26 Metabolic Encephalopathies Flashcards
Define encephalopathy
subacute onset of confused state marked by fluctuating consciousness that gets worse without treatment
Which category of encephalopathy is more likely to result in permanent brain damage: chemical or non-chemical?
non-chemical, such as trauma, infection, vascular, or seizures, are more likely to cause permanent damage. Chemical can be reversed if caught early enough.
What fat soluble vitamins can cause encephalopathy?
none. Only water soluble B1, Niacine/nicotinic, and B12 deficiencies can cause encephalopathies.
Lipid soluble ones can cause other neuro issues, but not enceph
What is Wernicke Korsakoff syndrome?
B1 (thiamine) deficiency. Atrophy of dorsomedial thalamus, mammilary bodies, and and periaqueductal gray.
Presents with opthalmoparesis, gait ataxia and confused state. Usually in alcoholics, sometimes nutritional deficiencies. Can be followd by Korsakoff syndrome which is amnesia of recent memories. Also may have peripheral neuropathy.
Is reversible if treated promptly
What is treatment of wernicke korsakoff?
give thiamine BEFORE glucose. Metabo of glucose requires thiamine and lguocse loads during a deficiency cause permanent brain damage in dorsomedial thalamus, mamillary bodies and periaqueductal gray area.
What diseases can B1 deficiency cause?
wernicke, wet or dry beriberi.
What is wet beriberi? Dry?
wet = high output cardiac failure dry = polyneuropathy starting in lower limbs, paresthesia, loss of ankle/knee reflexes and axonal degeneration
What does niacin deficiency cause?
pellagra
What is pellagra?
niacin deficiency that cuaes dementia and polyneuropathy. Diffuse involvment of CNS and PNS
What does B6 Pyridoxine deficiency cause?
polyneuropathy in adults and seizures in infats
What does B12 deficiency cause?
cognitive defects, spinal cord syndrome, subacute degeneration and lesions of dorsal columns and lateral corticospinal tracts, peripheral neuropathy, optic nerve damge and macrocytic anemia with hypersegmented neutrophils. Atrophy of tongue papillae
What other lab values will be affected in B12 deficiency?
methylmalonic acid and homocysteine levels will both be high
What will blood smear reveal in B12 deficiency?
macrocytic anemia with hypersegmented neutrophils
Most common cause of B12 deficiency?
pernicous anemia from intrinsic factor problems.
methylmalonic acid is normal but homocysteine is high, what should your differential be?
folate deficiency over B12 because B12 deficiency should increase homocysteine as well
