infection or vaccination. Clinical features include confusion or coma and focal neurologic deficits 1. acute disseminated encephalomyelitis - MRI -multifocal demyelinating lesions CSF may show lymphocytic, polymorphonuclear pleocytosis. 2. Bickerstaff brainstem encephalitis similar but affects the brainstem and cerebellum 3. acute hemorrhagic leukoencephalitis (high mortality!), MRI -bihemispheric demyelinating lesions associated with hemorrhage and edema, CSF - may contain red blood cells. Treatment - methylprednisolone 3 to 5 days, followed by prednisone 4 to 6 weeks.

Answer 8

``` impaired cerebral blood flow, BBB disruption cerebral edema. Gram-negative CSF examination - exclude meningitis. EEG abnormal. supportive treatment Mortality is high, but can be reduced by prompt diagnosis and treatment. ```

Answer 9

A sudden increase in blood pressure, develop hours to days. risk - acute glomerulonephritis or eclampsia. Vomiting, visual disturbances, focal neurologic deficits, and focal or generalized seizures can occur. BP - 250/150 papilledema, retinal hemorrhages, Stroke and subarachnoid hemorrhage risk diagnosis resolution after lowering blood pressure

Answer 10

autoimmune young women skin rash, arthritis, serositis, nephritis, anemia, leukopenia, and thrombocytopenia. neurologic involvement in 37% to 75% most common autoimmune cause of encephalopathy. Laboratory - antinuclear antibodies, anti-native DNA antibodies, anti-Sm antibodies, and false-positive serologic test for syphilis. Cerebral lupus is treated with corticosteroids, Seizures are treated with anticonvulsants. Neurologic symptoms improve in 80% may also resolve without treatment.

Answer 11

brain swelling Causes - hypothyroidism, adrenal insufficiency, drugs (eg, thiazide diuretics, nonsteriodal anti-inflammatory drugs, ecstasy), SIADH. symptoms - headache, lethargy, confusion, weakness, muscle cramps, nausea, and vomiting. Neurologic signs - confusional state or coma, papilledema, tremor, asterixis, rigidity, extensor plantar responses, focal or generalized seizures, and occasionally focal neurologic deficits. Neurologic complications - Na less than 120 Treatment - underlying cause Immediate management - water restriction, hypertonic saline with or without intravenous furosemide.

Answer 12

classic clinical syndrome is a seborrhoeic dermatitis-like eruption, atrophic glossitis with ulceration, angular cheilitis, conjunctivitis, intertrigo, and neurologic symptoms of somnolence, confusion, and neuropathy

Answer 13

ערנות, גירוי, אוריאנטציה, התמצאות, קשב

Answer 14

central pontine myelinolysis (osmotic demyelination syndrome ), confusional state, paraparesis or quad-riparesis, dysarthria, dysphagia, hyper- or hyporeflexia, and extensor plantar responses. Severe cases - locked-in syndrome and coma MRI may show pontine and extrapontine white matter lesions. no treatment for central pontine myelinolysis, so prevention is essential rasie serumn NA at rate not exceeding 8 mmol/L/d.

Answer 15

Vessels: Ascending - rolandi - broca, precentral, postcentral Descending - parietal, temporal, optic radiation, visual cortex, WERNIKE Leticulostriate - basal nucli

Answer 16

Rolandi, ascending- hemiparesis contra lateral without leg!!! Hemihipoesthesis contra lateral Motor aphasia (broca) Descending- contralateral hemonymus hemianopsia (temporal) Wernike - sensory aphasia Parietal - neglect (non dominant lobe), agraphia... Lenticulostriate - total hemianopsia Aphasia Hemihipoesthesis

Answer 17

Blood supply to frontal lobe and precentral gyrous of leg Contralateral monoparesis of leg Urine incontinance Cognition - disinhibition, apathy (upper part) Behave ( lower part)

Answer 18

גלוטמין נמוך - CSF