Dementia and disorders of equilibrium and vision Flashcards
What is dementia
syndrome that involves chronic impairment of multiple higher cortical functions such as memory, thinking, orientation, comprehension, and language.
Causes of dementia
Alzheimers
Vascular - e.g. from strokes
Parkinson’s association
Dementia with lewy bodies
Chronic alcohol abuse
What is alzheimer’s
Slowly progressive memory loss and other cognitive decline
- neurofibrillary tangles, neurotic plaques and cerebral atrophy in brain
Sx of alzheimer’s disease
Progressive memory loss despite being alert
Inattention
Inability to problem solve
Language difficulties
Sundowning - worse at night
Personality changes
Alzheimer’s disease diagnosis
Clinical diagnosis
If in psychiatry service - may do MRI / PET to see brain atrophy / amyloid plaques
Alzheimer disease medications
Acetylcholine esterase inhibitors e.g. donepezil, alantamine, rivastigmine
Memory clinic
Caregiver support
Physical and occupational therapy
- low prognosis
RF for strokes
HTN
Hypercholesterolaemia
Family history of cerebral vascular disease
Diabetes
Smoking
Atrial fibrillation
Diagnosis of vascular dementia
acute onset of symptoms followed by vascular event e.g. stroke
MRI - to look for signs of stroke
Blood tests - cholesterol
Vascular dementia treatment
Future stroke prevention
Manage blood pressure, glucose and cholesterol levels to prevent strokes
Physical and occupational therapy
Types of mild cognitive impairment
Amnestic
Non amnestic
Diagnosing mild cognitive impairment
History and family history
MMSE
Mild cognitive impairment treatment
No treatment
May go onto develop alzheimers dementia
PREVENTION OF PROGRESSION
Smoking and alcohol cessation
Control BP, glucose and cholesterol
Diet high in omega 3 fatty acids
Keep mentally active e.g. reading, puzzles etc…
RF for blow induced dementia
Footbal players - heading the ball
Bowers
Domestic vioelence survivors with repeated head trauma
Blow induced dementia treatmet
No treatment only prevention
Wear helmet
Treat concussion if present
What is normal pressure hydrocephalus!!!
Classic triad - dementia, gait disturbance, urinary incontinence
Clinical signs of normal pressure hydrocephalus
Gait
Urinary incontinence
Cognitive disturbance - low attention, low concentration, apathetic, depressed
Ix for normal pressure hydrocephalus
MRI of head
LP to test clinical response to removal of CSF (testing if it goes back to baseline level and return of cognitive function)
Neuro referral for more Ix
Normal pressure hydrocephalus treatment
Ventricular shunt placement
What is frontotemporal dementia
Rare cause of dementia causing extreme inappropriate behaviour
Huntington disease presentation, investigations and treatment
Inherited disease - onset from 35-45
Progressive irregular sudden muscle movements
Dementia
Bursts of anger
Antisocial behaviour
History taking and genetic testing
Symptmatic treatment - fatal in 15-20 yrs
Presentation and treatment of creutzfeldt-jakob disease aka bovine spongiform encephalitis
Abnormalities in all parts of neurologic symptoms
Rare fatal cause of dementia - no treatment - only symptomatic management
Difference in “dizziness” between BPPV, orthostasis or vertigo
Hearing diminished (BPPV)
Vertigo
Lightheaded on standing up (orthostasis)
Causes of peripheral vertigo
BPPV
Otitis media
Labrynthitis
Vestibular neuronitis
Foreigh body or wax in ear
Acoustic neuroma
Motion sickness
Causes of central vertigo
Stroke
Temporal lobe epilepsy
Tmour
Post concussion
Vertebral artery insufficiency
Basilar artery migraine
Symptom difference between peripheral and central vertigo
Peripheral
- sudden
- severe
- lasts minute
- intermittent
- horizontal nystagmus
- worse in certain positions
- no neuro findings
- reduced hearing
- tinnitus
Central
- gradual onset
- mild
- lasts hours/days
- multidirectional nystagmus
- not worse in certain positions
- neuro findings
- normal hearing
Symptoms, diagnosis and treatment of BPPV (benign paroxysmal positional vertigo)
Peripheral vertigo symptoms
- worse on rolling over in bed
History
Absence of neuro findings
Horizontal nystagmus
Tx - Head maneuvers to resposition or betahistine
What is Dix - Hallpike maneuver
Check for nystagmus
Sit upright with legs extended and rotate head 45 degrees then lie them down with head extended at 20 degrees
Observe for 45 seconds
Don’t do if neck problems
If vertical nystagmus seen = CNS abnormality
Sx of pseudotumor cerebrii
Headache - worse over time
Diplopia
Visual disturbance and flashes of light
Hearing pulsations inside head
Ix for pseudotumour cerebrii
Physical exam - PAPILLOEDEMA, decreased visual acuity, cranial nerve VI palsy, obesity
CT - rule out brain tumour
Lumbar puncure after ruling out mass in brain - visual symptoms may improve whilst taking CSF
Pseudomotor cerebrii management
Agressive weight loss
Sodium restriction
Carbonic anhydrase inhibitor e.g. acetazolamide (decrease rate of CSF production)
Diuretics
Shunting or serial lumbar punctures
