Encephalopathy Flashcards
what is wernicke’s encephalopathy?
psychiatric disorder due to thiamine deficiency- seen mostly in alcoholics
triad of wernickes encephalopathy?
opthalmoplegia/mystagmus, ataxia, and confusion
rarer causes of wernickes encephalopathy are?
stomach cancer, persistent vomiting and dietary deficiency
what occurs in wernickes encephalopathy?
petechial haemorrhages
features of wernickes encephalopathy?
oculomotor dysfunction nystagmus/ opthalmoplegia, gait ataxia, peripheral sensory neuropathy, encephalopathy : confusion, disorientation, indifference and inattentiveness
investigations of wernickes encephalopathy?
MRI (degeneration of mamillary bodies), decreased red cell transketolase (enzyme that require thiamine)
how to treat wernickes encephalopathy?
urgent thiamine replacement
korsakoff syndrome?
if wernickes is left untreated, confabulation, antero/retrograde amnesia
why does alcohol cause thiamine deficiency?
- interferes with conversion of thiamine to its active form thiamine pyrophosphate
- prevents absorption, by reducing thiamine transporter 1
- alcohol abuse causes cirrhosis- storage of thiamine
what is hepatic encephalopathy due to?
excessive ammonia absorption and glutamine from bacterial breakdown of proteins in the gut
what can precipitate encephalopathy?
transjugular intrahepatic portosystemic shunting (TIPSS)
features of hepatic encephalopathy?
confusion, asterixis, triphasic slow waves on EEG, raised ammonia level, Constructional apraxia
grading of hepatic encephalopathy?
- irritability
- confusion, inappropriate behaviour
- incoherent, restless
- coma
precipitating factors of hepatic encephalopathy?
infection, GI bleed, TIPSS, constipation, hypokalaemia, renal failure, drugs sedatives and diuretics,
treatment of hepatic encephalopathy?
treat underlying cause,
lactulose plus rifaximin
lactulose- promotes excretion and metabolism of ammonia
rifaximin- modulates gut flora- decreased ammonia production
