Encephalopathy

Question 1

Wernicke Encephalopathy (Acute/Reversible) may turn into _____ Syndrome (Chronic/Irreversible)

Answer 1

Korsakoff

Question 2

Wernicke Encephalopathy SS Triad

Answer 2

• Confusion
• Occulomotor Dysfn
• Gait Ataxia

Question 3

Wernicke Encephalopathy
- ET
- WU
- Tx

Answer 3

• ET = Thiamine (Vit B 1) deficiency, Chronic Alcoholism
• WU = Erythrocyte Thiamine Transketolase Activity, LOW Thiamine, HIGH Pyruvate/Lactate
• Tx = THIAMINE before Glucose

Question 4

Why do we give Thiamine before Glucose in Wernicke Encephalopathy?

Answer 4

W/O Thiamine, any Glucose given will turn into LACTIC ACID, which can cause a METABOLIC ACIDOSIS

Glucose -> Lactic Acid -> Metabolic acidosis = BAD

Question 5

Chronic Traumatic Encephalopathy
- ET
- SS
- WU
- Tx

Answer 5

• ET = Repeat/chronic head injuries
• SS = Memory, Executive fn, Sad, Mood
• WU = MR (incr cortical thinning and atrophy)
• Tx = CBT, SSRIs (behavioral issues)

Question 6

College football player with Hx of multiple concussions presents with memory and executive fn complaints.
- Orders?
- Tx?

Answer 6

• MRI = incr cortical thinning & atrophy
• Tx = CBT +/- SSRI

Question 7

Hashimotos Encephalopathy Tx for mental status change

Answer 7

STEROIDS

Methylprednisolone -> Prednisone

IF Steroid CI or FAILS -> Biologics

Question 8

Tx for HTN Encephalopathy

Answer 8

LOWER BP 10-20% in 1st Hr
- Nicardipine (CCB)
- Clevidipine (CCB)
- Fenoldopam (Dopamine Agonist/Anti-HTN)

Don’t lower BP >25% in 1st Day

Question 9

Hepatic Encephalopathy ET

Answer 9

• Liver failure
• HIGH Ammonia (Neurotoxin)

Question 10

Hepatic Encephalopathy WU

Answer 10

• Ammonia - HIGH
• Head CT W/O Contrast -> Atrophy (80%)
• # Connection Test (Reitan Test)
• EEG (NO normal alpha-rhythm)
• Check for Asterixis (tremor when arms outstretched and wrists extended)
• LOW PLTs, MCV >100

Question 11

Hepatic Encephalopathy Tx

Answer 11

TRY TO DECR BLOOD AMMONIA
- Lactulose (Enulose)
- Rifaximin (Xifaxan)

Question 12

What is Asterixis?

Answer 12

Tremor when hands outstretched and wrists extended

“hands flap when arms outstretched”

Seen in Hepatic and Uremic Encephalopathy

Question 13

Uremic Encephalopathy occurs when GFR < ___ mL/min

Answer 13

15

Question 14

Uremic Encephalopthy WU
- CT = ____-densities in basal ganglia, midbrain, or thalamus
- MRI = ______ Sign in cerebral cortex of basal ganglia

Answer 14

• CT - HYPOdensities
• MRI = Lentiform Fork Sign

Question 15

Uremic Encephalopathy Tx

Answer 15

Dialysis
Tx underlying e- abnorm