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Neuro > Delirium/LOC - Neuro > Flashcards

Delirium/LOC - Neuro Flashcards

1
Q

Delirium

A
  • Usually acute event hours to days
  • Often reversible, metabolic state
  • May be rapidly changing-LOC, Orientation, Hallucinations
  • History and signs of medical condition
  • Infection-fever, neurologic infection-(herpes simplex most common cause for delirium in encephalitis)
  • Metabolic condition-Nutritional state
  • Wernickes encephalopathy-acute Thiamine def-triad=ocular abn, gait ataxia,mental status changes
  • Drug toxicity-prescription or other
  • Withdrawal of drug or toxin-alcohol, barbs, opiates
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2
Q

Evaluation for Delirium

A
  • H+P (history from someone who knows the patient)
  • Labs-CBC, Metabolic Panel, UA/UC, Blood Glucose
  • Other tests-as the history or exam indicates
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3
Q

Head Trauma

A
  • Mimic dementia/delirium
  • May predispose to dementia
  • Acute change in LOC-concussion
  • Delayed change in LOC-subarachnoid bleeding
  • Permanent change in functioning-traumatic brain injury
  • Body trauma with LOC-shock-blood or fluid loss also possible
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4
Q

Dementia

A
  • Insidious onset
  • Slow progression
  • Social withdrawal
  • Paranoia
  • Anxiety
  • Loss of short term memory
  • Hallucinations
  • Alzheimer’s
  • Vascular
  • Lewy Body
  • Frontal Temporal Lobe
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5
Q

ETIOLOGIES of dementia

A 
D-Depression
E-Ethanol, withdrawal, nutritional
M-Medications
E-Electrolytes, labs, ammonia
N-Nutrition
T-Trauma, Tumors, Ticks
I-Infection-urine, lungs, neuro
A-Alzheimer’s, age
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6
Q

Alzheimer’s Dementia

A
  • Insidious onset-cause unknown
  • Slow progression
  • Social withdrawal
  • Paranoia
  • Anxiety
  • CT/MRI=shrinking of hippocampus, medial temporal lobe, posterior cortical atrophy
  • EEG-slowing of background rhythm
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7
Q

Vascular Dementia

A
  • step wise also slow changes
  • multiple infarcts often leading to cog decline
  • other stroke sx noted-incontinent, hemiparesis, other cardiovascular sx
  • CT/MRI-ischemic infarcts, hippocampal volume loss
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8
Q

Lewy Body Dementia

A
  • Fluctuating cognitive performance
  • Well formed visual hallucinations
  • Often sx of Parkinson’s emerging along with cognitive loss
  • CT/MRI-Hippocampal volume loss
  • EEG-slowing of background rhythm
  • R/o sleep apnea
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9
Q

Frontal Temporal Lobe Dementia

A
  • Disinhibition
  • Impulsiveness
  • Social inappropriateness
  • Apathy
  • Withdrawal
  • MRI/CT scan -frontal and temporal lobe atrophy
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10
Q

Depression Quick test

A 
Sig Energy Caps
S=sleep	
I=interests  
G=guilt
Energy-changes
C=concentration
A=appetite 
P=Psychomotor
S=suicidal thoughts or ideation.
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11
Q

Decorticate Posturing

A
  • Upper extremities flexed toward the heart,
  • Lower extremities extended and rotated inward-if progressing to Decerebrate then brainstem herniation likely.
  • Head may be hyperextended as well as back =opisthotonus.
  • may be damage to areas including the cerebral hemispheres, the internal capsule, and the thalamus It may also indicate damage to the midbrain
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12
Q

Decerebrate

A
  • a posture with lesions of the upper part of the brainstem or severe bilateral lesions of the cerebrum
  • arms extended with wrists rotated and fingers out
  • legs extended with feet internally rotated
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13
Q

Nystagmus

A

rhythmic oscillation of the eyes-horizontal, vertical, rotary, right or left lateral gaze

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14
Q

Fasciculations

A

visible twitching of muscle bundles(with atrophy=>lower motor neuron disease)

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15
Q

Tremors

A

at rest(pill rolling/Parkinsons), postural(in sustained position/hyperthyroid or anxiety) or intention(active movement/cerbellar ataxia)

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16
Q

Tics

A

repetitive movements of face, upper trunk-grimace, wink or shrugs/ Tourette’s, metabolic abn

17
Q

Chorea

A

involuntary movement of face, extremities, trunk, rapid jerky, irreg, unpredictable/Sydenham’s chorea in Rheumatic fever-at rest or purposeful

18
Q

Athetosis

A

involuntary mvts of face,extremities, trunk that are slower, more twisting, writhing-/cerebral palsy-at rest or purposeful

19
Q

Myoclonus

A

involuntary, sudden and rapid unpredictable jerks, faster than chorea-eg when falling asleep, in myoclonic seizures, a hiccough is diaphragmatic myoclonus.

20
Q

Asterixis

A

involuntary brief loss of muscle tone in the outstretched fingers and hands=non-rhythmic flapping of the fingers or hands/metabolic encephalopathy-severe liver disease or uremia( liver flap)

21
Q

Tardive dyskinesia

A

choreiform movements that affect the tongue, lips, face with repetitive grimacing, protruding of tonger, open close the jaw, jaw deviations, occas hands affected- eg drug complication psychotropic drugs like phenothiazines

Neuro (14 decks)

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