Localization skills: dementia, delirium, language/memory/cognitive loss Flashcards
What are the typical clinical features of delirium?
Waxing and waning level of consciousness w/acute onset. (“changes in sensorium”, reversible
- Disorganized thinking, hallucinations, illusions, misperceptions, sleep-wake disturbances, cognitive dysfunction
- Diffuse slowing EEG
What are the causes of delirium?
Usually 2ndary illness:
- CNS disease
- Infection (UTIs)
- Trauma
- Substance abuse/withdrawal
- Metabolic/electrolyte disturbance (eg kidney failure)
- Hemorrhage
- Urinary/fecal retention
- Meds (eg anticholinergics in elderly; illicit drugs)
- Post-ictal state
What are the typical clinical features of dementia?
Decreased intellectial fcn w/o affecting level of consciousness. See memory loss (irreversible), apraxia, aphasia, agnosia, loss of abstract thought, behavior/personality changes, impaired judgment.
- EEG usually nl
What are the causes of reversible dementia?
Reversible:
- Hypothyroidism,
- Depression
- B12 def.
- Nl pressure hydrocephalus
- Neurosyphilis
What are the causes of irreversible dementia?
Irreversible:
- Alzheimer dz
- Lewy body dementia
- Huntington disease
- Pick disease
- Cerebral infarct
- Creutzfeldt-Jakob disease
- Chronic substance abuse
What cognitive symptom is often seen 1st in dementia?
Changes in judgment and intellect
What personality changes might you see in dementia?
Suspiciousness, mistrust, paranoia +/- childishness, unprovoked anger/agitation
What should you consider w/younger person w/ dementia? (2)
- Hereditary if Fam hx
- AIDS dementia
What is the w/u for dementia? (labs + 2 tests)
CBC, BMP, B12, Thyroid
- MRI
- Mini mental status exam
If the dementia w/u is negative, what dx should you strongly consider?
Alzheimer dz (dx of exclusion)
What sign is in both Wernicke’s and Broca’s aphasia?
Both have imperfect repetition
Where is the lesion in Broca’s area? Wernicke’s?
Broca: Inferior frontal lobe lesion in dominant hemisphere
Wernicke: Posterior superior temporal lobe lesion
What are the s/s of a lesion in Broca’s area?
Fluency impaired, telegraphic speech, comprehension relatively preserved (pt becomes frustrated)
- Often accompanied by right hemiparesis (assuming left brain dominance)
What are the s/s of a lesion in Wernicke’s area?
Fluency preserved, comprehension very impaired, frequent paraphasias and neologism
Wernicke’s = Word Salad
